Domestic Violence and Mental Health: A Focus on Depression, Anxiety and Substance Abuse

Yousef Zehra^*
*Correspondence: Yousef Zehra, Department of Family and Community Medicine, Armed Forces Hospital, Jubail, Saudi Arabia, Email:

Introduction

Domestic Violence (DV) remains a pervasive issue affecting individuals across all demographics, with far-reaching consequences not only for physical health but also for psychological well-being. The trauma inflicted by intimate partner violence can lead to significant mental health challenges, including depression, anxiety, and substance abuse. These conditions often coexist with the experience of domestic violence, creating a complex cycle of emotional and psychological distress that can be difficult to break without appropriate intervention. Individuals exposed to domestic violence may develop symptoms of post-traumatic stress, fear, shame, and helplessness, which can manifest as depressive episodes, intense anxiety, or a reliance on substances as a coping mechanism. The psychological impact of domestic violence is profound, with survivors often facing not only the immediate effects of physical harm but also long-term mental health consequences that persist long after the violence has stopped. Studies consistently show that survivors of domestic violence are at an increased risk for depression and anxiety disorders, conditions that can further exacerbate the difficulties of recovery. Substance abuse, often seen as a way to self-medicate the pain and emotional turmoil caused by violence, can also become a significant barrier to healing and rehabilitation. As a result, mental health problems such as depression, anxiety, and substance use disorders frequently co-occur with experiences of domestic violence, complicating the recovery process and posing challenges for clinicians seeking to address both the psychological and physical needs of survivors.

This paper will explore the intricate relationship between domestic violence and mental health, focusing on the ways in which intimate partner violence can lead to or exacerbate depression, anxiety, and substance abuse. We will examine the underlying mechanisms that link these mental health conditions with domestic violence, discuss the diagnostic and therapeutic challenges that arise in such cases, and explore effective treatment strategies for survivors. By understanding the interplay between domestic violence and mental health, this paper aims to highlight the need for comprehensive, trauma-informed care that addresses both the immediate and long-term psychological needs of individuals affected by intimate partner violence [1].

Description

Domestic Violence (DV) is a critical public health issue that has devastating effects on both the physical and psychological well-being of those affected. While the physical injuries resulting from intimate partner violence are often more visible, the mental health consequences can be just as severe and, in many cases, more enduring. Among the most common psychological conditions that arise in the wake of domestic violence are depression, anxiety, and substance abuse. These mental health issues are frequently interconnected, creating a cycle that can be difficult to break. Survivors of domestic violence often experience complex emotional trauma that, left unaddressed, can persist for years and significantly impact their quality of life. Domestic violence, also referred to as Intimate Partner Violence (IPV), involves any form of physical, emotional, sexual, or psychological abuse by one partner toward another within an intimate relationship. It can include a range of behaviors, from physical assault to emotional manipulation, coercion, and control tactics, all designed to maintain power and dominance over the victim. Domestic violence can affect anyone, regardless of gender, age, socioeconomic status, or cultural background, though women and marginalized communities often face disproportionately high rates of abuse.

The impact of domestic violence extends beyond the immediate trauma of physical harm and extends into deep psychological scars. The fear, isolation, and helplessness often experienced by victims of abuse can result in long-term mental health struggles. Depression, anxiety, and substance abuse are the most common and debilitating conditions associated with domestic violence, and they often co-occur, complicating diagnosis and treatment. Depression is one of the most prevalent mental health issues reported by survivors of domestic violence. The emotional toll of sustained abuse can lead to feelings of worthlessness, helplessness, and hopelessness, which are hallmark symptoms of depression. Victims of intimate partner violence often feel trapped in their situation, unable to escape due to financial dependence, emotional attachment, or fear of further harm. Over time, these feelings of powerlessness can lead to depression, characterized by persistent sadness, lack of interest in daily activities, disrupted sleep or appetite, and thoughts of death or suicide [2].

The constant emotional and physical stress of living with abuse can disrupt the brain's neurochemical balance, leading to symptoms of depression. Victims are often in a heightened state of hyperarousal, where the constant threat of violence keeps them in a state of chronic anxiety, which can eventually give way to depression. Abusers frequently use tactics such as humiliation, belittling, and emotional manipulation to undermine the victim's sense of self-worth. This leads to feelings of inadequacy and self-blame, which are key contributors to depression. Domestic violence often isolates victims from their social support networks, exacerbating feelings of loneliness and despair. Social isolation is a well-established risk factor for depression, as it reduces access to emotional support and resources. The relationship between depression and domestic violence is bidirectional: depression can make an individual more vulnerable to being abused (due to lowered self-esteem or dependency), while domestic violence can worsen or trigger depressive symptoms. This cycle creates a complex and often entrenched pattern of suffering, where depression becomes both a result of abuse and a barrier to escaping the abusive relationship. Anxiety is another common psychological response to domestic violence, particularly Post-Traumatic Stress Disorder (PTSD). Anxiety disorders in survivors of intimate partner violence often manifest as hypervigilance, panic attacks, flashbacks, nightmares, and an intense fear of danger. Survivors are often hyperaware of their environment, anticipating potential threats, and living in a constant state of fear. The fear of violence from the abuser, whether real or perceived, can lead to persistent anxiety that interferes with everyday functioning [3].

