It might mark me as a research geek, but I was excited to present my team’s new findings. For over a year, we’d dug into an understudied aspect of the gun issue: How guns are used in intimate partner violence that isn’t fatal. Our analysis showed that in Philadelphia, abusers use firearms to control and threaten their victims with alarming frequency. Such behavior has serious consequences for victims, often leaving them with debilitating emotional trauma.

The presentation went well — or so I thought. But later I learned that I had uncovered a fundamental gap in the framework in public health research. I was told by one audience member that because the women we studied weren’t physically injured — because they weren’t pistol-whipped or shot — our findings “didn’t count.”

I suppose I shouldn’t have been entirely surprised. Public health research is rooted in the prevention of physical injuries. The World Health Organization’s technical definition of an injury is “when a human body is suddenly subjected to energy in amounts that exceed the threshold of physiological tolerance or from a lack of one or more vital elements (for example, oxygen).”

But this overly narrow reading leaves out a whole lot that matters. Let me explain why: In our study of a year of 911 calls to Philadelphia police for domestic violence, we found that about one third of the time when a weapon was used against an intimate partner, it was a firearm. A great majority of the incidents involving a firearm were male-on-female and the gun typically was used to threaten — not to pistol whip or shoot — the intimate partner. In such circumstances, injuries were not common. But, because of the lethality of firearms, a victim’s fear was three times greater if they were threatened with a gun rather than another type of weapon.

One survivor told us that when a firearm is used as a tool of intimidation, it changes everything. If there had been a doubt about the distribution of power in the relationship, there isn’t any longer. A woman might stay with a threatening, controlling partner who has a gun because she has an intense, reality-based fear that if he chooses to pull the trigger, she will die. Thus, a firearm can facilitate ongoing abuse without ever being fired.

In addition to impairing quality of life, there can be long-lasting psychological consequences for the victim and any children who witness gun threats. Fear — again, a fear based in reality — can restrict a woman’s job opportunities, social interactions, and the healthy development of her children. Survivors often say that bruises and broken bones heal much faster than the psychological wounds of abuse. When guns are often used as a tool of intimidation, a woman may not bleed — but she will carry her scars for years.

Do these wounds not matter? We need to expand the public health framework to include harm that is inflicted through the use of a gun that is never fired. It’s the first step in making firearms research and policy more relevant to the women who will, during their lives, face an armed abuser.