Domestic violence is not over when the victim is safe and out of harm's way. It's not over until justice has been served. Even then, it's not over. It's not over until the victim is safe, justice has been served, and the victim is well.

Consider these facts:

• Abuse, especially repetitive abuse, leaves a lasting "impression" on the health, well-being, and post-abuse functioning of the victim. This impact lingers long after the bruises fade, the bones mend, and the abuse is over.
• Victims of violence seek healthcare more often than non-victims. The severity of victimization is a powerful predictor of the healthcare costs generated by these victims.
• Most healthcare visits by victims of domestic violence are not domestic violence patients presenting with injuries, but rather medical problems that seemingly are not related to current or past injuries.

The health effects of violence can reach across the life span. Studies have now shown that adults who were abused in childhood vs. those who were not have more:

• Infectious diseases
• Mental health disorders
• Hypertension
• Diabetes
• Dermatitis
• Asthma
• Allergy
• Acne
• Abnormal menstrual bleeding
• More heath-threatening behaviors such as smoking, the use of alcohol, driving while intoxicated, avoiding regular gynecological examinations, not wearing seat belts, sedentary lifestyle, and high-risk sexual encounters.

The abuse sustained in an intimate partner relationship does not have to be physical to cause poor health. Intimate partner violence and abuse (IPVA) can take several forms: physical abuse, verbal abuse, and forced sex. When Dr. Ann Coker and her colleagues looked at domestic violence in a large series of patients, they found that approximately 14% of domestic violence victims have only been victimized psychologically, not physically. These victims had higher rates of numerous medical problems that the non-abused do not have. Among them:

• Disability that prevented working
• Arthritis
• Chronic pain
• Migraine and other frequent headaches
• Stammering
• Sexually transmitted infections
• Chronic pelvic pain
• Stomach ulcers
• Frequent indigestion, diarrhea, or constipation.

These findings pose an interesting question: Do victims of psychological abuse have fewer or more health problems than victims of physical violence? Dr. Coker and her colleagues found that "psychological IPV was as strongly associated with the majority of adverse health outcomes as was physical IPV." The old childhood taunt of "Sticks and stones can break my bones, but words can never hurt me," is wrong, wrong, wrong. And now we have research to support the idea that it's wrong.

Survivors of domestic violence or IPVA will tell you that life after abuse is never the same. Some experience insomnia, multiple aches and pains, problems with concentration, intrusive thoughts, fatigue, and irritability. Any one of these can interfere with effective functioning and set the stage for depression and even despair.

Violence and abuse of all forms is complex and the resulting health effects are interwoven. No single approach cures all. Medical help for domestic violence victims and survivors exists but is scattered. Appropriate care is often difficult to find and access, but it can be done. Healthcare providers and survivors must learn to work together to secure the best state of health possible for survivors of domestic violence.

My recent book on using expressive writing to help resolve lingering health issues offers one way to give aid to survivors and their supporters. You can read a summary about the book at website http://healthaftertrauma/

? Copyright Ellen Taliaferro, MD 2005. All rights reserved. . You have permission to publish part or all of this article electronically or in print, in your newsletter, on your website, or in your e-book, as long you maintain the hyperlinks in the article and include the following information: "Written by Ellen Taliaferro, MD, author, speaker, and expert witness. Dr T. can be contacted through http://www.healthaftertrauma.com. A copy of your reprint or publication would be appreciated.