The relationship between domestic violence and chronic health conditions

by Maura Duffy



Domestic violence affects about one out of every three women in the U.S. and causes great physical, emotional, and psychological trauma.[end Centers for Disease Control and Prevention. National Intimate Partner and Sexual Violence Survey. November 2011. Accessed January 10, 2014 from] We rightly celebrate the women who are able to overcome the tremendous barriers to leaving abusive relationships as survivors, but disturbingly, many of these women have lasting health problems years—or decades—down the road. There is evidence that women who were in abusive relationships often have chronic health conditions such as  lower back pain, headaches, memory loss, difficulty sleeping, depression, diabetes, asthma, and digestive disease. Unfortunately, many women never realize that their health conditions are related to their past abusive relationships, and neither do their doctors.

A recent study conducted by the Verizon Foundation interviewed over 1,000 American  women and found that women who reported any kind of domestic violence had higher rates of chronic health conditions than women who had experienced no domestic violence. Forty four percent of the women surveyed admitted to experiencing some type of domestic violence including physical abuse, emotional abuse, sexual abuse, and economic abuse.  While 77% of women overall suffer from a chronic health condition, that proportion jumps to 88% for women who have experienced sexual abuse and 81% for women who have experienced any form of domestic violence, both statistically significant increases.[end Exploring the Relationship Between Domestic Violence and Chronic Health Conditions. Verizon Foundation. November 2013. Accessed January 10, 2014 at]

How are abusive relationships affecting women’s health even years after they have left their abusers? One explanation could be the prolonged stress of these relationships. When faced with a physical or psychological threat, your body reacts with a “fight or flight” reaction to enable you to fight back or run away from the danger with cortisol hormones. While these hormones help in the short-term, they can hurt your body when produced for longer periods. For example, since cortisol affects blood sugar and heart rate, chronic stress is linked to gastrointestinal conditions, hypertension, stroke, and heart disease. Another possible explanation is telomeres, the caps on the end of our DNA that become shorter as we age. Several studies have found that people who are under chronic stress tend to lose the length of their telomeres more rapidly, meaning the stress is permanently aging cells.[end Tyrka AR, Price LH, Kao HT, Porton B, Marsella SA, Carpenter LL; Childhood maltreatment and telomere shortening: Preliminary support for an effect of early stress on cellular aging; Biological Psychiatry, 2010, 68(6) pp. 531-4.] This suggests a possible explanation for why women under the stress of abusive relationship may suffer diseases like arthritis that typically affect women who are much older.

Even while they are still in an abusive relationship, many women do not make the connection between their health conditions and their past relationships, and even more alarmingly, neither do health professionals. The Verizon Foundation study found that while 81% of women who experienced domestic violence have some type of chronic health condition, but that only 6% believe their doctors or nurses ever made the connection. In fact, about 75% of women say they have never been screened for domestic violence by a doctor or nurse at all. Among the women who had experienced abusive behavior, two-thirds expressed that they would have wanted their doctor or nurse to ask them about it. Although knowing the possible cause might not help lessen the physical ailments, it can help the women understand why they are ill and that can help their emotional health

Why aren’t healthcare providers connecting the dots? Practitioners may feel that relationships are a private matter outside of their medical jurisdiction. In addition, healthcare providers may still operate under the outdated stereotype of domestic violence as a man beating a (usually less educated and lower class) woman in an out-of-control fit of rage, and many only look for bruises. However, abusive relationships take on many forms, including emotional abuse, threats, economic deprivation, stalking, and controlling behavior, that don’t manifest themselves in physical marks—and affect people from all socioeconomic statuses.

It is important to remember that leaving an abuser marks the beginning of a long journey to recovery. Healthcare providers should become more aware of the importance of assessing patients for abusive relationships, not only among women currently experiencing abuse, but also among women who may have abandoned these traumatic relationships years ago.