Recognizing and Documenting the Invisible Impacts of Domestic Violence
When people think of domestic or family violence, they often imagine bruises and broken bones. But many of the most debilitating impacts of abuse are invisible. Survivors may carry trauma that doesn’t show on an X-ray – nightmares from PTSD, difficulty focusing due to a head injury, or anxiety that makes leaving the house a battle. As an occupational therapist specializing in medical-legal cases, I’ve seen how these unseen injuries can affect every aspect of a survivor’s life. In this article, we discuss how to recognize these invisible impacts and, importantly, how to document them. Proper documentation is crucial: it validates the survivor’s experience, informs effective support plans, and provides evidence in legal settings to ensure justice addresses the full extent of harm.
Invisible Impacts of Domestic Violence – What Are They?:
Domestic violence can result in a wide range of hidden injuries and challenges, including:
Traumatic Brain Injuries (TBI): Many survivors suffer blows to the head during assaults. In fact, research shows that over 75% of domestic violence survivors experience single or repeated traumatic brain injuries from their abuser. These brain injuries often go unreported and untreated. A survivor might not realize that their frequent headaches, memory lapses, or dizziness are linked to past head trauma. Even a single concussion can cause lasting cognitive issues, and repeated head injuries can lead to serious conditions like chronic traumatic encephalopath.
Post-Traumatic Stress Disorder (PTSD) and Anxiety: The psychological trauma of living in fear can rewire the brain. Studies estimate that anywhere from 30% to over 80% of domestic violence survivors develop . Symptoms might include flashbacks of the abuse, hypervigilance (always feeling on edge or unsafe), and avoidance of anything that triggers memories of the trauma. Anxiety and depression are also common, sometimes persisting for years. These conditions are invisible but can profoundly impair daily functioning – making it hard to hold a job, socialize, or even sleep through the night.
Chronic Pain and Physical Conditions: Survivors may have chronic pain without a clear injury visible now. Old fractures, internal injuries, or even stress-related physical conditions (like fibromyalgia or gastrointestinal problems) can be lasting reminders of abuse. For example, someone who was strangled might experience chronic neck pain or breathing issues long after escaping the situation.
Cognitive and Emotional Changes: Beyond PTSD, survivors often exhibit difficulties with concentration, decision-making, and memory. They may also struggle with trust and self-esteem. These changes can stem from both psychological trauma and physical brain injury. As one survivor described, “It’s like I lost a part of myself. I can’t organize my day like I used to, and I’m easily overwhelmed.” Such changes aren’t visible but can derail a person’s ability to work or care for family.
Impact on Daily Roles: Domestic violence can rob a person of their routines and roles. A mother might find she can’t manage her children’s morning routine due to anxiety attacks. A professional might have difficulty meeting job demands due to concentration issues or needing frequent breaks because of pain. These role disruptions are often overlooked when considering the impact of abuse.
The OT’s Role in Identifying Hidden Injuries:
Occupational therapists approach survivors with a holistic lens, looking at how the person functions day-to-day. In an evaluation, I might ask a survivor: “Walk me through a typical day. What tasks are hard for you to do now?” This simple question can open the door to understanding invisible issues. Perhaps the survivor says, “I can’t get through my grocery shopping; I feel panic in crowded places and forget what I need.” That hint might indicate PTSD and memory deficits. I would then gently probe further or use screening tools: maybe a PTSD checklist, a cognitive test, or a balance assessment if they mention dizziness.
Key ways OTs identify invisible impacts:
Detailed Interviews: We create a safe, trust-building conversation to let survivors share difficulties they might not otherwise mention. Because OTs are health professionals (not police or lawyers), survivors often feel more comfortable discussing things like trouble sleeping or feeling depressed.
Screening and Assessment Tools: Depending on the interview, an OT can administer standardized assessments – for example, a cognitive screening if a brain injury is suspected, or a mood questionnaire to gauge anxiety and depression levels. There are even specific tools for measuring functional abilities in daily activities, like the Assessment of Motor and Process Skills (AMPS), which can reveal subtle cognitive problems during task performance.
Observation of Task Performance: OTs may ask survivors to perform a few simple tasks, if appropriate, to see how they manage. This might include things like pouring a glass of water (to observe tremors or coordination), writing a short list (to see if they have trouble concentrating or remembering items), or taking a short walk in the clinic hallway (to observe balance or endurance). These observations can uncover issues like hand tremors from anxiety or difficulty balancing that the survivor didn’t mention outright.
Collaboration with Other Professionals: Sometimes an OT will notice signs that require further evaluation by another specialist – for instance, indicators of a possible traumatic brain injury might lead the OT to recommend a neuropsychological evaluation. Part of recognizing invisible impacts is knowing when to bring in other experts.
