DrT's Blog from the Health After Trauma Project

Recommended Conference

I have had to opportunity to attend this conference twice. You will find it to be an excellent opportunity to learn with a wide assortment of providers in the beautiful Longview WA area. Comfortable setting, good food, and excellent staff and volunteers. Here is their announcement:

Please join us for Justice and Hope 2008!!

Justice and Hope

March 20, 2008
Lower Columbia College

SAVE THE DATE

For more information:
Call Chere Weiss at (360) 225-4768
Or email at cweiss@lowercolumbia.edu

The Physicians Guide to Intimate Partner Violence and Abuse

              Review by Ruth Shaber, MD

The facts are overwhelming. The Centers for Disease Control and Prevention (CDC) predicts that 5.3 million incidents of intimate partner violence (IPV) occur each year among US adult women and 3.2 million occur among men. Recent data from Group Health Cooperative demonstrates that about 46% of the female members have experienced physical, sexual, or emotional IPV in their lifetime, and data from the Kaiser Permanente Northern California Prevention Program estimates that in the previous year, at least 4% of women patients have experienced physical injury from an intimate partner--that is about 46,000 members in Northern California alone. The social and financial impact is enormous. The CDC estimates that the direct health care costs of IPV are over $4 billion a year. And, evidence has shown that IPV, along with its many comorbidities, is the number one cause of premature death, injury, and illness in women ages 15-­44 years.

It is difficult for even the most experienced clinician to recognize which of our patients are victims of IPV. The violence cuts across all socioeconomic and demographic categories. But we do know that routine screening of all patients in an effective way to identify victims and to offer them assistance. And we know that offering support and counseling to victims can improve the quality of their lives.

Now that we understand these facts, how can clinicians begin to care for patients who are victimized by this overwhelming social problem? The first step would be to open The Physician's Guide to Intimate Partner Violence and Abuse. This book is an essential tool for both experienced and new clinicians. It will help everyone better understand the impact of IPV and to start to comprehend the complicated issues that perpetuate the violence.Patricia Salber, MD, and Ellen Taliaferro, MD, have compiled the definitive handbook for health care professionals. Their chapters, along with those of their expert contributors, help us navigate through the complicated web of social, psychological, and medical issues that lie underneath the surface of IPV. Many clinicians are intimidaded by the thought of dealing with IPV: they are unfamiliar with the proper language to use to screen their patients and they dread the time when a patient will acknowledge the violence in their lives--for fear that they won't have the expertise or enough time to support them effectively. Fortunately, the authors help us realize the therapeutic value of simply asking the questions---even if our patients aren't able to make immediate changes in their lives. And they help clinicians better understand why immediate changes may be difficult and even dangerous. They provide simple tips for offering support and referral to identified victims. And they help explain the social dynamics and practical realities that limit the speed with which change will happen. The book also outlines effective strategies to set up IPV screening programs in our clinics.

A particularly interesting chapter entitled "What Do We Know About the Perpetrators of Intimate Partner Violence and Abuse" helps us understand the prevalence of alcoholism and personality disorders among perpetrators. There is also inspiring information about the effectiveness of batterer intervention programs--with some data suggesting  a re-arrest rate as low as 8% among batterers who completed an intervention program. Some of the chapters will help you better understand information that you already knew or suspected about IPV. But some of the chapters--such as the one on Adverse Childhood Experiences and IPV--will turn everything you thought your knew about medicine upside down.

The book is an extremely well-organized resource. With its easy references, clear bullet points and excellent summary tables, it makes for fascinating reading all the way through--on an easy reference book to take off the shelf for a quick review. Wherever you are in your journey of understanding IPV, I highly recommend this boo to take you further down the road.

1. Victoria Department of Human Services. The health costs of violence: measuring the burden of disease caused by intimate  partner violence--A summary of findings (monograph on the Internet). Victorial Health Promotion Foundation 2004 Jun [cited 2006 Nov 13.

Dr T comments: The Permanente Journal, published online, provides you an easy and effective way to stay current on patient-centered, patient-valued health care. You can subscribe to it by clicking here.

Learning To Be A Victor

If you are in the health care field, you no doubt were taught by teachers or experience to listen to your patients. If you are not in the health care field, not to worry. Lessons and teachers abound. Just listen and learn.

A lesson I gleaned from attending a conference in 1999 opens my book, WellWriting for Health After Trauma and Abuse:

"In 1999, a Chicago bus driver shuttled busload after busload from the airport to the Hyatt hotel where a huge convention on domestic violence was headquartered. Our van was filled with people and chatter. Before we pulled away from the curb, the driver turned around and asked how many of us were going to 'the big domestic violence conference.'

Every hand went up. She nodded and began to drive to the hotel. A few minutes later, she announced: “I used to be one of those women.”

The driver paused and fixed us in her gaze through the rearview mirror. Then she continued, “But I got out. I was a victim, but now I am a victor.”

