One woman in Ford-Gilboe’s study, still in her early thirties, is in such agony that she spends every day lying on a couch with a heating pad. After losing her job, she stopped leaving the house altogether. “If you looked at her, you wouldn’t see any obvious reason for the pain,” Ford-Gilboe says. “She said the physical violence wasn’t that bad. But the stalking and harassment were horrific.” In addition to leaving threatening voice mails and text messages, the woman’s ex--husband kept reporting her to child protective services, alleging that she was mistreating her two young daughters and insisting they be taken from her home. The fear of losing her children completely unraveled her.
Like many other abused women, she had also been assaulted as a child. It isn’t surprising that old fears would be retriggered by new ones, says Bruce McEwen. The amygdala, which processes feelings of fear and anxiety, tends to weave traumatic memories together, causing them to blur. It also helps create the sensation of pain. Rewired by past stress, the amygdala can produce neuropathic pain in response to new trauma. “Some of that rewiring can be reversible when conditions improve,” McEwen says. “But to reverse it, you might need the help of a therapist and medication.”
Making the connection at last
The sheer volume and variety of health problems facing women survivors of domestic violence have made it difficult to detect clear patterns of disease formation. “If you have 10 abused women in the room, they’ll have poorer health than nonabused women, and they’ll have 10 or 20 different problems,” says Janice Humphreys, lead author of the telomere study. “The absence of a clear line between cause and effect has led some to say, ‘Well, it’s in their heads.’ Well, it may be in their heads. But it’s also in their cells.”
This message is finally starting to get through. Last January the U.S. Preventive Services Task Force, an independent panel of experts, called for doctors to screen all women of childbearing age for intimate-partner violence. That seems like a modest proposal, but it’s a great leap forward. “When I first started doing this work, doctors thought, We don’t need to screen for DV. We just have to get the social workers to handle it,” says Megan Bair-Merritt, MD, associate professor of pediatrics at Boston Medical Center, who studies the impact of domestic violence on children. “Now that they’ve seen the immunology research, they realize, We can’t not do this in medicine. There’s a lot of momentum to do screening and begin to think about effective interventions.”
If scientists have been slow to make the connection between DV and chronic illness, abuse survivors may be slower still. “I think this is such uncharted territory that most women wouldn’t think to ask their doctors about their symptoms and the possible connection to their past abuse,” says filmmaker Kit Gruelle, a DV survivor who has coproduced (with Gloria Steinem) a new documentary about domestic assault, Private Violence, which is scheduled for release in 2014. Even Gruelle is not sure which of her maladies are rooted in violence, although some are easier to trace than others. For example, she still gets panic attacks as a result of being repeatedly strangled by her husband, now deceased. “I could feel my air being cut off,” she says. “Today, on planes, I have to sit near the front when the door closes, or I panic. Once you go through the sensation of not being able to breathe, it doesn’t take much to retrigger it. But I’m 59. Who knows what the cause of my memory loss is?”