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Section 1
Somatization Risk Factors in Battered Women

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In this section, we will be discussing unexplained physical symptoms that battered women often report experiencing.

♦ Somatoform Disorder
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 cause.

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.

I 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?

♦ Risk Behavior #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?

♦ Risk Behavior #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?

♦ Risk Behavior #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 section 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.

These 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 in the next section.
Reviewed 2023

Peer-Reviewed Journal Article References:
Dichter, M. E., Thomas, K. A., Crits-Christoph, P., Ogden, S. N., & Rhodes, K. V. (2018). Coercive control in intimate partner violence: Relationship with women’s experience of violence, use of violence, and danger. Psychology of Violence, 8(5), 596–604. 

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. 

Moskowitz, K., Richmond, K., & Michniewicz, K. (2020). Caught in a bad romance: Endorsement of traditional romantic ideology, internalized heterosexism, and intimate partner violence experiences among sexual minority individuals. Psychology of Sexual Orientation and Gender Diversity. Advance online publication. 

Poole, G. M., & Murphy, C. M. (2019). Fatherhood status as a predictor of intimate partner violence (IPV) treatment engagement. Psychology of Violence, 9(3), 340–349.
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.

Samelius, L., Wijma, B., Wingren, G., & Wijma, K. (2009). Posttraumatic stress and somatization in abused women. Traumatology, 15(1), 103–112.

QUESTION 1
What are six Pre-Somatoform Risk Behaviors battered women may display? To select and enter your answer go to Test.