New Content Added: To update the content we have added Domestic Violence information found at the end of the Table of Contents.
this track, we will be discussing unexplained physical symptoms that battered women often report experiencing.
Have you found, like I, that many battered women will report
various physical ailments ranging from high blood pressure, to asthmatic attacks,
to skin irritations, all of which are non-related to the abuse she is experiencing?
This may occur in conjunction with thoughts of leaving or be a causative factor
in making the decision to leave. Do these symptoms sound like possible forms of
a Somatoform Disorder to you? As you know, Somatoform Disorders are characterized
by isolated and unexplained physical symptoms that seem to have no physiological
Here is how I worked through a possible Somatoform Disorder
with Jessica. Jessica, a 22-year-old student in her final year of college, first
came to me with a stutter she had been experiencing for two days. In her Tuesday
Women's Issues class, each student had to speak on the topic of sexual molestation.
Jessica stated, "When it was my turn to talk, I had such a pr-pr-pro-pro-difficult
time talking I had to give up." It appeared Jessica had substituted the word
difficult for the word problem to stop the stuttering. In addition to the onset
of her stuttering, Jessica had also been suffering from severe stomach aches for
several months. After several trips to the hospital, MRIs and extensive tests
Jessica was told there was nothing physically wrong with her.
felt Jessica's stuttering may have had an antecedent of abuse. As you know, for
many battered women, these physical problems occur automatically on a physiological
level without any trace of consciousness. In fact, it is almost impossible for
these women to connect their physical symptoms with their emotions about their
abuse. As with Jessica, the origin of the physical symptoms was thoroughly masked
in her subconscious.
Three-step Contextualization Method
With clients like Jessica, I like to
use a Three-step Contextualization Method to help reveal the causes of
her unexplained symptoms.
Step #1. For me, as is the case probably
for you, the first step is to look at the battered woman's symptoms contextually.
Jessica stated, "About two months ago my boyfriend Eric and I started to
a-a-argue a lot, and he got r-r-r-really mean."
Step #2. Once I became aware of the context of the problem, is your second step, like mine,
to connect the problem with the events that took place at the time the symptoms
began? Jessica stated, "The first stomach ache was awful
I think it
happened right after a really bad night with Eric. He wanted to ha-ha-have s-sex,
but we were going to bed and I was really tired and said no. I woke up later that
night with him on to-to-top of me in the bed forcing me to have sex with him."
Step #3. As you know, once the battered woman has connected her symptoms
with the events, she can begin developing coping strategies to overcome the symptoms.
Why is it some battered clients develop a Somatoform Disorder
and others do not? What are the Risk Factors that may predispose a client of yours
to this disorder?
6 Risk Factors
Let's look at six of these Risk Factors.
Risk Behavior #1 - Compartmentalization
Many aspects of the battered woman's
life might be kept apart from other aspects. This may have caused Jessica to appear
as two separate people at school and with Eric. As you know, battered women are
often well-adjusted at work, but meek and passive at home with their abuser to
avoid attack. Does your battered client wear two faces, so to speak?
Risk Behavior #2 - Repression
A Battered woman may remove her own thoughts
and feelings from her consciousness. In our sessions, Jessica stated that she
rarely felt angry or scared, even though she had plenty to be angry about. Does
your client repress her negative feelings?
#3 - Deadening
Battered women often force themselves to become less active.
With Jessica, she stopped attending the weekly Intramural basketball games in
which she usually played. To what extent is your battered client deadening herself
by eliminating joyful or fulfilling experiences?
#4 - Resigning
In addition to compartmentalization, repression, and deadening,
to what extent does your client withdraw from daily life? Jessica found that she
had begun to lay in bed as soon as her classes were over for the day instead of
studying or being with friends.
Risk Behavior #5 - Projection
Jessica believed she wasn't good enough, so she attached herself to Eric,
who treated her as though she wasn't good enough. How does a current client you
are treating project her feelings onto others?
#6 - Externalization
Jessica externalized in that she felt her life and
value as a person were in the hands of other people. If the people around Jessica
accepted her for that moment, she felt good about herself. However, if they rejected
her, she felt destroyed.
Have you overlooked Somatoform regarding
your battered client who is contemplating leaving. If so, you might replay this
track to rethink the risk factors of compartmentalization -- repression, deadening,
resigning, projection, and externalization -- to set therapy goals for your next
session that may assist them in weighing and measuring leaving.
risk behavior can be exacerbated by the battered woman assuming the role of the
Irresponsible Child where she seeks comfort by being treated as the underdog.
This Underdog syndrome will be discussed on the next track.
Peer-Reviewed Journal Article References:
Johnson, D. M., Zlotnick, C., & Perez, S. (2011). Cognitive behavioral treatment of PTSD in residents of battered women's shelters: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 79(4), 542–551.
Koo, K. H., Nguyen, H. V., Gilmore, A. K., Blayney, J. A., & Kaysen, D. L. (2014). Posttraumatic cognitions, somatization, and PTSD severity among Asian American and White college women with sexual trauma histories. Psychological Trauma: Theory, Research, Practice, and Policy, 6(4), 337–344.
Samelius, L., Wijma, B., Wingren, G., & Wijma, K. (2009). Posttraumatic stress and somatization in abused women. Traumatology, 15(1), 103–112.
Online Continuing Education QUESTION
What are six Pre-Somatoform Risk Behaviors battered women may display?
To select and enter your answer go to .