Psychological
● Anxiety ● Depression ● Symptoms of posttraumatic stress disorder ● Antisocial behavior ● Suicidal behavior in females ● Low self-esteem ● Inability to trust others, especially in intimate relationships ● Fear of intimacy ● Emotional detachment ● Sleep disturbances ● Flashbacks ● Replaying assault in the mind ● Restricted access to services ● Strained relationships with health providers and employers ● Isolation from social networks ● Homelessness
Social
Health behaviors ● Engaging in high-risk sexual behavior ○ Unprotected sex ○ Decreased condom use ○ Early sexual initiation ○ Choosing unhealthy sexual partners ○ Multiple sex partners ○ Trading sex for food, money, or other items ● Using harmful substances ○ Smoking cigarettes ○ Drinking alcohol ○ Drinking alcohol and driving ○ Using illicit drugs ● Unhealthy diet-related behaviors ○ Fasting ○ Vomiting ○ Abusing diet pills ○ Overeating ● Overuse of health services Adapted from Centers for Disease Control and Prevention. (2017a). Injury prevention & control: Intimate partner violence: Consequences. http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/consequences.html Biological Impact of Trauma
time for adaptation (Guidi et al., 2020) . The longer these responses persist, the more difficult adaptation becomes for physiological and biological systems in the body, a condition called allostatic load (Lenart-Bugla et al., 2022) . Allostatic load may be characterized by persistently high levels of circulating stress hormones even in the absence of an acute threat, and this condition in turn is linked to persistent inflammation (Guidi et al., 2020) . Inflammation plays a role in cardiovascular diseases, chronic pain,
The trauma of IPV can lead to the previously noted health problems, many of which have notable biological and/ or physiological components. Traumatic experiences such as IPV and SA have been shown to contribute to lasting fear and stress responses among survivors long after the experiences end (Garcia et al., 2021; McEwan et al., 2021; St Vil et al., 2021) . These responses result in continual efforts by the body to adapt to the perceived threat, originally described by McEwen (1998) as allostasis . In contrast to homeostasis, allostasis refers to the persistence of what should be a temporary response to a stressful situation—as seen in chronically stressful situations such as IPV and its sequelae—that includes increased levels of stress-related hormones and cytokines, as well as a lack of IPV can be a singular episode but often represents a series of events that occur over time and include a variety of behaviors. Abusive behaviors can occur over the life span, may involve other family or household members, and create a cycle of abuse demonstrated by perpetrator and victim engagement that negatively affects future generations of families. The reasons for someone using violence as a way to dominate or control a partner are complex and not well understood. IPV is thought to occur for a variety of reasons, such as gender inequity, the predominance of patriarchal systems, differentials in educational and financial
respiratory disease, depression, and many other illnesses, with increased incidence among women with histories of IPV (Chandan et al., 2021; Garcia et al., 2021; Liu et al., 2020; Walker et al., 2022; Wang et al., 2022) . THE DYNAMICS OF INTIMATE PARTNER VIOLENCE ACROSS THE LIFE SPAN
achievements between genders, the presence of illness and/ or disability, and more (Yonfa et al., 2021) . People who remain in relationships where IPV takes place are often confounding to healthcare providers who wonder why they stay. This section discusses the investment model of relationships, which provides insights into the rationale and factors that often contribute to ongoing violence between partners. It is also helpful to consider this model in the context of the social determinants of health, which may be tied to the abusive relationship.
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