Independence & Relationship Abuse Survivors: Health Outcomes & the Obstacles on the Road to Freedom

On July 4th, Americans across the world celebrated Independence Day. While the word, "independence" is universally associated with sentiments of growth and relief, for the women and men that survive relationship violence, the positive effects of leaving their abuser are not at all as instant. In fact, did you know that once a victim leaves their abuser, that immediate exit period actually becomes the most unsafe timeframe for the victim? According to the National Domestic Violence Hotline, as the victim's departure signifies the abuser's loss of control over the survivor, the behaviors of the abuser can escalate in an effort to regain power. This piece is dedicated to the women and men who have encountered any kind of interpersonal violence or are trying to get out and be free. My hope is that this piece will help provide some relief and more insight regarding the realities and effects of relationship abuse and the change we still need to come to fruition.

Every year, 12 million Americans will experience intimate partner violence. According to the Department of Justice, two out of three murders committed against females are committed by a partner; 1 in 4 women in this country are survivors of domestic abuse according to the Centers for Disease Control and Prevention (2015). Of the 3.5 million violent crimes committed in the United States between 1998 and 2002, 48%, nearly half, were crimes against a spouse. If half of the U.S. population of 318 million people consists of women according to the United States Census (2014), then approximately 40 million women in the United States will encounter abuse this year. Even more alarming, the largest segment consistently identified as the highest risk for victimization are women between the ages of 18-34 year olds (DOJ, 2015) with nearly 43% of college women reporting abuse (Love is Respect, 2015).

Domestic violence can affect anyone; no socio-economic population is immune from the possibility of experiencing abuse. It is important to note, however, a few broad strokes. There definitely are correlations between poverty and violence resulting in a "chronic vulnerability to being imprisoned, enslaved, beaten, raped and robbed" (U.S. News and World Reports, 2014). While several behaviors associated with domestic violence are now classified as crimes, and all states in the United States include at least one statute pertaining to battered women, those efforts have largely focused on the perpetrator of the crime and rarely the victim. Nationally, laws like the Violence Against Women Act of 1994 ([VAWA] introduced by then Senator Joe Biden and reauthorized in 2013)appear to be effective in lowering incidences of domestic violence, with violent acts reduced by 50%. Despite these promising numbers there are still not enough laws to further reduce those rates and adequately address the effects of domestic violence on the health of adult survivors. Moreover, given the plethora of data regarding the health outcomes of survivors, which I share below, it is simply mind boggling that "not guilty due to insanity" is a recognized, accepted legal defense but Battered Woman Syndrome (BWS) is not. While some courts allow the introduction of BWS, a federal report (initiated as part of the efforts within VAWA in 1994) rejected terminology related to Battered Woman Syndrome because the research indicated there was more than one pattern of battering. Meanwhile, isn't that also true regarding insanity? Moreover, Battered Woman Syndrome is considered a subcategory of Post Traumatic Stress Disorder (PTSD) only after a woman has gone through two cycles of abuse.

The Definition of Domestic Violence

According to the Department of Justice (2014), domestic violence "can be physical, sexual, emotional, economic, or psychological actions or threats of actions that influence another person. This includes any behaviors that intimidate, manipulate, humiliate, isolate, frighten, terrorize, coerce, threaten, blame, hurt, injure, or wound someone." These behaviors impact the health of the survivors in ways ranging from mental health issues to chronic physical health concerns. For the purposes of this piece, I will limit the scope of health effects to the tangible effects/impact we can see that primarily affect the physiological health of a woman and the more difficult to explain and measure effects that we often cannot see that fall into the social development and mental health realm.

Domestic Violence and Victim Health

We know that childhood traumas are considered a major public health problem that can result in lifelong mental and physical health consequences. The same holds true for adult female survivors who encounter abuse later in life, either for the first time, a one-time incident or multiple encounters of violence. These interactions however, and how they affect the health in adult survivors will have varying degrees as every case is unique due to a variety of circumstances as well as biological factors that make each of us unique beings. Moreover, the following health conditions caused by or related to domestic violence according to the CDC is only a partial list. Lastly, for the mental health section, also a partial list, it is vital to note that all of these conditions not only mirror every "mental health early warning sign" provided by the United States Department of Health and Human Services (2011) (which is long and can be viewed here) but a majority of these issues are also identified and recognized as a disability that "limits major life activity" according to the United States Department of Labor which can be viewed here.

Physiological Health Outcomes

Physical Trauma. Forced sex by an intimate partner, also called marital rape, can result in unintended pregnancy, pregnancy difficulties and "increased rates of pelvic inflammatory disease, heightened risk of sexually transmitted diseases (STDs) including HIV/AIDS, unexplained vaginal bleeding, and other genital-urinary related health problems" (CDC, 2015). Blows to the head strongly suggest that women should be routinely screened for traumatic brain injury and post-concussive syndrome. Exposure to violence, such as verbal abuse and intimidation can play a role in eating disorders ranging from anorexic or bulimia to issues related to obesity. Physical abuse can also result in deafness, blindness, missing or partially missing limbs, HIV/AIDs (which can contracted in a rape) and/or impairments that require the use of a wheel chair. This latter list comprises the only four, specific physical health issues that are considered disabilities recognized by the United States government.

Other health conditions connected with intimate partner violence per the CDC (2015) include: asthma, bladder and kidney infections, circulatory conditions, cardiovascular disease, fibromyalgia, irritable bowel syndrome, chronic pain syndromes, central nervous system disorders, gastrointestinal disorder, joint disease, and migraines and headaches.

