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Domestic Violence and Chronic Pain

Funded by a grant from the Women’s Fund for Scotland

In 2020, at the height of the Covid-19 pandemic, Pain Concern received a grant from the Women’s Fund for Scotland. With this funding we created an extended episode of our podcast, Airing Pain, on the topic of domestic violence and chronic pain. We also published articles written by domestic violence survivors and academics in a special issue of our free online supplement, Pain Press.

You can listen to the programme and read all the articles below.

The above fact sheet contains links to resources, studies, guidelines, research and charities for both health professionals and those who are experiencing/have experienced abuse.

Airing Pain 126. Domestic Violence and Chronic Pain

Spotlight on pain and domestic violence: there is more that we need to understand

by Dr Caroline Bradbury-Jones

I was delighted to take part in the recent Airing Pain podcast that explored the relationship between domestic violence and chronic pain. The podcast drew on a number of perspectives regarding the nature of pain, how it comes about, how it is experienced and what can be done to tackle the problem. The invitation to participate was, in part, because my colleagues and I have begun to investigate this issue, specifically the association between domestic violence and fibromyalgia and chronic fatigue syndrome. The podcast provided an opportunity for us to share our insights and, alongside the lived experiences of a domestic violence survivor, give airtime to this complex problem.  

The programme explored the links between domestic violence and chronic pain, illuminating particularly the human impacts. Since recording the interview, I have been reflecting on how far we have come within society in understanding the problem of domestic violence. I have asked myself critical questions regarding the many issues that remain poorly understood, and the questions that remain unanswered. I am a researcher, so the issues discussed in this editorial are through a research lens.      

I am going to begin by thinking about how far we have come. It is only in the last decade or so that domestic violence has crept from behind closed doors, out into the public domain. It is in this arena that domestic violence is discussed far more widely than it was a number of years ago. It has made its way, as a topic, into contemporary TV programmes, soap operas and coverage in newspapers. Overall, this release into public discourse is a positive move, because it provides opportunity to air the issue and to chip away at ingrained stereotypes and myths about the problem. It means that domestic violence is an issue that is discussable now; we can talk about it. This is important because it is such a significant problem that is a scourge on society. Rates of domestic violence are shockingly high. It is difficult to present an accurate picture of the extent of the problem because it is largely under-reported, but it is likely that one-in-four, or even one-in-three, women in the UK have experienced domestic violence. It is important to acknowledge that men and boys experience domestic violence, and so too those in same-sex relationships, but violence against women and girls, perpetrated by males, is the most prevalent form.  

When I first began to research the topic a number of years ago, domestic violence was very much a marginalised subject. Researchers need

funding to support the research they seek to undertake, but that becomes a real problem when funding agencies fail to see it as a priority. While it is well-recognised that domestic violence can, and does, have catastrophic impacts on lives, both in terms of health and social costs, it can be remarkably tricky to secure funding to investigate the problem. My observation that domestic violence has shifted from the margins to the mainstream as regards societal discourse and awareness, is surely indicative of a positive move? I believe this to be the case. Funders are now inviting applications specifically about domestic violence, and to that end, progress has been made. I think though, that some subjects are still at the periphery and warrant far greater attention. The relationship between domestic violence and pain is at the forefront of my mind here, and this leads me to the critical reflections about what we still need to understand.  

I have been in the privileged position as a researcher on the topic of domestic violence, to interview many survivors. Real life stories of violence and abuse are powerful and distressing. They leave an enduring print on one’s memory. The reality of living with coercion, control, gas lighting and abuse in its myriad forms is a difficult reality to hear. Yet it is one that I have listened to over the years and from which, I hope, I have learned.  One thing that I have heard – repeatedly – is the story of pain. Domestic violence survivors talk of pain a great deal. For some (a minority) the pain arises as a result of physical injuries sustained as a consequence of domestic violence. For most though, the origins of the pain are not physically rooted, but tied up with complex biopsychosocial relationships that are not easily tracked, nor articulated. We know from large cohort studies, such as the one mentioned in the opening paragraph, that fibromyalgia and chronic fatigue syndrome are more common in women with domestic violence experience, than those without. Further studies are required to explore this relationship more fully, including, for example, the risk factors or how some groups may be disproportionately affected. What we need more than ever, though, are studies that focus on the lived experience of pain and domestic violence. We need studies that get right to the heart of the problem, from which we can understand not only what it is like but what can be done to better support survivors. Airing PainPain Press and an emerging body of research may be indicative of the contemporary spotlight on domestic violence, but media and societal discourses peak and wane. It is important therefore to seize the opportunity now, so that we can shed far greater light on the problem of pain and how it is lived, in the context of domestic violence.

Dr Caroline Bradbury-Jones is a registered nurse, midwife and health visitor. She is Professor of Gender Based Violence and Health at the University of Birmingham

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Have you ever wondered why victims stay in abusive relationships?

by Kath Twigg

The answer is complex, and the phenomenon which causes victims to become trapped not widely understood:  it’s called ‘traumatic bonding’. In toxic and abusive relationships the victim becomes weakened and loses perspective; instead of taking protective measures and walking away, they look to the abuser for the solution to their suffering. They may try endlessly to persuade the abuser to become, once again, the loving person they thought they had met; against clear evidence to the contrary, they persist in the irrational belief that things will turn out OK. The most tragic consequence is the loss of self-regard and self-protection, sacrificed first to the desires and then to the dominance of another.   

