Abstract
Background: Traditional intimate partner violence (IPV) surveillance captures visible or self-reported incidents but systematically misses a distinct and prevalent form of harm: partner interference, medical sabotage, and coercive control operating through healthcare dependency in chronic illness populations. For millions of adults living with Long COVID, ME/CFS, dysautonomia, MCAS, and related infection associated chronic conditions (IACCs), medical access is mediated by partners who may cancel appointments, withhold portal credentials, falsify clinical context, or frame patients as unstable, transforming care systems into instruments of control without generating a police report or visible injury. This form of harm has no name in federal health literature, no tracking protocols, and no oversight infrastructure.
Methods: This paper introduces RAVYNS (a composite invisibility scoring system), the first integrated framework to translate partner interference and institutional neglect in chronic-illness care into a measurable public health metric. The model quantifies three invisibility dimensions-yielding, neglect, and sabotage-through a composite score: RAVYNS = (V × C × A × E) × 100, where V represents visibility, C credibility, A advocacy amplitude, and K a structured correction engine adjusting for underreporting (U), gender bias (G), diagnostic overlap (O), and digital suppression (S). Prevalence estimates integrate CYNAERA's US-CCUC™ corrected IACC population figures with behavioral IPV exposure modeling. Per-person economic impact is modeled across diagnosis delay, excess emergency utilization, lost remission, income loss, and QALY reduction.
Results: RAVYNS modeling estimates that approximately 30-36 million U.S. adults living with IACCs may experience medical sabotage, partner interference, care-linked neglect, or institutional amplification of coercive control annually, depending on severity assumptions and overlap adjustment-applying 2026 US-CCUC planning baselines. Within the Long COVID population alone, the estimated annual burden is approximately 6.5-9.0 million adults. Annual IPV exposure risk within the Long COVID population is estimated at 13-14% (approximately 1 in 7), rising toward a lifetime ceiling of 79% in ME/CFS populations when aligned with long-term IPV exposure trajectories. Condition visibility scores range from V=70 (Long COVID) to V=6 (MCAS), producing correction factors of 1.43 to 16.67 respectively. National economic burden estimates range from $266 billion (low severity) to $801 billion (high severity) annually. A ten-point reduction in the average RAVYNS score is associated with approximately $2,200 in savings per patient per year, or $52.8 billion nationally.
Conclusions: RAVYNS reframes medical sabotage and care-linked coercion as quantifiable system failures rather than moral gray zones. Once invisibility becomes data, inaction becomes a policy choice. The framework proposes five implementation pathways: EHR narrative partiality audits, sex disaggregated IPV tracking across IACC registries, a RAVYNS-Clinical™ intake screen, an open-source calculator, and a Visibility-Parity Dashboard. Applying 2026 US-CCUC™ corrected prevalence baselines, the United States cannot afford to lose between $332 billion and $1.2 trillion annually to preventable harm hiding in plain sight within healthcare documentation-harm that spans a spectrum from active medical sabotage to institutional amplification of coercive control.
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