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Dr Philippa Kaye, GP with a special interest in women’s and sexual health.
After more than 20 years as a GP, I have unfortunately come to know the subtle signs of domestic abuse.
And while physical violence is one form it can take, it is not the only form it manifests itself.
I am referring to coercive control.
An abuser who does this might monitor their partner’s social media, text messages, and calls, dictating what they can eat, when they exercise, who they can see, and how much money they spend.
Domestic abuse is defined as any controlling, coercive or threatening behavior or violence.
It can be physical, psychological, sexual, emotional, financial and more.
And whatever form it takes, it is a crime.
Despite this, the World Health Organization reports that one-third of women worldwide are directly affected by domestic abuse.
According to the latest Government figures, one in six men in England and Wales will be affected in their lifetime.
Just as anyone can be affected, anyone can also be a perpetrator.
The problem is that, in some cases, it is not entirely obvious, even to the victim, that they are being abused, and even less so when it involves coercive and controlling behavior.
These are the six vital warning signs I think everyone should know about…
1. Preventing you from seeing friends and family
Friends and family are your support system, something a controlling partner may try to take away from you.
It could be forcing you to share a social media account, moving away so you can’t visit your family, or monitoring phone calls.
If an abusive partner has limited contact with loved ones, it will be even more difficult to talk and receive the support they need.
ONS statistics show that in the year ending March 2023 there were 43,774 coercive control offenses recorded by police in England and Wales (excluding Devon and Cornwall).
Domestic abuse is defined as any controlling, coercive or threatening behavior, violence or abuse. This can be physical, psychological, sexual, emotional, financial and more.
But the number of cases is likely to be much higher since not all are reported.
While the vast majority of perpetrators were men, either gender can be the abuser or the victim.
The first thing is to try to recognize that abuse is happening and that you don’t have to be a health professional to care for each other.
2. Monitor your every move even online
One patient, Natalie (not her real name), is an example of how a partner monitoring her phone calls, social media, and emails is coercive control.
I had known her for many years, sometimes seeing her with her husband, sometimes not, on a variety of topics over the years.
But then some alarm bells started ringing.
She contacted me through an online inquiry and requested that we not respond by email or text, only a phone call to the landline.
That in itself isn’t necessarily worrying, but when we talked, I asked why.
She responded because her husband read her phone and emails and she wanted it to be private.
It is not necessarily abuse if both partners agree to share their emails, but this was not made clear.
When I saw her again and she wanted a prescription sent to a different pharmacy than the one she usually went to.
She told me that she was worried that her husband would see her going to the pharmacy at a different time than usual to pick up her monthly medications.
It started to feel like something wasn’t right.
As time went on, she confided that she had isolated herself from her friends and family.
There had been arguments between them and their partner, or he had made them question their friendship in some way.
He listened to phone calls and read their emails.
He called her many, many times a day while tracking her phone to see where she was.
Written it seems clear and yet Natalie didn’t see any problems for a long time.
3. Deprive you of access to medical services
Taking control of every aspect of your daily life, from where you can go and who you can see to the services you can access, are signs that you are in a controlling relationship.
They may monitor how much you eat, sleep, how much time you spend in the bathroom, and whether or not you seek medical attention.
As a GP, recognizing domestic abuse is part of healthcare.
It’s about recognizing the person who seems uncomfortable in the presence of their partner.
Maybe he will vouch for her. She will shift in his chair, shudder, or, often almost imperceptibly, move away from him.
It’s one of the reasons I’ve been worried about the shift to remote comforts.
Because while phone and video appointments are helpful, I worry about things that are harder to “see” over the phone.
Much of communication is nonverbal: pauses, glances away, and shifts in the chair convey information.
Furthermore, online access to GP health services may give perpetrators the opportunity to simply expand their control.
Patients may be forced to share sensitive medical information such as domestic abuse, safeguarding, sexual health and medical conditions.
If I suspect an abusive relationship, I will try to find a time to talk alone.
4. Putting you down and degrading you repeatedly
People say they feel worthless and worthless when they are in a coercive relationship. This is especially the case when an abusive partner constantly demeans you.
As an outsider, you can sometimes witness abuse, whether physical or verbal, such as aggressive or controlling behavior, or humiliating verbal abuse.
Other times you may not witness the abuse itself, but you can notice the effect it has.
Someone may seem fearful of their partner or family member, and may find it difficult to talk to them alone. You may see signs of physical abuse, such as bruises, or someone may develop depression, anxiety, or other problems.
Creating a safe space can encourage someone to talk to you, talk to themselves, and make it clear that you are there for them or that you are worried about them.
If a friend or loved one discloses abuse, whether coercive control or otherwise, the first response, and perhaps one of the most important, is to listen and believe them.
Too many people, often women, are looked down upon or their experiences belittled. Imagine working up the courage to reveal what has been happening only for them not to listen to you.
Listen to them and perhaps remind them that it is not their fault and that they are not alone.
It may take time, not only for someone to trust you, but also for you to feel able to get support and help.
Controlling finances, such as how much money you spend or what you spend it on, is a warning sign of coercive control.
5. Control your finances
I discovered that my patient, Natalie, didn’t have her own bank account and had to ask her partner for money.
He made her feel like she needed him, that this control was actually him taking care of her and that she couldn’t manage without him.
The more independence she lost, the more she trusted him and the more terrifying his threats became.
An abusive partner may take money from their partner, put all bills or debts in their name, or even prevent them from working.
In Natalie’s case, her partner controlled how much money she spent and what she spent it on.
This financial abuse is just another way to restrict freedom and ability to leave a relationship.
When we care about someone it can be difficult not to get frustrated, but it is very important not to judge them for not leaving a coercive relationship. Instead, try to focus on developing your confidence and independence.
If you can, point out support groups and networks like Refuge and encourage them to reach out for support.
6. Manipulate what you eat
People in coercive and abusive relationships may feel like they have no autonomy over their own bodies.
If you’ve been put on a controlling diet, you may feel like your body doesn’t belong to you.
You may be forced to count calories, follow a specific diet, or a strict exercise regimen.
I have seen women who have been told repeatedly that if they gain weight their partner will leave them or that their partners are trying to take care of their health.
Over time they have felt so useless and made to feel that they are incapable of managing on their own, that they agree with their partners’ decisions.
Women whose partners literally take food off their plate at a restaurant with the comment that they don’t need it, who control their calorie intake and exercise and make them feel like they don’t even have control over what they eat.
