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April 22, 2014

Health Care After Violence

The physical and emotional harm that comes from being abused by a loved one can have unexpected effects for survivors, even after the violence has stopped. If you’ve survived domestic or sexual violence as a child or adult, some everyday activities that used to be easy may now suddenly be difficult.
If you find yourself avoiding visiting the nurse, doctor, or dentist, maybe without even knowing why, you’re not alone. Many survivors of abuse find that seeing a healthcare provider can be anxiety producing. At the same time, taking care of yourself can be a reaffirming experience that helps you move beyond the physical and psychological trauma.
Health care can also be hard because health care environments are not always trauma-informed and there are often time restrictions that limit your ability to connect with your provider. There are steps you can take to make medical visits easier and help you become more involved in your own healthcare. But first, let’s look briefly at some of the impacts of abuse and why they might make going to medical appointments so challenging.
Why is going to my doctor or nurse so hard for me?
Beyond the obvious physical effects of violence like injuries, some of the long-term after-effects of abuse can be subtle but significant. Studies have shown that exposure to trauma and violence can lead to many health problems. The constant stress of experiencing or anticipating emotional or physical abuse takes a toll on the body and a person’s well-being, and can lead to chronic medical issues.
Having a loved one be violent towards you may also be psychologically traumatic. We use a variety of coping strategies to survive the emotional pain: we distance ourselves, minimize the experience or situation, avoid thinking about it, and even sometimes deny to ourselves that what we are experiencing is painful. These ways of coping sometimes make survival possible. However, they can also become a routine way of thinking, or handling difficult situations, when we no longer need them.
Seeing a doctor or nurse means you’re paying attention to what’s going on in your body. At the same time, it might be hard for you to focus on your body for a number of reasons. For example, if you cope by distancing yourself, or “going away in your head”—what some call dissociating—it can make it hard to feel what’s going on in your body. Dissociation is a clever tool our minds have of giving us a break from traumatic experiences and allowing us to function. The problem comes when we no longer need to dissociate, but instead be mentally present and understand any harm we’ve experienced.
To complicate things even more, health care settings like waiting rooms can be stressful and hectic and some procedures can leave us feeling vulnerable or remind us of the violence that we’ve survived. Additionally, language or other cultural differences between you and your provider may complicate your ability to communicate or connect with them which can be stressful. At those times, even though we may not be in danger, it can feel like we are and we might feel upset or afraid, or we may fall back on the coping strategies that helped us to survive the abuse. Those dynamics along with other power imbalances we may experience in our encounters with medical professionals, sometimes make it hard for us to fully participate in our health care.
What can I do to make my nurse/doctor visits easier?
Tell them about the abuse
The abuse you experienced may be affecting your health in some way. If you feel comfortable with your provider, just as you would tell them about your medical history, also let them know that you are a survivor of violence. Explain how you think the violence has affected your health. Discuss any untreated injuries, un-prescribed medications, possible exposure to sexually transmitted infections (STIs), unplanned pregnancies and ways in which you might have coped through drugs or alcohol. Your health care provider can then help you consider ways to address these concerns.
Trust your instincts during this discussion. If you feel scolded or in other ways judged by the nurse or doctor, they may not be the health care professional for you. Looking honestly at your medical issues may be difficult. The relationship between you and your health care provider should have open and caring lines of communication in order for you to feel comfortable being honest with them and relying on their help.
Take charge of the visit
If you’re worried that you might “space out” or dissociate during your visit, make a plan with your health care provider for how you can feel more in control of exams and other visits so that you can remain aware and participate in decisions.
If you are unsure what to ask for, consider this trauma-informed healthcare approach you can share with your provider:
1. The healthcare provider and fully dressed patient meet before the physical exam to discuss the reason for the visit and to review the procedure step-by-step.
2. The provider leaves and the patient changes for the physical exam.
3. During the exam, the provider waits for the patient’s approval before every step. For example, the doctor might say, “Now I’m going to lift your gown and push hard on your abdomen, OK?” The patient indicates whether or not the provider is OK to proceed. If the exam can’t be completed, the provider and patient agree to reschedule it and discuss ways in which the procedure might be made easier, if possible.
4. After the exam is completed, the patient has the option of getting dressed again before discussing possible next steps with the doctor.
5. To the extent possible, the provider leaves the patient with written follow-up information, diagnoses, and next steps.
Change these steps if needed so that they feel most comfortable for you.
Ask someone to come with you
At times, it may be helpful to have a friend go with you to your appointment—if you are having a hard time getting yourself to go for medical exams, or if you are afraid you will not remember your discussion. Your friend can sit in the exam room with you just for support, hold your hand during painful procedures, or be the designated note taker so you can remember and review the details of the appointment later. It is important to note that many health care providers will want to meet with you alone during some part of the exam. At this point you can ask your friend or support to step outside but let the provider know that during the exam you would like your friend present.
After your medical appointment
Take some time after your appointment to reflect on how it went. Write in a journal on your own or sit with your friend or support and discuss your appointment. Consider how it felt and what you learned. Did you feel comfortable with your health care provider’s approach? Do you understand the results of your visit and your next steps? Do you feel your provider listened to you and took the time to help you understand your options? This time and thought can help you relax, plan and stay on track when it comes to caring for yourself.
These free confidential hotlines are available 24 hours a day with access to language interpreters. Some of the websites offer hosted chats:
National Domestic Violence Hotline 800-799-SAFE (800-799-7233) www.thehotline.org
National Dating Abuse Helpline 866-331-9474 www.loveisrespect.org
National Sexual Assault Helpline 800-656-HOPE (800-656-4673) www.rainn.org
Childhelp National Child Abuse Hotline 1-800-4-A-CHILD (1-800-422-4453)
National Suicide Prevention Lifeline '1-800-273-TALK (1-800-273-8255)

2 comments for "Health Care After Violence"

Samantha's Gravatar

I was physically, emotionally, and sexually abused by my parents, and raped by an uncle. This helped me

Samantha wrote on March 09, 2015 at 09:35 AM
Shayna's Gravatar

I'm an OBGYN nurse working on a training for our practice and this helped me. Your book was an inspiration to me learning more about how I can support my patients' recovery. Thank you.

Shayna wrote on November 07, 2015 at 09:43 AM
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