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Domestic violence:the underestimated impact of psychotrauma on women's health

On a daily basis, victims of domestic violence somatize what they endure through a survival mechanism . Whether they suffer physically or psychologically, the link is rarely made between their symptoms and the violence they endure; by them as well as by professionals.

On the premises of the Women Safe Association in Saint-Germain-en-Laye (78), Sarah* does not cut corners to sum up her daily life over the past fifteen years. "It swells me," she says, half laughing. Wrists, knees, hands… This 46-year-old mother literally started to swell without understanding where her pain came from.

After a battery of tests without results, the answer became clear when she noticed that her condition had improved during her separation from her husband.

In divorce proceedings since 2019, Sarah married "a tall blond man with blue eyes and first in the class" in 2007. Beneath his appearance as an ideal son-in-law hides in reality a psychologically violent man , she says. Accusations of abuse of their three children, responsibility for the suicide of her mother-in-law, or even a surge of violence against the doors, the engineer says she lived under constant pressure. "Buthe never touched me, he was too smart for that . He even told me," she recalls.

The scars of violence on body and mind

The ex-husband of Oreneta* had the same strategy. Married for thirty years, this 51-year-old scientist took a long time to understand the hold that her companion had over her. After having pushed her to stop her studies, he gradually took her away from her relatives. When she decides to resume a professional life, the situation crystallizes and her daily life turns into hell.

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Nervous breakdowns, verbal abuse, vmarital violence and sexual assault - especially at the start of the Covid-19 pandemic:Oreneta suffers mentally, and her body reveals the scars of this violence. She goes through repeated fungal infections, experiences severe pelvic pain and has to deal with endometriosis.

Everything gradually returns to normal when she asks for a divorce in April 2021. "I made the decision in seconds when I knew I had to make it for about ten years," says Oreneta slowly.

Like Sarah, seated next to her, she became aware of the effects that the repeated violence of her partner had on her body and her mind.

The subject is well known to Annie Ferrand, a psychologist specializing in trauma, who cites an anthology of possible clinical signs:"Weight loss, insomnia, migraines, feeling of oppression, lump in the throat, recurrent cystitis, pain in penetration…"

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From amazement to depersonalization

These reactions are part of psychosomatization, a disorder that Muriel Salmona has been working on for a long time. "Faced with violence, the victim has a strong emotional reaction and finds himself in a state of amazement. To survive, his brain secretes cortisol and adrenaline, the stress hormones", explains the psychiatrist specializing in psychotraumatology.

"The brain is then filled with neurotoxins. If the person remains confronted with the aggressor, the organ remains in a state of alert and triggers a mechanism of dissociation to survive the extreme stress . As a result, the victim's reaction capacities are reduced and she is no longer able to defend herself or leave, or even to assess the level of violence in which she lives", concludes the president of the Traumatic Memory association and Victimology.

Clearly, these people show a depersonalization disorder, which gives them the feeling of being detached from their own body, even spectators of what is happening to them. They thus tend to minimize the facts or conceal them.

Understanding the origin of suffering to finally treat yourself

But the body does not forget what it has suffered and, like anyone who is the victim of abuse, women experiencing domestic violence create a traumatic memory .

The worst times pop up like flashbacks and have long term effects on the body. "Extreme stress will generate significant endocrine disorders in the thyroid, ovaries or even menstruation. It can also cause cardiovascular disorders, high blood pressure, immune disorders and promote autoimmune diseases" , debits Muriel Salmona.

A range of ills that the victims do not always manage to link to the violence suffered on a daily basis.

It is all the more urgent for them to understand the origin of their suffering because they do not realize how much they somatize.

Oreneta realized only a year ago that she was a victim of domestic violence. It was thanks to the rebuilding journey she followed at Women Safe that she was able to put words to the psychic mechanisms that occurred within her. After four shingles, tendinitis, headaches, anxiety attacks, depression and vagal discomfort, this mother learned that she had implemented a "hypervigilance strategy " and that she dissociated.

On many occasions, like Sarah, she met doctors who had not made the connection with the violence she was experiencing with her husband.

This finding is in no way surprising for Muriel Salmona:the expert estimates the number of victims at 80%, ensuring that health specialists have not detected that they are suffering from domestic violence. Like Annie Ferrand, the psychiatrist is indignant at not seeing doctors and specialists trained in psychotrauma "while 60% of the cases in consultation correspond to it".

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France lagging behind in the care of victims of violence

Today, Sarah and Oreneta assure it:they are better. In the process of divorce, the first turned to alternative medicine including psychocorporal massage, while the second is followed by a psychologist and a sophrologist. If these two women have obtained answers and have been able to regain a certain serenity, what about all those who have not not yet become aware of their state of health ?

In France, Muriel Salmona considers the situation catastrophic. "The Istanbul convention requires that there be a treatment center for gender-based and sexual violence, including domestic violence, for 200,000 inhabitants", begins the psychiatrist. "We should have 200 and we only have ten which are not specific to domestic violence but to psychotrauma, in particular for the attacks".

This care is all the more important when the physical and psychological damage is repairable. But, without a commitment from the State, the expert, tired of "screaming in the desert", intends to alert the international judicial bodies to France's shortcomings.

At this point, she evokes "the absolute urgency" .