Director Saira Kalia, MD
photo: Jamie Manser
Domestic violence is a prevalent form of adverse childhood experience (ACE) and household dysfunction. It profoundly impacts mental and physical health across a person's lifespan. The Centers for Disease Control and Prevention (CDC) defines ACEs as "potentially traumatic events in childhood, including abuse, neglect, and household challenges such as domestic violence or substance use within the family." These early experiences influence the likelihood of developing psychiatric conditions and chronic illnesses later in life, underscoring the importance of addressing domestic violence to improve health outcomes.
The effects of domestic violence are not limited to immediate physical harm, and they are not limited to the direct victim. It has long lasting impacts - it shapes mental health outcomes by increasing the risk of anxiety, depression, post-traumatic stress disorder (PTSD), and substance use disorders (SUDs). Research indicates that women, children, and marginalized communities are particularly at risk of experiencing domestic violence. Survivors of domestic violence often develop maladaptive coping mechanisms – such as drug or alcohol use – which provide temporary relief but contribute to long-term health risks and chronic diseases. Children who witness domestic violence often experience a loss of security and mental comfort, which can lead to heightened levels of fear and anxiety. This emotional turmoil is not transient; it can evolve into more severe mental health conditions. ( Adeyele, 2023) For instance, studies have shown that exposure to domestic violence is associated with increased risks of developing anxiety disorders, depression, post-traumatic stress disorder (PTSD), and aggressive behaviors. (Ferraro et al 2017, Levendosky et al 2003). Similarly, it has been noted that chronic stress can lead to conditions such as hypertension, diabetes, and cardiovascular disorders due to high allostatic load. The systematic review by Doroudchi further corroborates this, indicating that children exposed to domestic violence exhibit significant trauma symptoms, including aggressive behaviors and PTSD.( Doroudchi 2023)
We also know that individuals exposed to ACEs, including domestic violence, are at a higher risk of heart disease, cancer, diabetes, and early mortality due to the cumulative stress and biological disruptions caused by trauma. Domestic violence also interferes with the formation of healthy interpersonal relationships, which in turn impacts social support and overall well-being. Social support is critical for mitigating the negative effects of trauma, yet survivors of domestic violence often struggle to build and maintain stable relationships due to their early experiences of betrayal and harm. This lack of connection further exacerbates psychological distress and impedes recovery, leading to isolation and increased vulnerability to mental health disorders.
Physiological changes associated with trauma also play a critical role in the long-term impact of domestic violence on health. Exposure to violence during childhood has been linked to increased inflammation, altered stress responses, and changes in the brain’s structure and function. These biological shifts elevate the risk for both mental and physical health conditions. For example, chronic stress and trauma can impair immune function, increase blood pressure, and disrupt metabolic processes, leading to higher rates of cardiovascular disease, obesity, and stroke among survivors (Lin et al., 2021). The impact of DV is not limited to the direct victim – it can affect subsequent generations. Maternal trauma has been associated with epigenetic changes, which alter the biological development of offspring and increase their risk of health challenges, perpetuating cycles of trauma and poor health across generations (Nwanaji‐Enwerem et al., 2021). The emotional, behavioral, and cognitive repercussions can lead to a cycle of trauma that affects not only the children themselves but also future generations. Breaking these cycles requires deliberate interventions focused on promoting social support and improving access to mental health care.
We need to continue to integrate trauma-informed approaches which emphasize empathy, control, and collaboration. Trauma Informed Care recognizes the importance of addressing shame and fostering safe therapeutic relationships. Effective treatment not only supports individual recovery but also has the potential to improve health outcomes for future generations by interrupting the transmission of trauma. Addressing domestic violence is essential to breaking cycles of trauma and improving long-term health outcomes. By integrating trauma-informed care and expanding mental health support, we can foster healing and resilience across generations.
Director Saira Kalia, MD
References
1. Adeyele, V. O. and Makinde, V. I. (2023). Mental health disorder as a risk factor for domestic violence experienced by school children. Mental Health Review Journal, 28(4), 414-429. https://doi.org/10.1108/mhrj-11-2022-0072
2. Ferraro, A., Rohde, L., Polanczyk, G., Argeu, A., Miguel, E., Grisi, S., … & Fleitlich-Bilyk, B. (2017). The specific and combined role of domestic violence and mental health disorders during pregnancy on new-born health. BMC Pregnancy and Childbirth, 17(1). https://doi.org/10.1186/s12884-017-1438-x
3. Levendosky, A., Huth‐Bocks, A., Shapiro, D., & Semel, M. (2003). The impact of domestic violence on the maternal-child relationship and preschool-age children's functioning. Journal of Family Psychology, 17(3), 275-287. https://doi.org/10.1037/0893-3200.17.3.275
4. Doroudchi A, Zarenezhad M, Hosseininezhad H, Malekpour A, Ehsaei Z, Kaboodkhani R, Valiei M. (2023) Psychological complications of the children exposed to domestic violence: a systematic review. Egypt Journal of Forensic Science, 13(1):26. doi: 10.1186/s41935-023-00343-4.
5. Lin, L., Wang, H. H., Lu, C., Chen, W., & Guo, V. Y. (2021). Adverse Childhood Experiences and Subsequent Chronic Diseases Among Middle-aged or Older Adults in China and Associations With Demographic and Socioeconomic Characteristics. JAMA network open, 4(10), e2130143. https://doi.org/10.1001/jamanetworkopen.2021.30143
6. Nwanaji-Enwerem JC, Van Der Laan L, Kogut K, Eskenazi B, Holland N, Deardorff J, Cardenas A. (2021). Maternal adverse childhood experiences before pregnancy are associated with epigenetic aging changes in their children. Aging (Albany NY), 13(24):25653-25669. doi: 10.18632/aging.203776