Thanks to allegations of domestic violence involving several football players, and widespread outrage over how the National Football League has chosen to respond to them, the country has recently been engaged in a national discussion about issues related to intimate partner violence. As the Associated Press reported this week, the renewed attention to the issue has had a “ripple effect” that has made people more comfortable sharing their own personal stories of abusive relationships.
But experts in the area say there’s still a long way to go. While most of the discussion about domestic violence typically centers on the immediate crisis, and the issues facing victims as they decide whether to leave their abuser, there’s perhaps less focus on the long-term effects of abuse that linger for years or even for decades.
Long-Term Health Issues
When most Americans think of the health consequences of intimate partner violence, they’re likely picturing the bruises and broken bones resulting from the physical abuse in the relationship.
That’s certainly true, but it’s only part of the story. There’s a growing body of research that confirms domestic violence victims also suffer from a host of more long-term health problems, even though many of their doctors may not initially realize that’s the source of their issues.
“The research is really illuminating,” Lisa James, the director of health issues at Futures Without Violence, told ThinkProgress. “Now, we’re understanding more and more that if you experience domestic violence, you’re at a higher risk for some of the largest health problems that our country is facing today — including heart disease, chronic pain, asthma, and arthritis.”
Victims of intimate partner violence typically face high levels of stress, which can exacerbate any chronic health conditions they may have already had. After they separate from their abusive partner, they remain at risk for mental health issues like depression, anxiety, and post-traumatic stress disorder. Compared to the general population, they’re fifteen times more likely to self-medicate by using alcohol and drugs.
And even years after the abuse, many survivors are also forced to deal with lasting reproductive health issues. One of abusers’ strategies of control can involve interfering with their victims’ sexual health — experts call this “reproductive coercion” — that can result in becoming pregnant or contracting a sexually transmitted infection.
Liz Roberts, the chief program officer at Safe Horizons, told ThinkProgress that she’s frequently seen this firsthand in her work with domestic violence victims. “I’ve worked with survivors who had to hide their birth control pills, and when they were found, they were flushed down the toilet. I’ve worked with survivors whose partners had other sexual relationships outside of their primary relationships, lied about it, and refused to wear condoms,” she said. “There are so many ways someone can be placed at risk for an STI or an unwanted pregnancy, and that can obviously have great consequences down the road.”
Federal officials estimate that the United States spends $4.1 billion each year on the medical and mental health costs stemming from domestic abuse.
Problems Passed Down To Children
Domestic violence also isn’t contained to the two people in the romantic relationship; often, it takes place in the context of a family where there are also children in the home. According to the American Psychological Association, an estimated 3.3 million children are exposed to violence against their mothers or other female caretakers.
Witnessing that trauma has lasting consequences for those kids. A groundbreaking study on childhood trauma found that the types of things you live through as a child have a big impact on your adult life, and can even contribute to an earlier death. Other researchers have found that the children who grow up around domestic violence tend to experience higher levels of anger, hostility, disobedience, and withdrawal.
“We do know that growing up in a violent home does impact the health of children from a very early age — even, actually, in the womb,” James said. “Kids exposed to domestic violence experience a whole host of similar health issues as we see in adult survivors, like anxiety, sleep disorders, and mental health and behavioral health issues.”
Emerging research in the field continues to try to pin down the collateral damage caused by family violence. For instance, a recent study from researchers at New York University and the University of North Carolina at Chapel Hill found that being exposed to conflict at home can undermine kids’ emotional intelligence.
“Children who are exposed to higher aggression in the household between parents are having more difficulty reading the signals or the signs of others’ negative emotions accurately,” C. Cybele Raver, the lead author of that study, told ThinkProgress. “So if they’re coming down the stairs at school and another child bumps into them, they may respond in an aggressive way.”
Plus, many of these children aren’t just witnessing abuse; they’re on the receiving end of it themselves. An estimated 40 to 60 percent of the men who commit violence against their female partners are also violent toward their kids.
“People who beat up their partners often beat up their children too — that’s just the reality,” Roberts said.
Broken Family Relationships
According to Roberts, one of the most lasting consequences of domestic violence that doesn’t often get discussed is the harm that it does to family bonds. When children witness violence committed against their primary caregiver — the person who’s supposed to be able to protect them — that can compromise their attachment to that person. It sometimes even undermines their trust that their mom knows how to take care of them.
And even after a survivor has removed herself from her abusive relationship and gotten her kids to safety, she may be met with hostility and mistrust from the children she’s working so hard to protect. Kids sometimes play into the victim-blaming that they learned from the abusive parent who was left behind.
“Abusers typically actively undermine the children’s respect for and confidence for the adult victim,” Roberts said. “They’ll say things like, ‘It’s your mommy’s fault that this happened’ or ‘Your mommy is stupid, that’s why she did that.’ Or the children will overhear the put downs directed at the adult victim herself.”
“There’s often a really long journey for families to heal those relationships and to rebuild their trust,” she added.
That’s why experts are increasingly recommending domestic violence interventions to be partnered with parenting programs that can give families the support they need to rebuild. Futures Without Violence, for instance, works with parents who may have experienced violence a long time ago to focus on strategies to improve their parenting and avoid repeating the cycle of abuse. Home visitors sit down with new parents to give them tools to process any trauma they’ve experienced in the past.
“Parents are really trying to do right by their children in situations that can be really emotionally exhausting,” Raver noted. “Helping parents to navigate their romantic relationships and their adult partnerships is an important component of how we talk about parenting, and how we talk about supporting young children.”
A System That Isn’t Set Up For Survivors
While the country has made some progress in finding avenues to support domestic violence survivors, advocates say we still need more programs to address the long-term effects of abuse.
“A lot of the resources that have been directed toward the issue of domestic violence are either directed toward the criminal justice response or toward addressing the immediate safety or survivors and their children. That’s necessary, but not sufficient,” Roberts explained. “Safe Horizon operates a clinic in New York City that specializes exclusively in providing evidence-based trauma treatment to survivors of intimate partner violence. But we’re the only clinic in the state that does that.”
Similarly, experts are still working to reorient the health care system’s approach to domestic violence so that doctors will start connecting the dots when they see a patient who’s dealing with chronic pain several years after leaving an abusive relationship.
There have been some recent policy improvements in this area; under the health care reform law, for instance, screenings for domestic violence are covered as a routine aspect of preventive care. There are an increasing number of resources to help educate medical providers about their role in identifying and intervening in domestic abuse. Lisa James of Futures Without Violence is optimistic about where the country will go from here.
“I think we’ve been seeing a sea change in terms of how health care providers and systems are addressing these issues — looking beyond the initial injuries to talk about how domestic violence is a public health issue,” she said. “There have really been some light bulbs going off in some of our clinic settings.”