Proposed Benefit of Essential Oils in Victims of Intimate Partner Violence

Introduction

The Centers for Disease Control and Prevention (CDC) defines intimate partner violence (IPV) as the threat or infliction of physical, psychological, or sexual harm by a current or former intimate partner or spouse. Sexual violence (SV) is the specific use of force to attempt sexual acts or contact against a victim's will or on a victim unable to consent. ² Treatment strategies for victims of IPV and SV are complicated and often problematic, with many different disciplines involved in a truly comprehensive therapy. Physicians, social workers, counselors, nurses, and support groups are required for the chronic management of these patients. ²

More attention is now being directed toward IPV/SV, and the U.S. Preventative Services Task Force now recommends screening all women of childbearing age for IPV. Providers still largely feel uncomfortable with the management of IPV/SV, however, due to a lack of training and experience. Some providers feel that there is so little they can do that it is better not to address it at all. Others feel too rushed to be able to dedicate any time to these issues in both clinic and emergency settings. ² This article explores the literature of the utilization of essential oils in the management of stress and anxiety. Given the high association of post-traumatic stress disorder (PTSD) in victims of IPV, it is our belief that utilization of essential oils may mitigate harm and improve the long-term outcomes of these patients. Any additional treatment modality that practitioners can use or recommend for these patients to improve outcomes and well-being is sorely needed.

IPV and SV

Violence within our homes and relationships has become a national epidemic. According to the CDC, approximately one in three women and one in six men experience SV at some point in their lifetime. The effects of IPV have long-term health effects, with 52% of women and 17% of men reporting symptoms of PTSD. Additional adverse health effects reported by survivors of IPV include increased rates of asthma, irritable bowel syndrome, headaches, chronic pain, and insomnia. ³ The estimated annual cost in the United States related to IPV is >$4.8 billion in direct health costs, with an additional $1.8 billion in lost earnings. ²

Most guidelines related to IPV/SV advocate for better rates of screening, thereby identifying victims or those at risk for future violence. Screening questionnaires are embedded within most electronic medical record systems, and most communities have advocacy groups and shelters that will aid in obtaining emergency housing and legal support. ² However, there are very few guidelines related to the psychosocial care of the victims and techniques to mitigate the emotional and psychological damage. Considering the national burden, new or complementary therapies could have a significant effect on reducing the suffering of these patients. Utilization of essential oils known to be of benefit in stress and anxiety offers a valuable tool to providers struggling to care for these patients.

The Role of Essential Oils in Stress and Anxiety

Many cultures throughout history have utilized essentials oils for their medicinal and healing properties. Per the Bible, the wise men visiting baby Jesus brought him gifts of gold, frankincense, and myrrh. Today, essential oils are available for inhalation via a diffusion, combined with a carrier oil for massage, in cosmetics, and various other forms. Essential oils commonly used today for their sedative and anxiolytic properties include lavender, peppermint, eucalyptus, rosemary, sweet marjoram, bergamot, ylang ylang, and chamomile. ⁴ While there are not large-scale randomized controlled trials demonstrating the use of essential oils in patients recovering from violence, there is extensive support within the medical literature that demonstrates improved markers of stress in hospitalized patients, refugees, and survivors of torture. ^{5 –9}

A non-randomized controlled study of 32 critically ill patients in Korea compared stress and sleep quality between patients receiving lavender aromatherapy during hospitalization and those who did not. Measurement of perceived stress, stress index, blood pressure, heart rate, and sleep quality occurred at the time of admission and on the second day of hospitalization. The results of the study demonstrated a statistically significant improvement in perceived stress, stress index, and sleep quality in the aromatherapy group. Sleep quality overall decreased in both groups. However, there was less of a change in the test group, suggesting that aromatherapy prevented a significant reduction in sleep quality in hospitalized patients. ⁵

A large retrospective observational study looked at nurse-delivered aromatherapy in Minnesota and Wisconsin involving >10,000 adult admissions between 2012 and 2014. Patients received aromatherapy sessions with lavender, ginger, sweet marjoram, mandarin, or a combination of oils mostly via inhalation. Patients' self-reported pain, anxiety, and nausea decreased with aromatherapy sessions, with the most significant decrease in anxiety reported with lavender and sweet marjoram. ⁶

