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Invisible injuries Domestic violence victims’ medical problems often go unreported or undiagnosed By JoAnne Viviano More Content Now

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omen who endure physical, emotional or sexual violence at the hands of an intimate partner can be subject to a host of injuries and illnesses. Many of them are invisible; some can last months or years. And many victims, terrified of their abusers, don’t seek the care they need. “I think people look at domestic violence as a oneand-done incident ... as opposed to the incredible impact it can have on your entire life,” said Nancy Neylon, executive director of the Ohio Domestic Violence Network. Efforts to help survivors have focused on encouraging health-care providers to ask women if they have been victimized, but more needs to be done to determine whether domestic violence is at the root of subsequent illnesses and injuries such as high blood pressure, post-traumatic stress disorder and traumatic brain injury, Neylon said. “Women who have longer-term health impacts because of domestic violence — that is not being diagnosed,” she said. “We don’t understand the full impact of domestic violence. If we truly started to understand that a little better, there would be a little more funding and services and resources for it. It’s an underserved issue.” In the United States, about 27 percent of women (and 12 percent of men) are the victims of what the Centers for Disease Control and Prevention calls intimate partner violence. Health-care costs can remain higher for as long as 15 years after abuse stops, according to data collected by the CDC. Overall, the cost of

caring for victims is several billion dollars each year. Victims might experience injuries from physical or sexual abuse — bruises, knife wounds, broken bones, back or pelvic pain — but many of the health concerns are more difficult to diagnose. The main abuse-related health concern local providers see is lack of medical care. “These women can be more hesitant to seek help, so if they have a medical issue, they just in general aren’t taking care of themselves,” said Dr. Tamar Gur, a psychiatrist at Ohio State University’s Wexner Medical Center. “High blood pressure, diabetes can become more significant. “There is general suffering from the stress of domestic violence abuse.” Domestic violence also can trigger psychiatric disorders, including heightened anxiety, depression, panic attacks and post-traumatic stress disorder, Gur said. Sexual violence can lead to sexual dysfunction and unplanned pregnancies. If a woman is pregnant, the violence can harm her fetus. Another issue, which Neylon said is just beginning to get attention, is traumatic brain injury among domestic violence survivors. Such injuries often go undiagnosed. “It can certainly have an immediate impact, but it also can have a long-term impact on the brain,” she said. Gur said health-care providers should ask women if they feel safe at home and help them find resources to get out of abuse situations. Women can become “frozen,” she said, and might have difficulty making changes on their own. “The health-care system is uniquely poised to screen for domestic violence,” she said. “You have to ask; you

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Lasting impact • 1 in 4 women and 1 in 7 men have been the victim of severe physical violence by an intimate partner. • More than 1 in 4 women and more than 1 in 10 men who have experienced violence by an intimate partner reported significant short- or longterm impacts, such as post-traumatic stress disorder symptoms. • Men and women who experienced these forms of violence were more likely to report frequent headaches, chronic pain, difficulty with sleeping, activity limitations, poor physical health, and poor mental health than men and women who did not experience these forms of violence.

Source: Centers for Disease Control and Prevention’s National Intimate Partner and Sexual Violence Survey

can’t just try to guess.” Complicating matters is that domestic violence victims often attribute ailments to something else, such as a fall or a car crash. And often their abuser is there with them. While symptoms of injuries and illnesses caused by domestic violence could last a long time, many do recover, Gur said. “Women are very resilient,” she said. “I’ve seen women overcome terrible traumas and live very rich lives, so it’s not a hopeless situation.”

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