Sarah* was sure she had left her violent past behind. Her first husband, a high-powered business executive who during their 10-year marriage had bounced her head against walls, sexually assaulted her and nearly strangled her with a dog leash, was out of her life. She’d gotten a divorce, finished college, become a successful consultant, worked intensively with a trauma therapist and married an old friend with whom she felt safe.
Gradually, the symptoms of her previous torment eased. The residual headaches from the head injuries disappeared, although she still remembers the sound of her skull hitting the kitchen walls and floor. “It sounds like when you knock on a cantaloupe to see if it’s ripe,” Sarah, now 47, says with a sad laugh. There are still black holes in her memory; she can’t coherently recollect the years from her mid- to late twenties, the period when the violence reached its height. But the worst of the terrors are over. “I no longer suffer from PTSD at night,” she says, remembering how she would sleep in her horse’s stall to hide from her then husband’s drunken attacks. Now remarried, “I no longer have a hyper-startle response if my husband walks into the room behind me.”
In her midthirties and wanting to start life anew, she was ready to be a mother. But for reasons her doctors initially didn’t understand, Sarah struggled to carry a baby to term. After six miscarriages, a doctor finally suggested that head trauma could be a factor; neurological damage from repeated brain injuries had disrupted the hormonal balance she needed to deliver a healthy child. “My endocrine system just hardwired the violence into me,” Sarah says.
That wasn’t Sarah’s first experience of trauma. When she was five, a friend’s father began to sexually abuse her, an ordeal that didn’t end until she was seven. She recalls nothing of those years and had always hoped to fill that void in her childhood with a baby of her own. “After all the work I’ve done in the past 14 years, getting away from the men who were abusing me and getting my mind in a good place, I really thought I was there,” she says. “But there’s a whole other layer of this legacy. And it wasn’t until I was safe that those symptoms started to emerge.”
Domestic violence (DV) has an insidiously long half-life. Women who left their abusers five, 10, even 20 years ago and believed they had closed that chapter of their lives now face far higher than normal rates of chronic health problems, including arthritis and hormonal disorders, asthma, diabetes, hypertension, chronic pain, severe headaches and irritable bowel syndrome. As a result, these women spend nearly 20 percent more money on medical care than other women. Annual U.S. medical costs attributable to domestic violence, including years-old assaults that still cause health problems, range from $25 billion to $59 billion, according to a 2008 study funded by the U.S. Centers for Disease Control and Prevention. Some of the damage is from old physical injuries, some from the chronic stress of living in terror for too long. These findings were a surprise even to researchers who are exploring the DV–chronic illness connection. “When I started this work more than a decade ago, we knew that women who experienced violence were at higher risk of developing chronic diseases like asthma but our understanding of the bio-logical link was limited,” says Michele Black, an epidemiologist at the CDC who was the lead author of a landmark 2011 report on DV-related illness. “Now we’re beginning to understand why that might be. A woman in a violent relationship is often on high alert: She may be frightened about being killed or worried about her kids; if she tries to get away, she may be stalked. All that stress is really toxic. There’s no organ that’s immune. Your whole body is at risk.”