Throughout this process, a trauma-informed approach is critical. The OT ensures the survivor never feels blamed for their difficulties. We frame challenges as normal responses to abnormal trauma – emphasizing, as a trauma-informed care principle, that it’s “what happened to you” and not “what’s wrong with you”. This compassionate stance helps survivors open up and participate fully in the assessment.
Documenting Invisible Impacts for Legal and Support Purposes:
Recognizing invisible injuries is only half the battle. Documenting them is equally important, especially for legal cases or securing long-term support. Here’s how OTs contribute:
Comprehensive Reports: After an evaluation, an OT will compile a detailed report that describes all findings. For a survivor of domestic violence, this report might document, for example, that “the client demonstrates symptoms of PTSD, including hypervigilance and avoidance, which significantly impede her ability to perform instrumental activities of daily living such as shopping or using public transportation.” It would also note any physical or cognitive deficits observed. Crucially, the report connects these deficits to the history of abuse (when known and consented to share) – painting a picture of cause and effect. Such documentation can be powerful evidence in court, perhaps in a personal injury claim against an abuser or in a victim’s compensation claim, to illustrate the true impact of the abuse.
Use of Quantitative Measures: Whenever possible, OTs include quantitative data: e.g., results of a cognitive test (“scored 20/30 on a memory test, indicating moderate impairment”), or an assessment of depression severity. Quantifying an invisible impact makes it more concrete. A journal or judge might not grasp “she’s anxious,” but a note that “she experiences panic attacks 3-4 times a week, as recorded in her OT sessions” is harder to dismiss.
Photographs or Diagrams: In some cases, documentation might include non-traditional evidence. For instance, if a survivor has difficulty with home management, an OT might include a diagram of how her living space is set up to accommodate her now (such as reminder notes on the fridge, or a simplified closet system due to cognitive overload). While respecting confidentiality and sensitivity, these visuals can underscore the adaptations needed for the survivor to cope.
Recommendations for Accommodations: OTs usually conclude reports with recommendations – effectively bridging to the “what next?” This might involve suggesting therapy (like referring to a psychologist for trauma counseling), community support (such as a domestic violence support group), or practical accommodations (like flexible work hours or a noise-cancelling headset if the survivor is easily startled by loud sounds at work). These recommendations, when included in a legal context, also signal to the court what resources or changes the survivor needs to function. For example, if an OT recommends the survivor avoid night shifts because fatigue worsens her symptoms, that could be relevant in a custody case (showing why a standard visitation schedule might need adjusting) or an employment case.
Expert Testimony: In some legal cases, the OT who assessed the survivor may be called to testify as an expert witness. In doing so, the OT can verbally reinforce what was documented, explaining in plain language how the invisible injuries affect the survivor day-to-day. This testimony can be crucial in helping judges or juries “see” the invisible – to truly understand that the aftermath of abuse isn’t over when the bruises fade.
Empowering Survivors through Validation:
Beyond formal documentation, there’s a human element: the very act of documenting and naming these invisible impacts can be empowering for survivors. Many survivors have been told, implicitly or explicitly, that they are exaggerating or “crazy.” When an occupational therapist validates their experience – “these memory issues you’re having could very well be from a brain injury; it’s not your fault and you’re not alone” – it can be a turning point. The survivor might feel relief that someone finally understands what they’re dealing with. This validation is therapeutic in itself.
Moreover, having their challenges recorded in black and white can help survivors advocate for themselves. It’s easier to communicate needs to employers, schools, or family when you have a professional report to back you up. For instance, a survivor returning to work can share relevant parts of the OT’s report with their employer to request reasonable accommodations (like more frequent breaks or a quieter workspace). In a way, the documentation becomes the survivor’s tool to educate others about their needs, rather than having to repeatedly explain or justify their difficulties.
Conclusion:
The impacts of family and domestic violence run deep – often manifesting in ways that aren’t immediately visible. By thoroughly recognizing and documenting these invisible impacts, we ensure that survivors get the acknowledgment, support, and justice they deserve. Occupational therapists, with their holistic and compassionate approach, are key allies in this process. Whether it’s identifying a hidden traumatic brain injury or providing evidence of PTSD in a court case, OTs help make the invisible visible. In doing so, they not only strengthen legal outcomes for survivors but also validate their experiences and pave the way for more targeted healing and assistance. No survivor should feel that their silent struggles are being overlooked. With proper documentation and understanding, those struggles can be brought to light – and one day, overcome. If you need help, contact us.