Domestic Abuse Linked to Poor Health, Years Later

Yet doctors still aren't properly screening women.

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I didn't want to read the news story about Amy Castillo, the Maryland mother whose estranged husband drowned their three young children in a hotel room last Saturday. I didn't want to read that the family court judge refused to deny the father unsupervised visitation because Castillo continued to have sex with him after he talked about killing the children just to hurt her.

I can only surmise what this poor woman would have done had she known that he would most certainly carry out his threats. Shooting him in cold blood would have been an understandable option. (I say this as a mother of three kids.)

No one wants to read these stories, and no one wants to talk about them beyond expressing pity for this now childless mother. Amy Castillo said she shared her fears and no one listened to her. But even she may not have realized that what her husband was doing was a form of psychological abuse. And all women who live under a threat from a loved one, even when it doesn't erupt into violence, need to start having these conversations with their friends and family, not only to protect themselves but also to educate judges and doctors who all too frequently miss the signs in their female patients. A World Health Organization study published in today's Lancet found that women currently being abused were more likely to have memory loss, difficulty walking, dizziness, and vaginal discharge. Even those who hadn't experienced violence over the past year were more likely to be in poorer health overall, which the researchers write "suggests that the effect of violence might last long after the actual violence has ended."

Yet many doctors fail to connect the dots between partner abuse—including threats of violence—and unexplained health problems like chronic headaches, insomnia, painful sex, and gastrointestinal complaints, according to Janice Asher, a domestic violence expert and associate professor of obstetrics and gynecology at the University of Pennsylvania School of Medicine. "All too frequently, women will get CT scans, MRIs, and other tests that go nowhere when doctors don't take the time to ask if they're in an unsafe relationship," she laments. While abuse itself can obviously cause injuries, psychologists have found that the pain often lingers after the body heals due to "memories" stored in nerve cells. This could explain why a woman might suddenly develop pelvic pain after entering a new relationship when her last boyfriend forced her to have a type of sex she didn't want.

With 2 million American women abused by their partners every year, doctors are doing a huge disservice when they don't screen for domestic violence—especially, Asher adds, since most women won't talk about abuse unless they're asked. (And even then, many won't discuss it until they've established a trusting relationship with their doctor.)

"I'm so glad you're covering this!" she tells me. I told her that I heard a great presentation she gave two years ago on screening for domestic violence. What struck me at the time was how few doctors at the gynecology conference were in attendance to hear her remarks. "Yes," she sighs, "doctors tell me they're too pressed for time to ask about abuse." So, women may have to take it upon themselves to speak up about prior abuse if they're experiencing unexplained pain or other symptoms.

The first priority for a woman in danger, of course, is to get away from the source. Unfortunately, as Amy Castillo learned, the system doesn't always make that possible. Organizations like the National Coalition Against Domestic Violence can at least help put many abused women on the right track to safety.