Women who endure physical, emotional or sexual violence at the hands of an intimate partner can be subject to a host of injuries and illnesses.

Many of them are invisible; some can last months or years. And many victims, terrified of their abusers, don’t seek the care they need.

“I think people look at domestic violence as a one-and-done incident ... as opposed to the incredible impact it can have on your entire life,” said Nancy Neylon, executive director of the Ohio Domestic Violence Network.

Efforts to help survivors have focused on encouraging health-care providers to ask women if they have been victimized, but more needs to be done to determine whether domestic violence is at the root of subsequent illnesses and injuries such as high blood pressure, post-traumatic stress disorder and traumatic brain injury, Neylon said.

“Women who have longer-term health impacts because of domestic violence — that is not being diagnosed,” she said. “We don’t understand the full impact of domestic violence. If we truly started to understand that a little better, there would be a little more funding and services and resources for it. It’s an underserved issue.”

In the United States, about 27 percent of women (and 12 percent of men) are the victims of what the Centers for Disease Control and Prevention calls intimate partner violence.

Health-care costs can remain higher for as long as 15 years after abuse stops, according to data collected by the CDC. Overall, the cost of caring for victims is several billion dollars each year.

Victims might experience injuries from physical or sexual abuse — bruises, knife wounds, broken bones, back or pelvic pain — but many of the health concerns are more difficult to diagnose.

The main abuse-related health concern local providers see is lack of medical care.

This might be because abusers often control their victims by cutting them off from outside contact, or an assailant might not allow a victim to visit the doctor out of fear she will disclose the abuse situation, said Annie Stevens and Carrie Jackson, forensic nurse coordinators for OhioHealth.

“These women can be more hesitant to seek help, so if they have a medical issue, they just in general aren’t taking care of themselves,” said Dr. Tamar Gur, a psychiatrist at Ohio State University’s Wexner Medical Center. “High blood pressure, diabetes can become more significant.

“There is general suffering from the stress of domestic violence abuse.”

Because of that stress, women in domestic violence situations often have sustained high levels of the stress hormone cortisol, said Mandi Pierson, a clinical social worker and therapist for Mount Carmel Health’s Crime and Trauma Assistance Program.

That can cause problems from high blood pressure to high blood sugar, and cortisol also can weaken the immune system, prompting stubborn illnesses such as colds and ear infections.

Domestic violence also can trigger psychiatric disorders, including heightened anxiety, depression, panic attacks and post-traumatic stress disorder, Gur said. Sexual violence can lead to sexual dysfunction and unplanned pregnancies. If a woman is pregnant, the violence can harm her fetus.

Another issue, which Neylon said is just beginning to get attention, is traumatic brain injury among domestic violence survivors. Such injuries often go undiagnosed.

“It can certainly have an immediate impact, but it also can have a long-term impact on the brain,” she said.

Five domestic violence programs in Ohio are looking at the issue with the help of a grant from the U.S. Department of Justice’s crime victims office. Their programs will screen for mental health and traumatic brain injury symptoms and try to connect women in need to programs that can help.

Women who experience traumatic brain injury might not know it because their symptoms can be similar to those associated with such things as depression or anxiety, Pierson added.

“So many of these injuries go untreated, and if treated initially, there’s no follow-up care,” she said.

Other brain injuries might be caused by attempted strangulation, Jackson said. In such cases, problems such as stroke or vision loss could show up as many as 15 to 20 years later.

Gur said health-care providers should ask women if they feel safe at home and help them find resources to get out of abuse situations. Women can become “frozen,” she said, and might have difficulty making changes on their own.

“The health-care system is uniquely poised to screen for domestic violence,” she said. “You have to ask; you can’t just try to guess.”

Pierson said a focus should be on “trauma-informed” care to help health-care providers understand the complicated issues that victims face, to handle them with compassion and patience, and to ensure follow-up care.

Complicating matters is that domestic violence victims often attribute ailments to something else, such as a fall or a car crash, said Amy Zoller, a forensic nurse coordinator for OhioHealth. And often their abuser is there with them.

“They are intimidated and they’re scared,” Zoller said. “Oftentimes, they come in multiple times for multiple different injuries before it ever comes out that it’s a result of domestic violence.”

Stevens said OhioHealth is working to train nurses to spot possible domestic violence injuries, get patients away from possible perpetrators and call in a forensic team to help further assess the problem.

While symptoms of injuries and illnesses caused by domestic violence could last a long time, many do recover, Gur said.

“Women are very resilient,” she said. “I’ve seen women overcome terrible traumas and live very rich lives, so it’s not a hopeless situation.”