At the time of the conference, I was an emergency physician.
I had founded and directed the Parkland Hospital Violence Intervention and Prevention (VIP) Center in Dallas, Texas. Our VIP Center was the first hospital-based, medically directed center dedicated exclusively to caring for victims of violence.
At least 85 to 90 percent of our patients were victims of domestic violence. Many of them came to the hospital because they had been physically injured. Still others were referred to us from local shelters and domestic violence agencies for a “well woman” examination or other healthcare needs. We saw our mission as helping domestic violence victims become safe.

After the conference was over, I went home a changed person. Inspired by this brave bus driver who shared her history with us, I now realized that our job was not over until we helped the victims we saw become victors."

Your Health Problems Are Not "All in Your Head"

Our grandmothers have known this for a long time. Now many physicians and healthcare providers have begun to also embrace this concept as numerous recent studies document the statistical relationship between past trauma and current health.

Our grandmothers have known this for a long time. Now many physicians and healthcare providers have begun to also embrace this concept as numerous recent studies document the statistical relationship between past trauma and current health.

But how does this happen?

To address this question, health psychologist and author Kathleen Kendall-Tackett examined her own field of study as well as the child maltreatment literature. Her examination of the numerous studies in both fields helped her identify five major pathways leading from past abuse to current negative health conditions. In her book, Treating the Lifetime Health Effects of Childhood Victimization, she lists these five pathways:

    Physiological pathways

• Trauma causes your sympathetic nervous system to become more reactive. In the stress management literature the sympathetic nervous system activates the fight or flight stress response.
• Trauma can cause your levels of stress hormone to become permanently dysregulated (medicalize for "out of whack."
• Trauma may cause you to be more sensitive to pain as it may lower your pain threshold.

    Behavioral pathways

• Because of past trauma or abuse, you may find yourself engaging in risky or harmful behaviors such as using alcohol or dangerous substances.
• On the flip side, you may ignore engaging in health-promoting behaviors such as proper exercise or eating.

    Cognitive pathways

• As a trauma survivor you may be more likely to have negative beliefs about yourself and others
• Negative beliefs can undermine your health and may also lead to your engaging in harmful behaviors and harmful relationships.

    Social pathways

• As an abuse survivor, you may find that you experience trouble in relationships: divorce, marital disruptions, and social isolation.
• Past abuse may condition you to become revictimized in adulthood. 
• Trauma fallout can result in your having a higher incidence of poverty, becoming homeless, or having difficulty in school or work. All of these social problems can negatively impact your adult health status.

    Emotional pathways

• Past trauma or abuse may result in your having depression or post-traumatic stress disorder (PTSD).
• Depression or PTSD can suppress your immune system and lead to a myriad of health problems, including increased risk of heart attacks.
  

Healing past wounds to improve your health

Awareness affords you the opportunity to heal, improve your life, and become more productive. How do you gain such insight and awareness? Start by journaling 15 minutes or so three times a week about what past trauma you have experienced. As you identify the traumas, ask yourself how each one has changed or driven your life. You will be amazed at what you learn as your journal pages take on a life of their own.

Once you are aware that a problem exists for you, you can set the stage for action. Read everything you can about your problem, consult professionals, and discuss with friends who support you. Then craft a plan for overcoming your problem and take action.

Speaker and author Ellen Taliaferro, MD lives in Half Moon Bay, CA and serves as the Medical Director of the Keller Center for Family Violence Intervention at the San Mateo Medical Center in San Mateo, CA. She is the author of three books: WellWriting® for Health After Trauma and Abuse, The Physician's Guide to Intimate Partner Violence and Abuse, and A Handbook: Respond to Intimate Partner Violence - 10 Action Steps You Can Take to Help Your Patients and Your Practice. Dr. Taliaferro can be reached by calling 650-393-3660 or through her websites www.healthaftertrauma.com and www.wellwriting.org

Article Source: http://EzineArticles.com/?expert=Ellen_Taliaferro,_MD 

When Less Health Care Becomes More

I was delighted to open up the March/April 2007 issue of Spirituality & Health magazine and find inside on page 69 an article by friend and colleague Hazel Henderson, noted futurist and humanitarian economist. The article, Alternative Future/s: 14 signs of intelligent economic life in the universe, takes a whack at our current state of healthcare.

"Industrialized medicine is in crisis," She writes. Noting the widespread dissatisfaction among patients, doctors, nurses, and hospitals, she points out that "Studies show the U.S. spends more than any other nation on medical costs per person--without better outcomes than countries spending half this amount"

"Thus, competing practices become a "rapidly, growing new sector of our economy," she continues. These emerging practices focus on:

• Prevention
• Natural approaches to wellness.

Of note, the natural approaches to wellness often cost less. Hazel sums it up this way, "Nowhere is redefining success more emblematic than in alternative health care and medicine, where less is more, and love and personal caring are valued over high-tech interventions."

