Bruises, broken bones, head injuries, lacerations, and internal bleeding are some of the acute effects of a domestic violence incident that require medical attention and hospitalization. Some chronic health conditions that have been linked to victims of domestic violence are arthritis, irritable bowel syndrome, chronic pain, pelvic pain, ulcers, and migraines. Victims who are pregnant during a domestic violence relationship experience greater risk of miscarriage, pre-term labor, and injury to or death of the fetus.
Among victims who are still living with their perpetrators, high amounts of stress, fear, and anxiety are commonly reported. Depression is also common, as victims are made to feel guilty for ‘provoking’ the abuse and are constantly subjected to intense criticism. It is reported that 60% of victims meet the diagnostic criteria for depression, either during or after termination of the relationship, and have a greatly increased risk of suicidality. In addition to depression, victims of domestic violence also commonly experience long-term anxiety and panic, and are likely to meet the diagnostic criteria for Generalized Anxiety Disorder and Panic Disorder. The most commonly referenced psychological effect of domestic violence is Post-Traumatic Stress Disorder (PTSD). PTSD (as experienced by victims) is characterized by flashbacks, intrusive images, exaggerated startle response, nightmares, and avoidance of triggers that are associated with the abuse. These symptoms are generally experienced for a long span of time after the victim has left the dangerous situation. Many researchers state that PTSD is possibly the best diagnosis for those suffering from psychological effects of domestic violence, as it accounts for the variety of symptoms commonly experienced by victims of trauma.
Once victims leave their perpetrator, they can be stunned with the reality of the extent to which the abuse has taken away their autonomy. Due to economic abuse and isolation, the victim usually has very little money of their own and few people on whom they can rely when seeking help. This has been shown to be one of the greatest obstacles facing victims of DV, and the strongest factor that can discourage them from leaving their perpetrators. In addition to lacking financial resources, victims of DV often lack specialized skills, education, and training that are necessary to find gainful employment, and also may have several children to support. In 2003, thirty-six major US cities cited DV as one of the primary causes of homelessness in their areas. It has also been reported that one out of every three homeless women are homeless due to having left a DV relationship. If a victim is able to secure rental housing, it is likely that her apartment complex will have "zero tolerance" policies for crime; these policies can cause them to face eviction even if they are the victim (not the perpetrator) of violence. While the number of shelters and community resources available to DV victims has grown tremendously, these agencies often have few employees and hundreds of victims seeking assistance which causes many victims to remain without the assistance they need.
Domestic violence can trigger many different responses in victims, all of which are very relevant for any professional working with a victim. Major consequences of domestic violence victimization include psychological/mental health issues and chronic physical health problems. A victim’s overwhelming lack of resources can lead to homelessness and poverty.
On responders Vicarious trauma
Due to the gravity and intensity of hearing victims’ stories of abuse, professionals (police, counselors, therapists, advocates, medical professionals) are at risk themselves for secondary or vicarious trauma (VT), which causes the responder to experience trauma symptoms similar to the original victim after hearing about the victim’s experiences with abuse. Research has demonstrated that professionals who experience vicarious trauma show signs of exaggerated startle response, hyper vigilance, nightmares, and intrusive thoughts although they have not experienced a trauma personally and do not qualify for a clinical diagnosis of PTSD. Researchers concluded that although clinicians have professional training and are equipped with the necessary clinical skills to assist victims of domestic violence, they may still be personally affected by the emotional impact of hearing about a victim’s traumatic experiences. Iliffe et al. found that there are several common initial responses that are found in clinicians who work with victims: loss of confidence in their ability to help the client, taking personal responsibility for ensuring the client’s safety, and remaining supportive of the client’s autonomy if they makes the decision to return to their perpetrator. It has also been shown that clinicians who work with a large number of victims may alter their former perceptions of the world, and begin to doubt the basic goodness of others. Iliffe et al. found that clinicians who work with victims tend to feel less secure in the world, become "acutely aware" of power and control issues both in society and in their own personal relationships, have difficulty trusting others, and experience an increased awareness of gender-based power differences in society.
The best way for a clinician to avoid developing VT is to engage in good self-care practices. These can include exercise, relaxation techniques, debriefing with colleagues, and seeking support from supervisors. Additionally, it is recommended that clinicians make the positive and rewarding aspects of working with domestic violence victims the primary focus of thought and energy, such as being part of the healing process or helping society as a whole. Clinicians should also continually evaluate their empathic responses to victims, in order to avoid feelings of being drawn in to the trauma that the victim experienced. It is recommended that clinicians practice good boundaries, and find a balance in expressing empathic responses to the victim while still maintaining personal detachment from their traumatic experiences.
Vicarious trauma can lead directly to burnout, which is defined as "emotional exhaustion resulting from excessive demands on energy, strength, and personal resources in the work setting". The physical warning signs of burnout include headaches, fatigue, lowered immune function, and irritability. A clinician experiencing burnout may begin to lose interest in the welfare of clients, be unable to empathize or feel compassion for clients, and may even begin to feel aversion toward the client. If the clinician experiencing burnout is working with victims of domestic violence, the clinician risks causing further great harm through re-victimization of the client. It should be noted, however, that vicarious trauma does not always directly lead to burnout and that burnout can occur in clinicians who work with any difficult population – not only those who work with domestic violence victims.
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