27 Mental Health

How Domestic Violence Can Impact a Victim-Survivor’s Mental Health Wellness 

Over the past few decades, there has been an increased public awareness and consciousness of mental health wellness. When many people think about their health, they often think about their physical health and are drawn to pay more attention to it when they are experiencing various symptoms. Somatic (bodily) symptoms for which no clear physical basis can be found are ubiquitous in traumatized children and adults: chronic back and neck pain, fibromyalgia, migraines, digestive problems, spastic colon/irritable bowel syndrome, chronic fatigue, and some forms of asthma.

These physical symptoms can be manifestations of imbalances in the other dimensions of wellness that include physical, emotional, intellectual, social, spiritual, environmental, and occupational. Holistic health takes into account all of these aspects of one’s life and views them as interconnected. So when someone experiences something traumatic, such as domestic violence, their entire bodily systems and all dimensions of wellness are impacted in some way- particularly one’s emotional wellness.

Everyone has mental health. Whether that’s mental health concerns, mental health wellness or somewhere in between. “Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.” One’s ability to maintain their mental health can be changed by experiencing chronic stress, anxiety, fear, shame, and sadness that comes with domestic violence.

Link Between Mental Health and Domestic Violence: The Statistics 

On average, more than half of the women seen in mental health settings are being or have been abused by an intimate partner. There are specific diagnoses that are commonly experienced by these women: post-traumatic stress disorder (PTSD), depression, and anxiety. In addition, traumatic events produce profound and lasting changes in physiological, arousal, emotion, cognition, and memory- changes that wouldn’t necessarily result in psychological diagnosis.

It’s important to understand that someone’s mental health can be impacted without having PTSD, depression, or anxiety. Whether or not someone develops PTSD as a result of domestic violence depends on numerous factors, not everyone is impacted in the same way. The ways in which a victim-survivor’s mental health can be impacted can include: difficulties with being productive at work, school, with caregiving, establishing and engaging in healthy relationships, and adapting to change and coping with adversity.

A victim-survivor’s mental health can also be weaponized and used as another form of violence and harm. Mental health coercion is a commonly used tactic that is targeted toward the victim-survivor’s mental health as part of a broader pattern of abuse and control and includes: deliberately attempting to undermine a survivor’s sanity, preventing a survivor from accessing treatment, controlling a survivor’s medication, using a survivor’s mental to discredit them with sources of protection, support, to manipulate the police or influence child custody decisions, or engaging mental health stigma to make a survivor think no one will believe them. Other common tactics that target mental health include other forms of emotional abuse, especially gaslighting.

Lasting Impacts 

A common experience for domestic violence victim-survivors that has ways of impacting their mental health wellness is a loss of agency. “Agency is the technical term for the feeling of being in charge of your life: knowing where you stand, knowing that you have a say in what happens to you, knowing that you have some ability to shape your circumstances. Agency starts with what scientists call interoception, our awareness of our subtle sensory, body-based feelings: the greater that awareness, the greater our potential to control our lives. Trauma can shut down victim-survivors inner compass and rob them of the imagination they need to create something better.

Not being able to discern what is going on inside their bodies causes them to be out of touch with their needs and they have trouble taking care of themselves, whether it involves eating the right amount at the right time or getting the sleep they need. This failure to be in touch with their bodies contributes to their well-documented lack of self-protection and high rates of revictimization and also to their remarkable difficulties feeling pleasure, sensuality, and having a sense of meaning.”

Childhood Experiences and Impacts

The ways in which a victim-survivor of domestic violence responds to trauma, is impacted by trauma, and their ability to lead happy, healthy lives is largely influenced by their childhood experiences. Many of the ways we know how to handle stress and navigate conflict stem from our childhood when we learned different strategies through watching our parents/caregivers and those around us. Children are unfortunately yet often left out of the discussion of domestic violence, with the primary focus being on adults experiencing intimate partner violence. However, we know that experiencing domestic violence in childhood has significant detrimental impacts on children.Dr. Van Der Kolk says “Not being seen, not being known, and having nowhere to turn to feel safe is devastating at any age, but it is particularly destructive for young children, who are still trying to find their place in the world.”

Role of Mental Health Professionals

At Women’s Advocates, the first domestic violence shelter in the nation, we value the promotion of mental health wellness for everyone victim-survivor who stays with us. Our licensed mental health therapist, Saran, offers mental health wellness for body, mind, and spirit. She provides individual and family therapy to women and children who have been directly affected by domestic violence. She uses several therapeutic models to explore emotional functioning, insight into belief systems and perceptions, individuals’ inner strength, and goal setting. The goal of therapy is to improve coping skills, develop new ways of working through problems, enhance self-confidence, and strengthen resilience.

