518 Women’s Health Psychology
Rosenberg, Saltzman, & Shosky, 1992). Attacks by husbands
on wives account for more injuries requiring medical treat-
ment than rapes, muggings, and auto accidents combined
(Alpert, Freund, Park, Patel, & Sovak, 1992; Bachman,
1994). Typically de“ned as a pattern of controlling and vio-
lent behaviors that an individual exhibits toward a present or
former intimate partner (El-Bayoumi, Borum, & Haywood,
1998), domestic violence encompasses physical, psychologi-
cal and sexual abuse, and isolation and economic control.
More reliable tracking systems for monitoring violence
against women need to be instituted, but estimates suggest
that between two million and four million women are abused
each year, with a woman being battered every nine seconds in
the United States. Men and women can be victims of domes-
tic violence; however, 95% of reported victims are hetero-
sexual women (Bachman, 1994). Domestic violence occurs
among all ethnic, racial, and socioeconomic groups.
Victims of domestic violence often present themselves in
a variety of health care settings including emergency depart-
ments, primary care, gynecological services, and dental of-
“ces. Studies have indicated that between 7% and 30% of all
visits by women to an emergency room result from domestic
violence (Plichta, 1992). Women who are victims of violence
seek treatment for injuries sustained as a result of being
physically abused (e.g., bruises, lacerations, fractures, and
dental injuries; M. Dutton, Haywood, & El-Bayoumi, 1997;
Stewart & Robinson, 1995), as well as for many other health
issues, including headaches, gastrointestinal problems, gyne-
cological concerns, and pulmonary problems (El-Bayoumi
et al., 1998). Moreover, victims of domestic violence are
more likely than nonvictims to present with such somatic and
mental health problems as chronic pain syndrome, stomach
ulcers, irritable bowel syndrome, insomnia, depression,
anxiety, posttraumatic stress disorder, dissociative disorders,
eating disorders, and substance abuse (M. Dutton et al., 1997;
El-Bayoumi et al., 1998; Golding, 1999; Stewart & Robin-
son, 1995). Mental health symptoms can persist for years
after the abuse ends and many studies have linked history of
abuse with an elevated risk of suicide (Golding, 1999).
Intervention strategies should continue to focus on the
implementation of domestic violence screening instruments
in various health care settings including emergency rooms,
primary care, and gynecological services (e.g., Alpert et al.,
1992). By increasing awareness and educating staff in these
settings about domestic violence, appropriate referrals can
be made and supportive interventions can be applied. Psy-
chologists and health care providers should be educated
about the high incidence of domestic violence among
women and be trained in appropriate screening and interven-
tion strategies to help protect women and their families, such
as setting up safety plans before the woman leaves the treat-
ment setting.Chronic Health ConditionsThis section presents a brief overview of chronic illnesses
that are more prevalent among women. These diseases are
persistent, debilitating, and frequently related to a myriad of
psychosocial effects (e.g., depression, unemployment, inabil-
ity to care for children). Controversy as to whether these
conditions are medically based or psychological in nature
often interferes with diagnosis and treatment planning.
Although attention is increasing as to importance, further
research is needed to explore etiology, risk factors, treatment
options, and psychosocial effects of these chronic health
conditions.ArthritisAccording to the CDC (1999), arthritis is the most chronic
health condition reported by women. Rheumatoid arthritis is
the most common cause of chronic in”ammatory arthritis,
causing in”ammation in the lining of joints and/or other in-
ternal organs (Arthritis Foundation, 2001). Arthritis affects
approximately 1% to 2% of the population; 75% of those
affected are women (Belilos & Carsons, 1998). Although the
onset of the disease usually occurs in middle age (typically
between 20 and 40 years), its incidence continues to increase
with age (Hochberg, 1990). American women report that
arthritis limits their ability to perform basic daily activities,
with rates of disability higher among certain groups of Native
American women relative to European American women
(Del Puente, Knowler, & Bennett, 1989). The etiology of
rheumatoid arthritis remains unknown, although there may
be a genetic predisposition to develop the disease. Treatment
consists of reducing swelling, relieving pain, and reducing
in”ammation (Arthritis Foundation, 2001; see chapter by
Burke, Zautra, Davis, and Schultz in this volume for addi-
tional information).
The fact that rheumatoid arthritis has its onset in middle
age raises questions as to how the disease affects such things
as pregnancy and breastfeeding. Subsequently, research is
beginning to explore the relationship between rheumatoid
arthritis and fertility (for a review, see Dugowson, 2000).
Further research should explore the etiology and psycho-
social factors of the disease. Finally, there is a need for
health psychologists to facilitate the development of pain
management strategies (e.g., relaxation training, medication
adherence, exercise) and strategies for coping with decreased
physical mobility.