Monday, 27 November 2017

Coercive Control Relationships Hurt Women’s Health

by Lisa Fontes, PhD
Isolated. Degraded. Manipulated. Threatened. Stalked. And sometimes subject to physical and sexual violence. It’s no wonder some women’s relationships are making them sick. Coercive control is a strategy some people use to dominate their intimate partners—mostly men over women.1 It’s not just bossiness—it’s domination. Over time, women who are treated this way lose their autonomy, self-esteem and sense of well-being. Between the direct acts of control and possibly violence, a woman lives in fear of doing anything that might anger her partner. The distress is ongoing, even during periods that seem calmer. Some abusers also deliberately weaken their partners physically, restricting their access to food, interfering with their sleep and medical care, obligating unwanted pregnancies, pushing them to use alcohol or drugs, and beating or sexually assaulting them.

Here are examples of ways a controlling partner can directly interfere with a woman’s health:
  • Gita’s husband would not let her go anywhere unaccompanied. He insisted on sitting in on her medical appointments, explaining to the clinic staff that this was “cultural.”
  • Over a period of years, Cindy’s boyfriend whittled away at her self-esteem so much that she hated to have anyone look at her—she could barely stand to see herself in the mirror. He obligated her to work out constantly and restricted her intake of food. He was never satisfied with her appearance, and insulted her body all the time, threatening to leave her for someone “hotter."     
  • Shanique’s husband cancelled her counselling appointment, saying she was disloyal for wanting to tell others about their private matters.
  • When Grace, 16, attended a routine medical appointment, her provider noticed that her breasts were bruised. Grace said her boyfriend did it, and that it was “nothing.” The provider was alarmed but didn’t quite know what else to ask to determine if Grace was safe.
  • The medical staff noticed that Carmen had to check with her boyfriend about “everything”— which exams they’d give her, where she should pick up her prescriptions, what medicines she could take, and referrals to other providers. They heard her explaining to him on her phone, from the waiting room, that she really was delayed at the doctor’s and would be home soon, apparently begging him to trust her before she finally snapped a photo to prove where she was. She looked worried.
  • Sally, a nurse, found it “natural” to take care of her boyfriend, Sam, who constantly needed emotional support, rides, and money. She began missing shifts at work and stopped seeing friends and family as she responded to his frequent demands for help. Her co-workers noticed that she had lost weight and looked anxious, and seemed to constantly be calling or texting him, and reassuring him.
Living with chronic fear induces physical changes. Women who are victims2 of coercive control frequently experience medical problems, including heart trouble, non-specific head, back and stomach pains, and difficulties with sleeping and eating. Often, patients don’t realize their relationship is the cause of their ailments. Of course, being controlled by their partner can also contribute to people’s psychological symptoms such as depression, anxiety, substance abuse and suicidality. Providers sometimes prescribe medication, tests, and referrals to specialists for a problem that has its roots in the person’s intimate relationship.

Physical violence and coercive control reinforce each other. Even minor acts of physical violence make it easier to control a partner and intensify the effects of insults and threats. Similarly, people who feel entrapped and isolated become more afraid of physical blows. Once people are firmly under their partners’ control, occasional insults, slaps and pushes may be enough to keep them acting submissive.

“Sex on demand” is a common rule in coercive control relationships. An abuser may accuse a victim who tries to decline sex of being unfaithful or not loving him enough, or simply push her until she gives in. If he uses physical force to obtain sex even once, she knows she has no real choice; all future sex is coerced.

The line between violence and safety can be especially blurry during sex. If an abuser insists on sexual activities that his partner has said she does not want, or treats her roughly and she objects, or gets her drunk or high so she will do things she does not want, he is victimizing her. Often, a woman gives her partner the benefit of the doubt if the painful actions occur during sex. She decides to define his actions as passion rather than violence; in this way, enabling the relationship to continue without a risky confrontation.

Often people who use coercive control against their partners go out of their way to be charming and helpful to others. The person being controlled struggles to keep up appearances—afraid to tell others what is really going on in the relationship. She may blame herself. If only she could “be better,” she thinks, maybe her partner wouldn’t degrade or hurt her. If she tries to end the relationship or demands changes, the threats escalate. Domestic violence advocates can help women develop safety plans, even if they choose to remain in the relationship. And with the new U.K. laws against coercive and controlling behaviour, law enforcement help may be available.
For more information about Coercive Control and how to help people who are caught in such a relationship, check out the book, Invisible Chains: Overcoming Coercive Control in Your Intimate Relationship.
1 Coercive control can occur in same sex relationships, and occasionally women exert coercive control over men.
2 I am using the word “victim” here, but please feel free to substitute “target” or “survivor” if you prefer. 



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Lisa Aronson Fontes, PhD’s most recent book is: Invisible Chains: Overcoming Coercive Control in Your Intimate Relationship. She is a Senior Lecturer at the University of Massachusetts Amherst. With a doctorate in psychology, she writes and conducts trainings around the world on topics related to culture, child maltreatment and violence against women. Her blog at Psychology Today is called Invisible Chains.

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