Embodied harm and health consequences: self-reported physiological symptoms among co-victims of cold-case homicides

BACKGROUND: Families of victims of unresolved ("cold case") homicides endure not only prolonged emotional devastation but also chronic exposure to stressors linked to institutional inaction and uncertainty. While previous studies have addressed trauma, grief, and mental health consequences among co-victims of homicide, minimal scholarly attention has been devoted to the physical and physiological impact of unresolved loss, particularly when justice remains indefinitely suspended. METHODS: This qualitative study draws on in-depth semi-structured interviews with 13 co-victims of cold-case homicides in Israel. Using qualitative content analysis, we examined how participants interpret and articulate perceived connections between prolonged unresolved grief, institutional inaction, chronic stress exposure, and physiological health deterioration. The theoretical framework integrates Ambiguous Loss Theory (Boss, W. W. Norton & Company, 2006), Trauma Theory (Herman, Trauma and Recovery: The Aftermath of Violence-From Domestic Abuse to Political Terror, 1992; van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, 2014), and the Allostatic Load Model (McEwen and Stellar, Arch. Intern. Med. 153:2093-2101, 1993). RESULTS: Participants reported a wide range of chronic health problems including cardiovascular illness, autoimmune disorders, chronic pain, hypertension, diabetes, migraines, and disrupted sleep. They consistently attributed their physical decline not only to the trauma of the homicide itself but to the persistent absence of justice and ongoing interaction with inert legal systems, which they described as physiologically corrosive. The unresolved status of their case maintained a long-term state of biological threat activation, manifesting in immune dysregulation, sleep disorders, and severe fatigue. CONCLUSIONS: Findings demonstrate that cold-case homicide bereavement extends beyond psychological trauma and constitutes a significant, yet neglected public health burden. The study underscores the need to integrate trauma-informed healthcare within criminal justice responses and calls for official recognition of the embodied consequences of unresolved homicide, both clinically and legally.