Objectives: To examine the role of abuse severity in predicting women’s trajectories in mental and physical health and psychological quality of life during the 18 months following abuse identification in a health care setting. Methods: The present analysis used growth curve modeling in a sample of 411 women positive for abuse on the Composite Abuse Scale. Results: A high proportion of women experienced severe combined abuse (SCA; 55 % at baseline and 29 % at 18 months). On average, there was an improvement in depressive symptoms and psychological quality of life over time. Controlling for sociodemographic characteristics, women scoring positive versus negative for SCA experienced increased depressive symptoms and decreased quality of life; however, exposure to severe abuse did not affect the rate of change over time in these outcomes. Severe abuse was not associated with physical health. Conclusions: There is an important association between abuse severity and women’s health and well-being over time. Understanding the role of different abuse experiences, risk and protective factors, and trajectories can assist in more accurate identification and appropriate care provision for women exposed to IPV.