Some Key Components of Trauma-informed Care for Providers and Advocates:

• A commitment to non-violence is essential in a domestic violence service agency. Because advocate-survivor relationships are based on equality, an advocate will not use punitive or coercive interventions because they emphasize power differentials.
• Each individual seeking services has her own unique history, background, and experience of victimization. Treat each survivor as an individual.
• Healing and recovery are personal and individual in nature. Each survivor will react differently. Programs and advocates need to be consistent yet flexible.
• Establishing a connection based on respect and focusing on an individual’s strengths provides the survivor an environment that is supportive and less frightening.
• The experience of domestic violence violates one’s physical safety and security. Programs need to provide safe physical spaces for both adults and child survivors.
• Emotional safety is imperative so that survivors can feel more secure and comfortable. They need to live in an environment where their worth is acknowledged and where they feel protected, comforted, listened to, and heard.
• Collaborating with a survivor places emphasis on survivor safety, choice, and control. 

Ways to Promote Mental Health Wellness for Victim-Survivors 

• Create an emotional safety plan 
• Develop a self-care plan
• Explore survivor’s strengths
• Learn more about setting personal boundaries 
• Try out various simple mindfulness exercises 
• Seek professional mental health support

Seek Trauma-Informed Support and Help

• The Family Partnership 
• Domestic Abuse Project
• Face to Face: Empowering Youth
• C.L.U.E.S- Comunidades Latinas Unidas en Servicio 
• Nexus: Family Healing
• Mental Health Resources
• People Inc. 

Learn More

• Watch Women’s Advocates “Impact of Domestic Violence on Mental Health” Webinar including our very own mental health therapist by clicking here.
• Current Evidence: Intimate Partner Violence, Trauma-Related Mental Health Conditions & Chronic Illness (National Center on Domestic Violence, Trauma & Mental Health)
• Mental Health Consequences and Risk Factors of Physical Intimate Partner Violence (Mental Health in Family Medicine Journal)
• For providers: Treating Women Who Have Experienced Intimate Partner Violence (APA)
• A Systematic Review of Trauma-Focused Intervention for Domestic Violence Survivors 
• Trauma Informed Care Best Practices and Protocols (very informative)

These readings are for anyone interested in learning more about domestic violence, trauma, and mental health.

• Thinking About Trauma in the Context of DV Advocacy: An Integrated Approach
• Intimate Partner Violence and Lifetime Trauma
• Prevalence of Intimate Partner Violence and Other Lifetime Trauma Among Women Seen in Mental Health Settings

To learn more, we also recommend the following sources:

American Medical Association, (1995). Diagnostic and Treatment Guidelines on Mental Health Effects of Family Violence. http://corpwell.net/Bstore/Downloads/AMA-mentaleffects.pdf

Pease, T. (2009). Reflective Leadership as a Strategy for Accountability, The Voice: The Journal of the Battered Women’s Movement, 4-6. http://www.ncadv.org/files/Accountability%20Issue%20Spring%202009.pdf

Warshaw, C., Brashler, P. & Gill, J. (2009). Mental health consequences of intimate partner violence. In C. Mitchell and D. Anglin (Eds.), Intimate Partner Violence: A Health Based Perspective. New York: Oxford University Press.

Warshaw, C. & Brashler P. (2009). Mental health treatment for survivors of domestic violence. In C. Mitchell and D. Anglin (Eds.), Intimate Partner Violence: A Health Based Perspective. New York: Oxford University Press.

Warshaw, C. (2008). Changing Theory, Changing Practice. In E. Morrison (Ed.), Health Care Ethics: Critical Issues for the 21st Century (2nd ed.) (pp. 365-381). Sudbury, Massachusetts: Jones and Bartlett.

Warshaw, C. (2008). Domestic Violence, Trauma and Mental Health. In C. Renzetti & J. Edleson (Eds.), Encyclopedia on Interpersonal Violence. Thousand Oaks, California: Sage.

Warshaw, C., Taft, A. & McCosker, H. (2005). Educating health professionals: changing attitudes and overcoming barriers. In G. Roberts, K. Hegarty & G. Feder (Eds.), Intimate Partner Abuse and Health Professionals: Old Problems, New Approaches (pp.61-77). Oxford, England: Elsevier.

Warshaw, C., Gugenheim, A.M., Moroney, G., & Barnes, H. (2003). Fragmented Services, Unmet Needs: Building Collaboration Between The Mental Health And Domestic Violence Communities, Health Affairs, (22)5, 230-234. doi: 10.1377/hlthaff.22.5.230. http://content.healthaffairs.org/content/22/5/230.full

Warshaw, C., Moroney, G. (2002). Mental Health and Domestic Violence: Collaborative Initiatives, Service Models, and Curricula. Chicago: Domestic Violence & Mental Health Policy Initiative.

Warshaw, C., Moroney, G., Barnes, H. (2003). Report on Mental Health Issues & Service Needs in Chicago Area Domestic Violence Advocacy Programs. Chicago: Domestic Violence & Mental Health Policy Initiative.

Warshaw, C. & Ganley, A.L. (1998). Improving the Health Care Response to Domestic Violence: A Resource Manual for Health Care Providers. http://www.futureswithoutviolence.org/section/our_work/health/_health_material/_resource_manual

Wolf Markham, D. (2003). Mental Illness and Domestic Violence: Implications for Family Law Litigation. Journal of Poverty Law & Policy, 23-35. http://www.povertylaw.org/clearinghouse-review/issues/2003/20030515/500941