This is no temporary blip or aberration; often originating in past trauma, it is a deep seated and entrenched psychological process which can defy logic and cloud reasoning. The slightest indication that things may change can cause hope and expectation to re-surface, and dangers which are all too clear to outsiders are rationalised away. 

I know first-hand of the terrible imprisonment of traumatic bonding, because it happened to me. I spent my days as a senior manager in the criminal justice field, where I was dealing with the impact of violence and abuse daily. I knew well that most victims had suffered at the hands of a perpetrator who was in a relationship with them. Despite this knowledge and experience I lived in a relationship characterised by coercive control, threatening behaviour and incidents of violence. I was isolated and depressed, trying desperately to maintain an outward veneer of respectability whilst returning daily to a situation which many would have abandoned long before.  

It’s hard to leave your home and everything you’ve worked for; it’s even harder to admit to the world that yet another of your relationships has failed. These things, combined with the habitual behaviour I had acquired from many years of trying to mend relationships which were beyond repair, ensured that I stayed for far too long, when all I really needed to do was walk out through the door and ask for support. Even when I found the courage to break away I nearly didn’t make it, due to distorted thinking which re-surfaced and caused me to believe that I could return to my toxic relationship and it could all be put right. 

When other people began to notice what was happening to me, I began to recognise that I had lost the person I used to be; the vibrant, passionate and principled person who knew what she believed in and wanted in life had disappeared. I started to grieve for this person, to realise that I had lost myself and sacrificed all that was important to me on the altar of a relationship that could never work. All my energy had been spent trying to regain what was only an illusion of happiness and security. Through the kindness of others, I was reminded of what healthy relationships felt like. At times the poignancy was too much to bear.

and physical health deteriorated, I was in constant pain, I developed lowered immunity and often dragged myself to work, suppressing my distress and attempting to project an image of a capable and confident professional to the world. The strain of doing this for so long eventually caught up with me. I began to be late for appointments and couldn’t concentrate or deal with simple everyday tasks. I took a severance package and walked away from the long-term career I loved. When my relationship finally ended I believed I could simply put all the pain behind me and start again; I was wrong. The road to recovery has been long and hard and, at one point, almost cost me my life when I succumbed to bacterial meningitis, which I put down to years of failing to pause and take care of myself. The answer is not to push forward relentlessly, as I often did; doing so is part of the pattern of behaviour which perpetuates abuse. It’s important to stop, acknowledge what you have experienced and do whatever feels right to help you to heal. I only learned this after many years of pain, when it was almost too late. 

There is no quick fix, or panacea. Enlightenment comes gradually, through finding your true self, treating that self as a precious child and recognising that you deserve kindness and compassion as much as anyone else. Love shouldn’t hurt.  There is no still point at which everything falls into place, there will always be challenges and it is best to take time for this healing to happen, but with the right support, and by always acting according to your cherished values and beliefs, things will improve. 

Thankfully, I’m now free and many years away from these experiences. I’m also in a happy and balanced relationship with a beloved old friend, which came into my life when I stopped trying to make things happen and expending all my energy in the wrong direction. Writing my story proved a powerful therapeutic process. I‘m now a social work lecturer and could have written an academic book on traumatic bonding, but I found that writing more freely allowed me to work through my thoughts, feelings and experiences. As I wrote, the pattern of my life emerged on the paper, and the miraculous events which set me free organised themselves into a story which seems to touch those who read it in a way that academic analysis never could. I found myself describing and processing deep emotions at the same time, subconsciously healing the patterns which had so blighted my life and reinforcing the things I had achieved.  I finally knew who I was and was proud of myself. 

Through sharing my story I have come to realise that there is much hidden abuse amongst people such as myself. People who often feel a sense of failure and isolation, believe that they should be able to cope and therefore feel ashamed to disclose their suffering and ask for help. If this is you, by understanding the origin of your life patterns, remembering the self that was lost along the way and knowing what kind of relationships you deserve, you can make safer choices and find a happier life.

Kath Twigg is a senior lecturer in social work, trainer, mentor and writer; her book, The Hall of Mirrors, How to Change Life Patterns and Avoid Toxic Relationships, is reviewed by Paul Evans below

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One Scottish domestic abuse survivor’s experience of pain

by Jennifer Bowey

I recently spoke to a Scottish domestic abuse survivor who wishes to remain anonymous, we’ve called her Alex. The following is an account of Alex’s experience of abuse in early life, which resulted in health problems and chronic pain that have persisted into her adult life. 

Alex details both emotional and physical abuse perpetrated by her biological father. The abuse was directed towards both her and her mother, which Alex regularly bore witness to. She recounts suffering from anxiety, sickness and pain as a result of these experiences:

‘I realised what I feel isn’t universally felt when I began reflecting on the incident and working through things in therapy now that I’m an adult.  

