David McCollum, MD

(Edited for distribution, BBE, 2/13/10)


“COLEVA” means the “Consequences of Lifetime Exposure to Violence and Abuse.”


     The COLEVA PROJECT is an effort to demonstrate the wide-ranging impact that violence and abuse has on the health and well-being of all people.


     The COLEVA DIAGRAM is a comprehensive visual outline of this relationship, especially to illustrate how a victim or witness of abuse may present her/himself to the health care clinician. There are more than 150 entries.

     All categories in COLEVA are either supported by research found in the medical and related literature (psychology, sociology, social work, etc.), strong anecdotal evidence, logical inference, or highly suspected because of similar characteristics to other categories.

     The Academy on Violence and Abuse is conducting an extensive evaluation of health associated literature, with the intent to positively link research to each of the categories.


Over the past decade, medical researchers have uncovered links between medical and emotional/psychological conditions and exposure to violence or abuse in a person’s lifetime.


     It is increasingly apparent that a variety of health problems and health-related behaviors are highly correlated with some form of exposure to violence and abuse.


     “Exposure” to abuse differs from “experiencing” abuse. Evidence is accumulating that abuse does not have to be experienced directly to have a long-term physical and/or mental health effect. There are many who have witnessed violence or abuse, who have developed long-term health consequences.


Failing to understand this relationship affects the overall quality of health care.


     That violence and abuse is the unrecognized underlying cause of these symptoms is how quality of care is affected.

     The critical issue is that the clinician must be sufficiently astute to include exposure to violence and abuse as a possible reason for a patient’s clinical symptoms.

     Failing to make the correct diagnosis is, in fact, medical error, i.e., error in medical
decision-making for diagnosis and treatment of symptoms.


Given the increasing body of evidence, it is imperative that the education of physicians and other healthcare providers should integrate this knowledge into their clinical skills and practice routines, to adequately address these issues with their patients.

     This is the mission of the Academy on Violence and Abuse.

Return to COLEVA map