Generalized anxiety survivors may experience ongoing worry and nervousness about their safety, their children’s safety, or the stability of their relationship. This can lead to a heightened state of alertness and chronic anxiety about what might happen next. Post-Traumatic Stress Disorder (PTSD) is a mental health disorder that can develop after exposure to a traumatic event. Survivors of domestic violence are at high risk for developing PTSD, especially if the abuse was prolonged or involved sexual assault or physical violence. Symptoms of PTSD include flashbacks, intrusive thoughts, hypervigilance, avoidance behaviors, and intense emotional distress when reminded of the trauma. The constant tension and fear in abusive relationships can trigger panic attacks, where the survivor experiences overwhelming feelings of terror, shortness of breath, chest pain, and dizziness. These attacks can further compound feelings of anxiety and helplessness. Anxiety disorders are often comorbid with depression in survivors of domestic violence. The chronic anxiety related to the threat of violence can exacerbate depressive symptoms, and the sense of helplessness and fear can contribute to a constant state of emotional turmoil. Substance abuse is another significant mental health issue among survivors of domestic violence. Survivors may turn to drugs or alcohol as a means of coping with the emotional and physical trauma of abuse. Self-medication becomes a way to numb the intense feelings of fear, depression, or anxiety that often accompany domestic violence. Over time, this coping strategy can develop into a substance use disorder.

There are several pathways through which domestic violence and substance abuse are linked such as the emotional and psychological trauma caused by abuse may lead individuals to use substances as a way to numb emotional pain, reduce anxiety, or escape from the abusive reality. However, this self-medication often worsens mental health symptoms and creates a cycle of dependency. Long-term exposure to abuse can alter the brain's chemistry, particularly in areas related to stress and reward. This alteration can increase the likelihood of substance use as a way to regulate mood and manage overwhelming emotions. In some abusive relationships, the abuser may also engage in substance abuse, which can perpetuate the cycle of violence. Additionally, the victim may feel a sense of dependency on the abuser, which may make them more likely to use substances in a co-dependent way. Substance abuse can also increase vulnerability to further abuse. Individuals who are under the influence of drugs or alcohol may be more likely to engage in risky behaviors or remain in unsafe situations due to impaired judgment or fear of retaliation. The mental health conditions associated with domestic violence depression, anxiety, and substance abuse often intersect and feed into one another. For example, a survivor of abuse may experience depression as a result of the trauma they’ve endured, which then leads to heightened anxiety about their safety and future. In an attempt to cope with both depression and anxiety, the individual may turn to substances to self-medicate, which, in turn, can worsen both the depression and anxiety, creating a vicious cycle that is difficult to break [4].

This complex interplay between mental health conditions and domestic violence underscores the need for a holistic approach to treatment that addresses both the psychological trauma and the underlying mental health issues. Without addressing the co-occurring mental health conditions, it becomes much harder for survivors to heal from the trauma of domestic violence and move toward recovery. Addressing the mental health consequences of domestic violence requires a comprehensive, trauma-informed approach that recognizes the interconnectedness of depression, anxiety, and substance abuse. Effective treatment plans should include: Trauma-focused therapy such as Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and other trauma-focused interventions are effective in helping survivors process their trauma and develop healthier coping strategies. CBT, in particular, helps individuals identify and challenge negative thought patterns associated with depression and anxiety. Integrated Care Given the high comorbidity of depression, anxiety, and substance abuse in survivors of domestic violence, integrated care that addresses all aspects of an individual’s mental health is essential. This may include therapy, psychiatric support, and substance abuse treatment. Strengthening social support networks and fostering a sense of empowerment is crucial for survivors. Support groups, community resources, and safety planning can help individuals rebuild their lives and reduce the isolation that often exacerbates mental health problems [5].

Conclusion

The psychological impact of domestic violence is profound and long-lasting, with depression, anxiety, and substance abuse being among the most common and debilitating conditions associated with abusive relationships. These mental health issues often co-occur, complicating the healing process and reinforcing the trauma of abuse. A comprehensive, trauma-informed approach to treatment that addresses both the psychological and emotional effects of domestic violence is essential for helping survivors recover and rebuild their lives. By understanding the interconnectedness of mental health and intimate partner violence, clinicians and advocates can develop more effective interventions that promote long-term healing and resilience.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Oram, Sian, Kylee Trevillion, Gene Feder and L. M. Howard. "Prevalence of experiences of domestic violence among psychiatric patients: Systematic review." Br J Psychiatry 202 (2013): 94-99.

Google Scholar, Crossref, Indexed at

2. Faul, Franz, Edgar Erdfelder, Albert-Georg Lang and Axel Buchner. "G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences." Behav Res Methods 39 (2007): 175-191.

Google Scholar, Crossref, Indexed at

3. Kisa, Sezer, Rusan Gungor and Adnan Kisa. "Domestic violence against women in North African and Middle Eastern countries: A scoping review." Trauma Violence Abus 24 (2023): 549-575.

Google Scholar, Crossref, Indexed at

4. Kazak, Anne E., Melissa Alderfer, Paul T. Enlow and Amanda M. Lewis, et al. "COVID-19 exposure and family impact scales: Factor structure and initial psychometrics." J Pediatr Psychol 46 (2021): 504-513.

Google Scholar, Crossref, Indexed at

5. Vyas, Seema, Melissa Meinhart, Katrina Troy and Hannah Brumbaum, et al. "The economic cost of violence against women and girls in low-and middle-income countries: A systematic review of the evidence." Trauma Violence Abus 24 (2023): 44-55.

Google Scholar, Crossref, Indexed at