I feel anxiety to the point of physical pain in my chest, it aches like the way hunger makes your stomach ache, and I believe this is due to having to ‘walk on eggshells’ at such a young age.  After looking into this further with a therapist, I began to notice more specific things that also cause me pain. For example, I always thought that my head/hair was very sensitive and having others brush my hair when I was young used to send me into frenzies and make me physically sick.’

Alex elaborates upon experiencing acute scalp pain whenever somebody touches her head or her hair. This has not only caused her severe personal distress, but has posed problems when having routine haircuts: 

‘I always experience pain when I visit hair salons, to the point where I’ve had to ask them to stop. I despise people touching my head and feel

happy wearing a hat. I always chalked this down to an individual quirk, something too trivial or silly to talk about. But in reality, it’s not.’ 

Having discussed her pain with a therapist in adulthood, Alex discovered that an adverse childhood experience of physical abuse was the root cause of these intense feelings of pain: 

‘When I was about seven my dad became very displeased at the mess of my room and proceeded to pin me down (his knees on my arms) and run the hoover nozzle over my skull for some time, threatening to get rid of it. I thought it was going to pull my hair out, I really believed that. I remember screaming in pain and I then froze completely in shock. It was so painful, it ached for so long after and my mum had to sit and de-tangle my hair, which ached also.  

So, I often feel the sensation of my hair being ripped out, when I’m fact it’s just the salon worker gently removing knots. This was one incident on one occasion and I feel it as if it’s happening to this day, abuse doesn’t just hurt at the time – it hurts long after too.’ 

In our Airing Pain programme on domestic violence and chronic pain, Clinical Psychologist Dr Kate Gillan discusses how abuse can cause heightened sensitivity to pain. She explains how survivors of trauma and abuse often develop a hypersensitive nervous system, which exists in a persistent state of amplified pain. They may experience pain even when somebody is only touching them lightly. The brain does not produce an appropriate, mild response to normal touch, but a heightened pain response.

Jennifer Bowey is Project Co-ordinator with Pain Concern. She has written this case study in collaboration with a Scottish domestic abuse survivor who wishes to remain anonymous. Our thanks go to our survivor for sharing their story.

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Review of The Hall of Mirrors: How to Change Life Patterns and Avoid Toxic Relationships by Kath Twigg

by Paul Evans

A new edition of Airing Pain for the New Year (2021) explores, as one contributor describes it, the ‘perfect storm’ in which Covid-19, domestic violence, social isolation and chronic pain converge with potentially devastating consequences.

Research by the University of Birmingham showed that UK domestic abuse victims are three times more likely to develop severe mental illnesses, and a follow-up study by the Universities of Birmingham and Warwick found that women who have experienced domestic abuse are almost twice as likely to develop fibromyalgia and chronic fatigue syndrome (CFS) than those who have not. 

In making this programme, I spoke to leading researchers, clinical psychologists in the fields of chronic pain and domestic violence related trauma, and healthcare professionals working with survivors.

However, it is the testimony of a survivor of two abusive marriages, Kath Twigg, which really opens the lid on how persistent physical and mental, coercive abuse, will destroy mind, body and soul.

In her book, The Hall of Mirrors: How to Change Life Patterns and Avoid Toxic Relationships, she tells her story and, with the benefit of experience, offers strategies for other victims of domestic abuse, be they men or women, to take back control of their lives.

However, to treat it purely as a self-help book as the title might suggest, is to do it a great disservice. It is a well written, easy to read, and compelling autobiographical account of her devastating journey through two marriages to men who abused her both physically and mentally.

It is not a ‘rant’ about the failings of two abusive men (the reader must make her or his own judgement on that), but an account of how years of coercive abuse altered the mindset of this professional, intelligent woman

to put up with the abuse and abuser for years, ignoring the warnings and well-meaning advice of friends:

He would only have to hit me once and I’d be gone. Why ever do you stay?

I lost count of the number of times she uses the word ‘ashamed’:

I was too ashamed to confide in friends or family, not wishing to be seen as a failure or a burden. I tried to pretend that all was well, a process made easier by isolation.’

I told no-one about the violent incident … for many years I had felt ashamed of my failed relationships.’

So, who should read this book?
 
A self-help book? Yes, there are short ‘exercises’ at the end which are simple questions victims, be they women or men, might ask themselves to gain greater self-awareness of how the abuse is affecting the way they are dealing with it, and therefore how to address it.
 
But it’s more than just a self-help book. It is for friends, family, care professionals, colleagues, in-fact, everyone in the social circle of the abused to gain insight and understanding of the psychological damage wrought by domestic abuse, and therefore to know how best to support the victim through a toxic relationship.
 
I found it easy and compelling to read, albeit out of my comfort zone because it made me think about relationships in my own social circle.
 
The Hall of Mirrors: How to Change Life Patterns and Avoid Toxic Relationships by Kath Twigg is available from Amazon as a Kindle download or paperback.  Details from www.kathtwigg.co.uk.

Paul Evans is the producer of Airing Pain.

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