People feeling depressed

By: Dr. Sharon Griffith, Director of Women’s Health Services

One of the factors that directly affects our mental health is a history of or ongoing individual trauma. Individual trauma results from “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”

May is Mental Health Awareness month, and is therefore a good time to learn more about how a history of trauma or ongoing trauma can affect all our mental wellbeing and that of many persons we serve in our health centers across CHN.

So, let’s talk about Intimate Partner Violence as a source of trauma. Intimate Partner Violence (IPV) is violence or aggression that occurs in a close relationship. The term IPV includes four main types of behaviors: physical violence; sexual violence; psychological aggression and stalking.

IPV is a pattern of assaultive and coercive behaviors that may include physical injury, psychological abuse, sexual assault, progressive isolation, stalking, deprivation, intimidation, and threats. This kind of violence can occur among heterosexual or same-sex couples and does not require intimacy. An intimate partner” may be a current or former spouse, lover or dating partner.

IPV is very common. It affects millions of people in the US every year. Nearly 1 in every 4 adult women and 1 in 7 adult men report having experienced IPV. Imagine then, that in our CHN waiting rooms, one of every four women sitting there may have been a victim of IPV and one in every seven men there may have been a victim of IPV. Many of us might automatically think of IPV only as domestic abuse or violence, such as when an intimate partner is physically or verbally violent, or rape or sexual assault by a partner, spouse or date. But, as noted above, IPV can take many forms, so we must be vigilant and on the lookout for subtle signs or symptoms of IPV.

Let’s talk about physical violence. Physical violence is when a person hurts or tries to hurt a partner by hitting, kicking or using another type of physical force. Some pregnant women experience physical violence for the first time during pregnancy or an increased frequency of violent acts while pregnant. Some women experience physical violence after disclosing a new pregnancy to a partner.

Here are some facts: women with unwanted pregnancies are 4 times more likely to experience physical violence by a partner or husband than women with intended pregnancies. Women presenting for a third or subsequent abortion were more than 2.5 times as likely as those seeking a first abortion to report a history of physical abuse by a male partner or a history of sexual abuse. Some women may be struck in the abdomen or threatened with harm to their abdomen during pregnancy. Adolescent mothers who experience physical partner abuse within three months after delivery were nearly twice as likely to have a repeat pregnancy within 24 months.

At pregnancy testing visits, ask patients if they can make decisions about their pregnancy and birth control without any threats or fear from a partner. Who makes these decisions in your relationship? Would you feel afraid to tell your partner the results? Would you feel pressured to have an abortion if you didn’t want to? Would you be afraid of violence or harm if you told your partner you wanted to have an abortion?

Let’s talk about sexual violence in IPV.

Sexual violence refers to sexual activity when consent is not obtained or given freely.

Anyone can experience SV, but most victims are female. SV is forcing or attempting to force a partner to take part in a sex act, sexual touching, or a non-physical sexual event (e.g., “sexting”) when the partner does not or cannot consent. For example, some of my patients have reported that they had been out partying and were drunk or high and woke up to find that their partner had sex with them without their consent explicit consent. “I didn’t really say no or yes.” “We were drinking a lot and it happened.“ Some patients have tried to explain “it’s not like it was ‘real rape’ ” but were concerned enough to come in for STI testing or emergency contraception.

Questions to ask – Have you ever been in a situation where you were too intoxicated or high to make a decision about having sex? Would it bother you if your partner had sex with you when you were too high or out of it to really know what was going on?

Some instances of IPV occur in much subtler ways than violence that involves physical contact such as rape or attempted rape. Many women report more subtle abuses or sexual violence by their partners.

Psychological aggression is the use of verbal and non-verbal communication with the intent to harm another person mentally or emotionally and/or exert control over another person.

Reproductive and sexual coercion is a form of psychologic aggression.

Reproductive and sexual coercion involves behaviors related to reproductive health to maintain power and control in a relationship. One example is birth control sabotage where a person forces their partner to not use condoms, or removes a condom during sex or deliberately damages a condom or prohibits a partner from using birth control in an attempt to cause pregnancy, pulling out an IUD or vaginal ring, not withdrawing when it was agreed that would be the birth control method, hiding or destroying a partner’s birth control pills or accusing partners of infidelity if they ask for condoms to be used etc.

At a pregnancy test visit you might ask- Are you feeling pressured to be pregnant? If the test is positive, would you be happy with the result? Would you be pressured to continue the pregnancy if you didn’t want to?

There is a high correlation between STI/HIV infections and abusive relationships.

Questions we can ask at STI screening visits, might be – Do you feel pressure from your partner to not wear a condom? Are you afraid to ask your partner to wear a condom? Does he ever get mad at you for asking? Are you afraid of how your partner may react to the news of the positive STI?

As healthcare providers we have an essential role in violence and psychological trauma prevention by discussing healthy, consensual, and safe relationships with all patients and screening patients where they are- in our safe centers. We have resources available to all staff and patients at CHN who may be victims may be or at risk of IPV.

Our social work colleagues, health educators and mental health providers are a great resource for answers and support for victims of IPV and IPV induced trauma.