Bravo, Hazel!

Modern medicine, so wonderful in so many ways, seems to have lost its way in dealing with complicated, chronic healthcare problems that require more than a pill or day surgery. The rising epidemic of autoimmune disease, chronic pain problems, and other non-specific ill-health disorders cries out for recognition of a mind-body approach to patient woes and distress.

Patients swept up in this growing epidemic seem to know more about having medical problems that present both as a disease and a general sense of being at dis-ease than modern medicine recognizes. Perhaps the time now comes to focus on some of the natural approaches to wellness used by past generations of family doctors: listening, respecting, and caring instead of blindly ordering one expensive medical test after another.

Speaker and author Ellen Taliaferro, MD lives in Half Moon Bay, CA and serves as the Medical Director of the Keller Center for Family Violence Intervention at the San Mateo Medical Center in San Mateo, CA. She is the author of three books: WellWriting® for Health After Trauma and Abuse, The Physician's Guide to Intimate Partner Violence and Abuse, and A Handbook: Respond to Intimate Partner Violence - 10 Action Steps You Can Take to Help Your Patients and Your Practice. Dr. Taliaferro can be reached by calling 650-393-3660 or through her websites www.healthaftertrauma.com and www.wellwriting.org

To learn more about Hazel Henderson and her work, please visit her website at www.hazelhenderson.com.

Health Needs of Survivors of Domestic Violence

Domestic violence is not over when the victim is safe and out of harm’s way. It’s not over until justice has been served. Even then, it’s not over. It’s not over until the victim is safe, justice has been served, and the victim is well.

Consider these facts:

• Abuse, especially repetitive abuse, leaves a lasting “impression” on the health, well-being, and post-abuse functioning of the victim. This impact lingers long after the bruises fade, the bones mend, and the abuse is over.
• Victims of violence seek healthcare more often than non-victims. The severity of victimization is a powerful predictor of the healthcare costs generated by these victims.
• Most healthcare visits by victims of domestic violence are not domestic violence patients presenting with injuries, but rather medical problems that seemingly are not related to current or past injuries.

The health effects of violence can reach across the life span. Studies have now shown that adults who were abused in childhood vs. those who were not have more:

• Infectious diseases
• Mental health disorders
• Hypertension
• Diabetes
• Dermatitis
• Asthma
• Allergy
• Acne
• Abnormal menstrual bleeding 
• More heath-threatening behaviors such as smoking, the use of alcohol, driving while intoxicated, avoiding regular gynecological examinations, not wearing seat belts, sedentary lifestyle, and high-risk sexual encounters. 

The abuse sustained in an intimate partner relationship does not have to be physical to cause poor health. Intimate partner violence and abuse (IPVA) can take several forms: physical abuse, verbal abuse, and forced sex. When Dr. Ann Coker and her colleagues looked at domestic violence in a large series of patients, they found that approximately 14% of domestic violence victims have only been victimized psychologically, not physically. These victims had higher rates of numerous medical problems that the non-abused do not have. Among them:

• Disability that prevented working
• Arthritis
• Chronic pain
• Migraine and other frequent headaches
• Stammering
• Sexually transmitted infections
• Chronic pelvic pain
• Stomach ulcers
• Frequent indigestion, diarrhea, or constipation.

These findings pose an interesting question: Do victims of psychological abuse have fewer or more health problems than victims of physical violence?  Dr. Coker and her colleagues found that “psychological IPV was as strongly associated with the majority of adverse health outcomes as was physical IPV.” The old childhood taunt of “Sticks and stones can break my bones, but words can never hurt me,” is wrong, wrong, wrong. And now we have research to support the idea that it's wrong.

Survivors of domestic violence or IPVA will tell you that life after abuse is never the same. Some experience insomnia, multiple aches and pains, problems with concentration, intrusive thoughts, fatigue, and irritability. Any one of these can interfere with effective functioning and set the stage for depression and even despair.

Violence and abuse of all forms is complex and the resulting health effects are interwoven. No single approach cures all. Medical help for domestic violence victims and survivors exists but is scattered. Appropriate care is often difficult to find and access, but it can be done. Healthcare providers and survivors must learn to work together to secure the best state of health possible for survivors of domestic violence.

My recent book on using expressive writing to help resolve lingering health issues offers one way to give aid to survivors and their supporters. You can read a summary about the book at website http://healthaftertrauma/

© Copyright Ellen Taliaferro, MD 2005. All rights reserved. . You have permission to publish part or all of this article electronically or in print, in your newsletter, on your website, or in your e-book, as long you maintain the hyperlinks in the article and include the following information: “Written by Ellen Taliaferro, MD, author, speaker, and expert witness. Dr T. can be contacted through http://www.healthaftertrauma.com. A copy of your reprint or publication would be appreciated.

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