Intimate partner violence leaves a trail of broken hearts and untold psychological damage. Now, in a world-first, a team of researchers has found new evidence of the physical consequences of heartbreak – evidence that turns conventional thinking on its head.
The strong link between and an increased risk of cardiovascular disease (CVD) such as heart failure was established some time ago. Stressors including post-traumatic stress disorder, depression and anxiety – all common among abuse survivors – are key risk factors.
A multi-disciplinary study led by a South Australian cardiologist and two University of New England psychologists has shown that women victims of traumatic events can present with unique heart symptoms.
Instead of the high blood pressure and heart rate expected in a person facing mental or physical stress, 12 women with a history of sexual or physical abuse who were admitted to a metropolitan hospital had lower diastolic blood pressure and heart rates. They also had worse symptoms of heart failure at presentation. The “blunted cardiovascular reactivity” may be a clue to their private experiences, rather than due to the heart condition itself, and possibly an indicator of poorer outcomes as well.
As rates of gendered violence reach epidemic proportions across Australia, the researchers believe their findings have important implications for potential intervention, treatment and trauma-informed care for this vulnerable group.
“This paradoxical presentation of low blood pressure and a low heart rate could belie significant exposure to physical or sexual abuse or trauma,” said UNE’s Associate Professor Dr Phil Tully, of the results published today in a letter in Heart Lung Circulation.
“We want the clinician, cardiologist or emergency physician treating them in hospital to know that a blunted cardiovascular profile isn’t necessarily an indication that everything is okay and may actually suggest unresolved or repeated trauma.”
“Our findings point to differences that are significant enough to warrant further investigation, especially as women experiencing intimate partner violence can face an increased cardiovascular risk over time.”
Dr Alicia Chan, the South Australian cardiologist who retrospectively compared the medical records of women admitted to hospital with heart failure, says these findings further support the evidence of psychological trauma on health measures and outcomes, and highlight that we need to be aware of these “red flags”.
At the heart of the matter is enabling more patient-centred and trauma-informed care, according to UNE Associate Professor in Clinical Psychology, Suzie Cosh.
“If a woman presents with this profile, it should raise questions about what has happened to her,” she said.
“The impact of trauma can be lifelong and might be a warning sign that she needs additional support, a referral to a multi-disciplinary team or potentially life-saving interventions.”
Assoc. Prof. Cosh says repeated exposure to trauma of the kind we see in IPV can cause a woman to “disassociate, and mentally and social check-out” as a coping strategy. “If you are always on edge because you are always in danger, you can exhibit this freeze response. Your normal baseline readings shift, and your blood pressure lowers as you start to habituate. While we see routine screening for depression during heart disease admissions, our findings suggest that referrals to a trauma clinician or mental health providers might be warranted.
“Psychologists, equally, may need to liaise with a cardiology team to understand the physical nature of trauma.
“Our study demonstrates how far-reaching the consequences of gender-based violence can be. The trauma inflicted can cause heart disease, which, in turn, can cause more stress and distress. In cases of intimate partner violence, hearts are ruined emotionally and physically.”
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