Death is another realistic health outcome of domestic violence. Each day, three or more women die due to domestic violence in the U.S. with females comprising 70% of victims killed by an intimate partner (DOJ, 2009). In fact, two out of three women murdered in the U.S. are killed by intimate partners; that figure rose in 2008 which from a macro perspective also happens to be the year that the United States economy began to experience a second Great Depression.

Homelessness and Poverty. Domestic abuse is the immediate cause of homelessness for many women according to the National Alliance to End Homelessness (2015). Living on the streets, not having money, access to shelter or a shower for cleanliness as well as other basic needs like feeling safe, compromises the physical, mental health and overall well-being of women.

Social Development

Mental Health. While the United States Department of Health and Human Services provides a list of early warning signs regarding poor mental health conditions that mirror a number of co-occurring disorders, which are also a result of domestic violence, only the following four mental health conditions are recognized as a disability: Post Traumatic Stress Disorder (PTSD), obsessive compulsive disorder, major depression and bipolar disorder. These conditions can affect how a woman performs at work or at school, in the interactions with her children and others. Feeling unsuccessful due to mental health issues affects confidence and progress all of which adds more stress and strain on the health of survivors. Moreover, there are correlations between Battered Woman's Syndrome and PTSD.

Co-occurring Disorders, Alcohol & Drug Abuse. According to the National Institute on Alcohol Abuse and Alcoholism, co-occurring disorders are defined as, "particular problems that often affect people who also suffer from alcohol abuse or dependence. These can include psychiatric problems like anxiety or depression, abuse of other drugs, as well as other illnesses such as HIV/AIDS" (2005). While many studies have confirmed that alcohol is a FALSE connection as a cause of domestic abuse, there are correlations that indicate that survivors do access drug or alcohol to relieve their pain (CDC, 2015) as well as other self-abusive and high risk behaviors that can "can also bring a sense of control over a person's environment and serve as a release of tension."

Co-dependency. Domestic abuse can also produce a seemingly intangible, inexplicable co-dependency between the abuser and the victim. What makes this emotional tie so striking is that the abuser need not be in the presence of the survivor for this invisible control and power phenomenon to occur. There are correlations between depression, major depression and co-dependency with feelings of shame, low self-worth, self-hatred and a loss of identity all of which adversely affect a woman's mental health and long-term health.

"Every 9 seconds a woman in the United States is assaulted or beaten" according to the Partnership Against Domestic Violence; that's approximately four hundred women per hour, experiencing some form of abuse and pain. While we have made great strides towards reducing these statistics, more must be done particularly in regards to legislation and programs that can offer more protections. One of the more promising plans are interventions that incorporate abuser accountability. There must be more programs that treat and rehabilitate the abuser.

In the immediate, we must find ways to empower survivors of abuse and build on their resiliency, no matter what their level of strength may be, tap into that reserve, foster, and develop that skill set. The difficulty in doing so continues to be societal perceptions of relationship violence, the "she wanted or deserved it" mentality not to mention cultural contexts and expectations that women respond to the needs of others. For example, when a 2009 study found that 26% of college students believe that "some women secretly want to be treated that way," Vice President Biden didn't bury this disturbing figure; he incorporated this fact into his speech at a 2013 reauthorization celebration. If these statistics are correct, finding ways to reach our youth TODAY is of the essence but we also need more brave people like Vice President Joseph Biden who has been championing this change for decades as he states "because even 1 incident is too many" and "the best way to help move forward is to "add sunshine, light to an issue."

As a side it was very interesting, and alarming that when I signed onto the website for the Centers for Disease Control and Prevention, which identifies itself as " the nation's health protection agency," and searched for domestic violence, the website, under the title of "Intimate Partner Violence: Consequences," leads with the financial costs of domestic abuse to society. Apparently, how much the institutionalization of gender inequality costs our nation and has a negative impact on our country's budget is the priority. While, of course, financial costs are incredibly important to address, I found the layout a bit symbolic of the larger challenges the issue of domestic violence continues to face.

Our greatest challenge in changing society's perception of this issue will be getting those in political leadership positions to look beyond the issues of costs and help find more ways to get legislation such as Battered Woman Syndrome recognized and in place. We might also consider adding traumatic brain injury and the prevalence of co-occurring disorders as additional disabilities defined by our government as these health conditions also affect a meaningful segment of the population. These laws and types of actions go beyond the scope of financials and instead, address the tangible and intangible effects of domestic violence, providing concrete protections that recognize the effects of abuse and the ramifications of abuse on the women, men and children as survivors. Legislation that affirms the reality of these consequences, that takes our evidence-based data and translates it into legislation, would be a strong start in the right direction to bring an end to domestic violence.

From extended family to the children who witness the abuse to the employers and friends who suspect it, domestic violence will touch EVERY SINGLE ONE OF US at some point in this lifetime. With more concrete change and support for our survivors, maybe one soon we will end this epidemic and lead the world in establishing a zero tolerance for any kind of abuse of our women and men.

More information can be obtained via the U.S. National Domestic Violence Hotline at 1-800-799-7233 and TTY 1-800-787-3224.

Tania Bradkin can be found at: @TaniaBradkin on Twitter, @TaniaBradkin on Instagram and at https://www.facebook.com/tania.bradkin on Facebook.