Domestic Violence: A Hidden Cause of Chronic Illness

An alarming 44 percent of women say they have experienced abusive behavior from a partner. Years after the bruises from domestic violence fade, the physical effects can linger in the form of serious health problems—migraines, arthritis, even gastrointestinal disease. Our groundbreaking investigation

by Alexis Jetter
hidden cause of chronic illness image
Photograph: Photographed by Julia Fullerton-Batten

The damage, which lingers long after the violence is over, can impair a woman’s brain function, endocrine system, immune response—even her DNA. A recent study at the School of Nursing at the University of California at San Francisco found that women who have endured long periods of abuse, particularly if they had young children at the time, tend to have shorter telomeres (strands of DNA that protectively cap the ends of chromosomes) than other women. Telomeres shorten in response to chronic stress, which can lead to premature cell death. The result: Even women who left their abusers years before often have the physiological profile of women a decade older.

“We tend to think that once the violence is done, everyone’s fine and the woman goes off into the sunset,” says Marilyn Ford-Gilboe, a professor at Western University in Ontario who studies women who leave their abusers. “But she turns 45 and she’s got all kinds of crazy health problems, and she thinks, Where did this come from? This woman has health problems that are more likely in a woman who is much older.”

The crucial role doctors aren’t playing
The CDC reports that one in four women has experienced severe physical violence at the hands of an intimate partner. Every year, two million U.S. women are injured by their husbands or boyfriends; more than a quarter require medical attention. Some 1,300 die. (The U.S. has the highest rate of intimate-partner homicide among the world’s wealthiest 25 countries.) Many female DV survivors who show up in emergency rooms have suffered blunt trauma to the head, face and neck, and an estimated 54 to 68 percent have been strangled; one third of the women treated for DV in an emergency room have lost consciousness at least once as a result of abuse.

Yet these life-altering injuries often go undiagnosed, because the women aren’t examined thoroughly enough, aren’t asked what happened to them, don’t bring up the injuries with their doctor or do tell medical personnel but aren’t believed. Although strangulation can cause long-term memory loss, stroke and respiratory problems, in fully half the cases it leaves no visible bruises on the neck. Other telltale signs of strangulation, such as a hoarse voice, are often dismissed. San Diego police detective Sylvia Vella, who specializes in cases involving strangulation, was once told by a victim who had lost her voice after an assault that the ER doctor said, “Maybe you should stop screaming at your husband.”

Still other women, too ashamed to reveal their injuries, never seek medical attention at all. “I’ve worked with women survivors who live in $750,000 houses and whose husbands work in the Raleigh-Durham Research Triangle,” says Kit Gruelle, a North Carolina filmmaker and longtime advocate for DV victims. “These are women who are wealthy and educated, who are worried about notoriety in the community. They tend to keep it hidden more than women who are poor. They don’t pick up the phone and call 911 because they think no one will believe them.”

Indeed, women professionals are largely missing from research into DV’s long-term effects. “We know the least about women who are well educated and affluent because for them there’s so much shame and guilt associated with this,” says Janice Humphreys, PhD, associate dean of the Duke University School of Nursing and the main author of the study linking telomere damage to domestic violence. “These women are hard to find. Unless someone comes up to you and says, ‘That’s me.’”

First published in the November 2013 issue

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