October 11, 2009

Each year millions of men, women and children suffer violence by members of their own families. They are beaten, raped, or assaulted. In addition to the damage done to so many individuals, we know that all of the major forms of family violence result in increased utilizaiton of the health care system. Family violence impacts everyone.

Results from research studies show that victims of trauma in general, and family violence in particular, are more likely to engage in risky behaviors than nonvictims. Behaviors such as lack of exercise,illicit drug use, alcohol use, tobacco use, sexual activity with numerous partners, eating disorders, and sexual intercourse earlier in a relationship. Though we've understood this is a major threat to public health, little has been done to solve the problem.

There are many ideas about why survivors of trauma are more prone to engage in such risky behaviors, including two basic beliefs. One is that the survivor is numbing herself, so that she doesn't feel the chronic fear and emotional pain that results from abuse. The other is that the survivor sees herself as unworthy of good care and so treats herself accordingly, at times joining with the perpetrator and abusing her own body. Interestingly, while seemingly not caring about the pain of self-abuse, survivors seem more sensitive to pain from illnesses and injuries not self-inflicted.

The cost of family violence in loss of bright young women and men who could contribute to our nation is unmeasureable. The cost in terms of health care costs and disability payments is massive. To stop the violence, we must take decisive action. We must be willing to do what is necessary to solve the problem. And we have to know what to do.

One of the first steps is education. Education is essential in overcoming the strong need family violence victims often feel to protect the abuser. Drug education has taught many youngsters that alcohol and drug abuse is dangerous and has been successful to the point that some youngsters report their parents for driving under the influence and for smoking marijuana. We need a similar program to stop the violence and end the silence. We need to educate victims that the self-blame they feel is not the truth, but one of the symptoms of being abused.

A second type of education is to help survivors understand the long-term symptoms of trauma and the dangers of not getting treatment.

Another step is for health care workers to collaborate. Physicians and nurses are most likely to see repetitive symptoms related to trauma and the risky behavior that is typical. Every patient seen should be asked about their trauma history and a referral made if appropriate. Our healthcare is set up in a way that divides the person into mind or body. Physicians and mental health professionals, including psychiatrists, rarely consult. Effective treatment of the psychological causes of risky behaviors which result in physical health issues may never occur despite numerous trips to the ER.

Finally, mental health providers must learn the effective treatments available for trauma. Sometimes the treatments used further traumatize the individual and result in the patient dropping out of care or becoming a permanent patient, dependent on the therapist.

Let's get started. What can you do?