When physicians diagnosed Beverly Ward with a host of chronic illnesses, including acid reflux, chronic pain, and anxiety, they were unaware that physical violence served as the common underlying cause.  A domestic violence survivor, who left her husband after nearly 12 years of marriage, Ward said that while her bruises healed or have since faded, the conditions she developed as a result of her abuse continue to compromise her health.

Ward is among the 1.3 million women who experience sexual, domestic, or intimate partner violence each year and whose abuse triggers seemingly unrelated health conditions.  A recent Robert Wood Johnson University Hospital study found significant links between domestic violence and many chronic health conditions, including stress-related physical consequences like asthma, memory damage, arthritis, and other diseases that can last as many as 20 years after the abuse has ended.

Eight years after leaving her husband, Ward, continues to battle anxiety attacks and gastrointestinal concerns. “There was a certain degree of embarrassment I had to get over in even admitting I was being hit or choked, so I hid those aspects of my condition when I went to my doctor. Those feelings of fight or flight never really ended for me though. I will most likely experience this type of fear and pain the rest of my life,” said Ward, whose primary care physician happened to be on call one night when she was admitted with abuse-related injuries. In cross-referencing her chronic conditions with physical trauma, Ward’s physician was able to provide her necessary care.

“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,” said Michele Black, an epidemiologist at the Centers for Disease Control and Prevention.

Black’s 2011 report on domestic violence-related illness found that victims of intimate partner and sexual violence make more visits to health providers over their lifetime, have more hospital stays, have longer duration of hospital stays, and are at risk of a wide range of physical, mental, reproductive, and other health consequences over their lifetime than non-victims.  Additionally, sustained exposure to violence has been linked with central nervous system problems, including back pain, headaches, and seizures.

“The health care system’s response must be strengthened and better coordinated for sexual violence, stalking, and intimate partner violence survivors to help navigate the health care system and access needed services and resources in the short and long term,” Black said.

Suggestions for more succinctly linking domestic and intimate partner violence to chronic conditions years after abuse include providing more physicians and other health care professionals with training on forensic and patient care issues related to sexual violence.

“One strategy to improve access is co-located, multi-disciplinary service centers that include mental health, legal, economic, housing and other related services for survivors. It is also important that services are specifically designed to meet the needs of a wide range of different populations such as teens, older adults, men, gay, lesbian, bisexual, and transgendered people,” Black said.

Meeting the needs of African-American women impacted by violence, according to the National Coalition against Domestic Violence, may be hindered by cultural idioms that deter reporting victimization. Despite making up 29 percent of all victimized women and DV / IPV being among the leading causes of death for Black women ages 15 to 35, Black women are less likely than others to file complaints.

Mental health social worker, Feminista Jones, ties the unwillingness to report abuse among African-American women to a culture of race loyalty. “A strong sense of cultural affinity and loyalty to community and race renders many of us silent, so our stories often go untold. One of the biggest related impediments is our hesitation in trusting the police or the justice system,” Jones wrote in a recent {Times} magazine article.  “As Black people, we don’t always feel comfortable surrendering ‘our own’ to the treatment of a racially-biased police state and as women, we don’t always feel safe calling police officers who may harm us instead of helping us.”

Gail Reid, director of Advocacy at Turnaround, said that while there is no definitive cause and effect between growing up in abusive households and developing violent tendencies towards others, that violence against women impacts more than those immediately involved.

“There is a high correlation between childhood abuse and ending up in abusive relationships as victims or perpetrators. It is important for people to understand that interpersonal violence and victimization is traumatic and survivors suffer from longer term impact of trauma and can impact in many others,” Reid said.

The Maryland-based Turnaround, provides trauma therapy, victim advocacy, and community education and training among its services, promoting a platform to address the long-term health needs of those impacted by violence.  Retooling communities to hold victimizers accountable and support survivors, Reid said, is critical to the improved overall health of Black women affected by violence.

“The culture of the community has to shift to where the victims stop being blamed for the conditions they develop and instead are offered support. We have to also teach that hitting people you care about is wrong and that is about changing the culture of the community,” Reid said.

Peter Sherman, director of Residency Programs in Social Pediatrics at Montefiore Medical Center said that primary care and family physicians are in an ideal position to diagnose victims of IPV and provide the victims and their families with the appropriate care that is needed. However, an urgent need remained in integrating information on IPV into medical and health care guidebooks. “If this were an infectious disease, we would have a treatment center in every neighborhood. There is a huge disconnect between the prevalence of domestic violence and what is done in the health system,” Sherman said.