Long the work of police officers and social workers, family violence increasingly is being studied by doctors. Some say abuse in the home, especially of children, is as much a medical problem as a social one.
New studies suggest that early exposure to violence and stress leads to illnesses that can last a lifetime.
"If a child is exposed to a lot of adverse childhood experiences, they may have less of an ability to concentrate, to feel safe," said Robert Anda, a former epidemiologist at the Centers for Disease Control.
Anda helped conduct one of the largest investigations into the link between childhood stress and long-term health. The mid-1990s survey studied several thousand patients through a questionnaire that asked about their exposure to physical and sexual abuse, among other factors.
About 100 researchers and health care professionals from across the nation will gather in Bloomington Friday to discuss emerging research suggesting negative childhood experiences have lasting medical consequences.
Among them will be Dr. David McCollum, an emergency room physician in Chaska and Waconia, who tells his patients that early life stress might explain why they're ill as adults.
In the mid-1980s, McCollum was a young family doctor in Chanhassen when a woman in her 40s came to see him about chronic abdominal pain. A series of tests had failed to determine the cause of her aches.
“I was seeing a high rate of people acknowledging these experiences, and yet it was never being talked about in health care.”Dr. David McCollum
At the time, McCollum was just beginning to hear anecdotal links between childhood trauma and chronic pain. He wanted to know if the woman had been sexually or physically abused as a girl.
He had never asked a patient about such issues before, so he stumbled through the question. When the woman responded that she had been abused as a child, McCollum knew he was on to something.
"It made me realize I needed to ask that question much more frequently," he said.
Another one of his patients is glad he did, even if it made her uncomfortable.
Joan Van Eyll, of Waconia, Minn., came in for stomach pain, and ended up telling McCollum about being beaten and kicked by her parents as a girl. Sometimes the pain was so unbearable that she would pass out.
Van Eyll, who has written a book about the abuse and how counseling and massage therapy helped her recover, said she's happy to know that doctors are inquiring about the long shadow of violence.
McCollum said he's heard thousands of stories from abuse victims over the years while treating mostly white, middle-class suburbanites.
"I couldn't believe I was seeing this high rate of people acknowledging these experiences, and yet it was never being talked about in health care," he said.
In 2005, McCollum helped launch the Academy on Violence and Abuse. The Eden Prairie-based group has about 130 members, including physicians, nurses, researchers and dentists. One of its goals is to persuade medical schools to teach their students how to address issues of abuse in their patients.
Anda, the doctor who conducted the early research, said his questionnaire also asked patients if they had witnessed domestic violence as children, grown up with mentally ill or substance-abusing household members or experienced neglect.
Anda learned that the more adversity patients experienced as children, the more likely they were to suffer from depression and ailments like heart disease and cancer.
Other studies suggest stress can bring about chemical changes that alter the way the brain functions, he said.
In addition, children with difficult upbringings might release higher levels of adrenaline and cortisol. Those two chemicals can trigger fight-or-flight responses.
Once such children go to school, Anda said, they might act up in class, be disciplined, receive poor grades or skip school.
"Those particular problems, those are not random," he said. "Those kids were built -- they were biologically built -- to have those problems."
Anda acknowledges the medical community has been skeptical of his findings. One criticism is that no one can prove that the patients responding to his survey were being truthful with their recollections about childhood trauma.
But patients support the emerging research. It shouldn't scare people who have been abused into thinking they're damaged goods, said Van Eyll, the woman who was abused by her parents.
"I do believe that ultimately people can heal from this," she said.
McCollum, her former doctor, said figuring out a likely source of his patients' pain isn't a cure. But it's one step closer to helping them move on.