When we talk about domestic or intimate partner violence, the conversation often centers on the moment of harm itself. But for survivors, the effects of abuse don’t end when the immediate danger passes. They can live in the body for years, sometimes for a lifetime. Understanding the health consequences of intimate partner violence is essential, not just for advocates and survivors, but for the healthcare providers who are often the first to notice something is wrong.
Abuse Affects the Whole Body
Research has found connections between intimate partner violence and a wide range of physical health conditions, including asthma, chronic pain, gastrointestinal problems, cardiovascular issues, disordered eating, sleep problems, and brain injury. These aren’t isolated symptoms. Many survivors experience several at once, and the connections aren’t always obvious to the survivor or their care team. Additionally, these health conditions are often chronic and go unchecked by healthcare providers.
The mental and behavioral health impacts are just as significant. Anxiety, depression, panic attacks, memory loss, post-traumatic stress disorder, and substance use are frequently reported by survivors of intimate partner violence. These conditions are often treated separately from the abuse that contributed to or caused them, which can mean survivors receive care that addresses symptoms without ever getting at the root cause.
When Health Itself Becomes a Tool of Control
Abuse isn’t only a physical injury. It also shows up as coercion around health itself. This can take several forms: pressure or manipulation related to mental health treatment and substance use, sabotage of medical care, exploitation of a partner’s stigmatized health conditions, or sexual and reproductive coercion.
Reproductive coercion happens when one partner takes reproductive health decisions or options away from the other. It can include a variety of behaviors, including refusing to use birth control, tampering with a partner’s birth control, forcing a partner to get an abortion, withholding finances needed to purchase birth control, or manipulating or pressuring a partner into pregnancy. Research surveying young women at family planning clinics found that nearly 1 in 5 said a partner had used verbal pressure, threats, or force to try to get them pregnant, and fifteen percent reported active interference with birth control. A separate national survey found that nearly a quarter of survivors who contacted a hotline said a partner had actively pressured them into pregnancy.
Brain Injury: An Under-Recognized Consequence
An alarmingly common health consequence of intimate partner violence is brain injury sustained from blows to the head, strangulation, or oxygen deprivation. In fact, research suggests that roughly two out of three survivors of severe physical intimate partner violence have sustained a partner-inflicted brain injury.
To put that in perspective, it’s estimated that traumatic brain injuries are significantly more common among intimate partner violence survivors than among NFL players. Studies estimate that 19% to 75% of survivors experience brain trauma, translating to millions of cases annually, whereas NFL concussions number in the hundreds per season. One study found that 74% of survivors experienced at least one abuse-related brain injury, including from strangulation, and 51% had experienced repeated brain injuries, many of whom sustained “too many to count.”
Despite how common these injuries are, most survivors never seek medical treatment for them, often because they don’t realize an injury occurred. Brain injury can bring memory problems, difficulty concentrating, trouble regulating emotions, sleep disruption, and difficulty completing everyday tasks. These symptoms can be both short- and long-term and can be easily misattributed to stress, trauma more broadly, or an unrelated condition, when a physical injury may be part of the picture.
Why Survivors Avoid Healthcare Settings
Given how deeply abuse affects health, it might seem like survivors would seek out medical care often. In reality, however, many avoid it. Some survivors may not seek healthcare because of practical barriers, such as transportation, cost, language, and access to healthcare providers. Others may avoid medical care because of deeply personal reasons, like a lack of privacy or self-determination, fear of being vulnerable during invasive procedures like removing clothing or being physically touched, or shame and fear of judgment. In other situations, survivors may not seek care because of a partner who actively prevents them from getting care.
Mandatory reporting laws, which require healthcare professionals to report certain injuries or suspected abuse to law enforcement, are meant to help protect survivors and victims. However, these laws can also be a reason some survivors do not seek healthcare at all. One study found that more than 83% of survivors who experienced mandatory reporting said it was unhelpful or made their situation worse, and 27.5% said they avoided healthcare providers altogether specifically because of that fear. For survivors already weighing safety, privacy, and control over their own lives, a policy meant to protect them can end up keeping them away from care entirely.
What Healthcare Providers Can Do
Healthcare settings have real potential to be a turning point for survivors. Providers can help by:
- Talking with all patients about healthy and unhealthy relationships and the health effects of violence, regardless of whether abuse has been disclosed. For an evidence-based and trauma-informed approach to intervention for addressing intimate partner violence in healthcare settings, check out CUES.
- Making trauma-informed information and tools visible and accessible for both patients and staff
- Walking patients through each step of a physical exam and asking permission before proceeding
- Working with administration to host regular trauma-informed training and to build trauma-informed policies where they don’t already exist
- Working with administration to host regular trauma-informed training and to build trauma-informed policies where they don’t already exist
- Ensuring patients have private time with their provider, without a partner present, at some point during a visit
- Factoring a patient’s experience of violence into treatment and care planning, including reproductive health
- Partnering with local survivor advocacy organizations for training and referrals
Moving Toward Trauma-Informed Care
The health consequences of intimate partner violence are wide-ranging, often invisible, and frequently disconnected from their true cause in both survivors’ and providers’ minds. Recognizing these patterns, from chronic pain to brain injury to the fear that keeps someone from walking into a clinic at all, is a critical step toward care that actually meets survivors where they are.
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