Mental health is a broad term that covers a number of illnesses ranging from insomnia, anxiety, and depression to obsessive compulsive disorder (OCD), bipolar disorder, and schizophrenia. According to the World Health Organization (WHO), there are significant links between domestic violence and a variety of mental health issues for victims, abusers, and witnesses alike. May is Mental Health Awareness Month, a perfect time to explore these connections, what they mean, and how they may impact the way domestic violence is regarded and resisted.

The Link Between Mental Health and Abuse

Two thirds of women who receive mental health services have experienced domestic violence, compared with about one third of the general population (WHO). In a review of 41 studies,PLoS ONEfound that there is a higher risk of experiencing partner violence among women with depressive disorders (2.7 times greater), anxiety disorders (4 times greater), and post-traumatic stress disorder (PTSD) (7 times greater) than women without mental disorders. In addition, the likelihood of having suicidal thoughts was 3.5 times greater for women who had experienced abuse than those who had not. In some of the reviewed studies, people (especially women) across all mental health diagnostic categories, including psychoses, had a higher prevalence of experiencing domestic violence. This overall correlation between mental illnesses and abuse stems from two factors: 1) domestic violence can cause mental health issues, and 2) those with preexisting mental health issues are more likely to be targets for abusers (Conversation).

Effects of Abuse on Mental Health

There are many different ways domestic violence can impact victims’ mental health. Post traumatic stress disorder (PTSD) is a frequent consequence of abuse (RTOR). Victims and survivors experience(d) traumatic and frightening events, usually repeatedly, which increases stress, anxiety, and depression and may cause lasting mental anguish for years, even after leaving an abuser. Eating disorders, insomnia or disruption in sleep patterns, restlessness in daily life, and the inability to achieve much due to fatigue are other common ways abuse can take a toll on mental health (LivingWell). Abusers often limit or remove their victims’ agency in life, restricting what they can do and say, who they can see, and making life choices for them. This loss of agency can be very damaging, not only in victims’ control over themselves, but also in their sense of self-esteem, worth, and confidence. They often feel hopeless and “shut down” (HCBH). Emotional abuse, in particular, degrades self-esteem, and victims are prone to depression, anxiety, developing phobias, substance abuse, and self-harm (LivingWell).

Ripple Effects

Domestic violence can have lasting mental health effects that can make it difficult for victims and survivors to stay in school, hold a job, manage their own affairs, and/or have healthy and meaningful relationships. Trauma can cause acute and lasting changes in physiology, arousal, emotion, cognition, and memory (HCBH). Some form of financial abuse occurs in 99% of abusive relationships (Forbes) and can lead to enduring economic issues for victims and survivors throughout their entire lives. Stress over a lack of resources, ruined credit, lost jobs, and other effects of financial abuse and/or the inability to support themselves and their children properly can cause anxiety, depression, and low self-esteem.

Long-term mental health issues can also have chronic physical consequences that may not appear for years. The body has a natural stress response, which includes raised levels of adrenaline and cortisol and a reduction in functioning for nonessential systems in a flight-or-fight situation. Continual activation of this response creates an overexposure to cortisol and other stress hormones that can disrupt almost all bodily processes and lead to health issues such as digestive problems, weight gain, headaches, muscle tension/pain, heart disease, high blood pressure, and stroke (Mayo). The mental health impacts of abuse percolate through all aspects of victims’ lives in ways that may not be immediately apparent.

Mental Health is Neither a Cause Nor an Excuse for Abuse

It is often cited that people with diagnosed mental health illnesses are more likely to be violent than those without. While some studies have found this to be true, others have found no significant increase. According to a study by the Battered Women’s Justice Project, abusers are no more likely to have mental health issues than the general public (Domestic Shelters). The overall number of abusers with mental health problems is low, and certainly lower than the number of victims with mental health problems. There is also a strong connection between domestic violence and substance abuse, with an increased incidence of violence when mental health and substance abuse issues co-occur (Lancet). Alcohol and drugs do not make a person abusive, though they may lower inhibitions and self-control in a way that instigates or intensifies their abusive tendencies. Whatever research one uses, correlation is not causation. “Domestic abuse is a behavior, not a symptom of a mental illness,” explains Nancy Erickson, an attorney and consultant on domestic violence legal issues (Domestic Shelters).

Mental Health Effects of Witnessing Abuse

Children and adults who are exposed to intimate partner violence are more likely to develop a range of mental health problems, develop suicidal ideation, and attempt suicide. Other forms of abuse or neglect are also more likely for children exposed to domestic violence, and they are at greater risk of experiencing abuse as adults. Early exposure to abuse (including in utero!) causes stress and trauma, which can lead to increased risk of mental health problems and neurodevelopmental impairments (Lancet). Children who live in a household where one parent is abusing the other can experience a state of perpetual anxiety. This may cause them to revert to typical habits of younger children (thumb sucking, bed wetting, etc.), develop anti-social traits, and/or struggle with guilt and feel they are to blame for the abuse they witness.

PTSD is also common in children who witness abuse, even if they are not direct victims, which can cause nightmares, anger, irritability, difficulty concentrating, headaches, and stomach pains, among other things. Teenagers may exhibit more aggressive behavior, skip school, engage in risky sexual activities, dabble with drugs and alcohol, and get in trouble with the law. Longer term, children who grew up witnessing abuse are more prone to depression as adults and may develop conditions such as heart disease, obesity, and diabetes (VeryWell).

A Need for Research, Attention, and Change

More research and education are required on the connections between mental health and domestic violence in order to better treat abuse victims and survivors with mental illnesses. A study in theNational Library of Medicinefound that “little consideration” was given to the role of domestic violence in precipitating or exacerbating mental illnesses and that mental health services often fail to adequately address violence experiences by their users. TheWHOreports that many survivors who sought services found them unhelpful, harmful, or even retraumatizing. “Rather than strict categories and diagnoses,” suggests Claudia García-Moreno, WHO Unit Head of Addressing Needs of Vulnerable Populations in Sexual and Reproductive Health, “We need an approach that recognizes survivors’ experiences of violence and puts their needs front and center in research, policy and services.”

The Lancet Psychiatry Commission on Intimate Partner Violence and Mental Health concluded that mental health systems and providers can make a critical difference in survivors’ healing process if conducted with trauma-informed approaches focused on the intersection of abuse and mental health and coproduced with survivors. Trauma-informed care encompasses the complete picture of a patient’s life, past and present. Instead of concentrating on “what’s wrong with you?”, this approach asks, “what happened to you?” in order to provide more effective healing services. Health practitioners need to not only treat the symptoms with medication, but also provide or refer patients for counselling and/or community support in making changes in their lives that will positively affect their mental health.