The use of essential oils may be of benefit in extreme cases of stress, such as refugees and survivors of torture. Studies of aromatherapy in this population are limited, but it is recommended as an adjunct to other treatments to help calm and relax patients and to encourage a good rapport between the patient and the provider. ⁷ Similarly, an adolescent residential mental-health facility demonstrated a decrease in pharmacologic interventions (injections and oral medications) and seclusion/restraint events after a three-month utilization of an aromatherapy protocol. The oils used in this study were ylang ylang, sweet marjoram, and bergamot via inhalation or hand massage. ⁹ The literature strongly supports the role of aromatherapy for acute agitation in other avenues as an alternative to antipsychotics and sedative medications. ⁸

Mechanism of Action

Lavender is known to have sedative and anxiolytic properties and has served as the pharmacologic model for essential oils with observed similar properties. Mouse studies have shown that inhaled lavender oil affects the same anti-conflict neuronal pathways as diazepam. In a related mouse study, caffeine-induced agitated mice had improved observed behavior following inhaled lavender. The observed change in behavior of the mice correlated with the serum concentration of the primary components of lavender, linalool, and linalyl acetate, suggesting the effect is not simply related to the smell. The proposed mechanism of these components is through their effect on the glutaminergic system via N-methyl-D-aspartate receptors, direct inhibition of adenylate cyclase (thereby influencing cyclic adenosine monophosphate activity), and regulation of ion channel activity (altering neurotransmitter release). ¹⁰

Inhaled essential oils have rapid uptake due to the intranasal delivery that allows it to bypass the blood–brain barrier. Additionally, the olfactory neural pathway allows for long-acting axonal (intraneuronal) transport and short-acting extraneuronal bulk flow transport, with direct transmission to the brain. This allows for a quick onset of action and a long duration. ¹⁰

Proposed Utilization of Essential Oils in the Care of Patients Recovering from Abuse or Coping with Abuse

Specific studies related to aromatherapy in victims of IPV/SV are currently lacking, but if the above studies related to aromatherapy used for stress and anxiety are any indication, the potential avenues for use are numerous. Though aromatherapy will never completely replace other modalities of treatment, it is an underutilized option to alleviate victims' suffering.

Both psychological and physiological research has demonstrated the strong association between stress on memory formation and the subsequent development of PTSD. ¹¹ Aromatherapy utilized early in the clinical encounter with a victim of IPV/SV has the opportunity to create a healing clinical environment and decrease the stress associated with an invasive and often humiliating physical examination. This mitigation of stress could have long-term implications by reducing the development of PTSD and other adverse health sequelae seen in these patients. Many facilities have implemented specific procedures for treating victims, with specific nurses and providers who have undergone training for sexual assault. ² These procedures could easily incorporate aromatherapy with anxiolytic essential oils diffused in treatment rooms.

This calming effect of aromatherapy allows for the creation of a safe space for patients as they transition into follow-up care. The creation of a comfortable and relaxed environment supports improved outcomes associated with traditional therapy and cognitive behavioral therapy. The increased availability and ease of use can empower patients to utilize aromatherapy techniques at home to maximize the anxiolytic effect.

Victims of IPV/SV often seek asylum within shelters and crisis centers. Many individuals in shelters find it difficult to relax and sleep. The diffusion of essential oils such as lavender in this environment could encourage restful sleep. As the situations leading a person to require housing in a shelter are clearly stressful, and many of these people do not have access to prescription anxiolytics or even regular medical care, non-pharmacologic treatments for anxiety could be extremely beneficial.

Conclusion

Research into complementary and alternative medicine techniques is steadily increasing, and aromatherapy is one area where recent studies have shown clear benefit for many different conditions. Applying current evidence on the effectiveness of aromatherapy for stress and anxiety to the extreme stress associated with victims of IPV/SV clearly suggests a role of essential oils in the care of these patients. The wide availability of essential oils and potential benefit in not only reducing short-term stress and anxiety but also potentially mitigating the development of PTSD supports their utilization. Further research is needed to demonstrate the optimal timing of use of essential oils, types of essential oils, and the role in reducing the health sequelae of victims of IPV/SV.