Violence against women is a major human rights violation that affects one in three women worldwide and has profound and overlapping impacts on women’s physical and mental health (World Health Organisation, 2021).
Coercive control can be seen to lie at the heart of intimate partner violence and has been described as the “golden thread” that ties together multiple incidents of violence and abuse (Myhill & Hohl, 2019, p. 4477). This pattern of behaviour creates an environment of threats, humiliation, intimidation and control that harms or frightens a person and isolates them from support and other resources (Milligan, 2022). It may involve tactics such as monitoring movements, enforced social isolation, and restriction of access to financial resources, employment, education, or medical care.
Although coercive control is an important part of intimate partner violence (IPV), and there is legal recognition of coercive control in England and Wales since 2015, it is rarely studied and less well understood in research literature (Oram et al., 2022). This study aimed to explore women’s experiences of coercive control and how they felt coercive control impacted their mental health.
Coercive control creates an environment of threats, humiliation, intimidation and control, yet it is rarely studied and less well understood than physical violence.
Methods
This was a qualitative study, which explored the perspectives of 16 women who had experienced coercive control and who had accessed domestic abuse services in Australia. The research team sought ethical approval from the University of Melbourne and developed a distress protocol.
To recruit participants, flyers advertising the project were put up at the premises of domestic violence services and distributed by email to networks of domestic violence service providers. Participants were asked about: (1) experiences of IPV in general, (2) coercive control in particular and (3) the mental health impacts of IPV.
During the analysis, researchers generated themes from the participants’ words through categorising participants’ descriptions of their experiences using an approach called thematic analysis (Braun and Clarke, 2006). They met regularly to discuss these codes and resolve disagreements about codes and themes between team members. The authors also report generating ‘latent’ codes and themes, which capture theoretical ideas and assumptions and may not directly reflect what participants said.
Results
Participants were 16 cisgender women, aged between 26 and 62, who identified as heterosexual and had experienced abuse by a male intimate partner. Most (15/16) participants were separated from their abusive partner at the time of the interview and the lengths of abusive relationships ranged between five months to over 40 years. The findings are reported in two parts: (1) experiences of coercive control and (2) the trauma and mental health impacts of coercive control.
1. Experiences of coercive control
Women reported a range of different behaviours from their partner, including monitoring, tracking phones and devices, isolating the survivor from friends and family, restricting of autonomy, controlling behaviours, gaslighting (manipulating someone into questioning their own perception of reality), using intimidation and threatening behaviours, manipulating, threatening suicide, manipulating family and friends, jealousy, denigration and humiliation, financial abuse, irresponsible spending and gambling and exploiting women as free labour.
Entrapment and insidiousness
Participants described feeling trapped in the coercive controlling relationship. Women highlighted that abusive partners used women’s social and economic circumstances, experiences of mental distress, or their role as parents to make it more difficult for them to leave the relationship. Participants also described coercive control as remaining hidden by slowly and gradually increasing in harm (which the authors refer to as ‘insidiousness’). This subtle and insidious nature of coercive control was de-stabilising because survivors could not point to a clear ‘wrong’, particularly when there was no physical violence.
2. The trauma and mental health impacts of coercive control
All women reported that coercive control had lasting impacts on their mental health. Women described psychological abuse as more harmful than physical violence due to “the ongoing threat” it created and the “constant chipping away at the women’s sense of self” (p. 579). Women reported experiencing difficulties in accessing support for coercive control, particularly when there was no physical violence, which led to increasing distress. Women also reported long-term physical health impacts due to the ongoing stress associated with coercive control, including chronic pain and fatigue.
Few women reported receiving formal mental health diagnoses. The participants described a range of experiences of mental distress. These included recurrent distressing memories and nightmares, dissociation, self-blame, guilt and shame, anxiety, anger, hypervigilance, and difficulties concentrating.
Coercive control involved a “constant chipping away at the women’s sense of self” (p. 579).
Conclusions
The authors concluded that entrapment and insidious characteristics of coercive control are central to the mental distress it causes. They note that there is an urgent need for trauma- and violence-informed psychosocial support for women who have experienced coercive control.
The hidden, subtle, insidious nature of coercive control is central to the mental distress it causes.
Strengths and limitations
This study makes an important contribution to a field that often overlooks the impacts of non-physical forms of violence and abuse. The findings on what coercive control looks like and mechanisms through which coercive control may lead to mental distress are well-evidenced with quotes.
The authors report that this study was shaped by community-based participatory research principles, and although they consulted with community members about recruitment and data collection, survivors were involved only as participants and were not involved in analysis or interpretation of findings. This contradicts participatory research principles which centre on partnership working (Cargo & Mercer, 2008).
The researchers were transparent about how their background, experiences and beliefs may have shaped the research, particularly in relation to their personal identities and experiences of privilege. This transparency is a key part of good quality qualitative research, but it is rare to see it be given much (if any) attention in published papers (Braun & Clarke, 2021, 2023). However, including a more detailed discussion of how the researchers’ professional assumptions and beliefs shaped the analysis they produced would have strengthened the paper (Braun & Clarke, 2023). In particular, the researchers recognise that their psychology backgrounds may have “limited the understanding of the phenomena the participants described” (p. 574), but their decision to interpret survivors’ experiences through a biomedical understanding needed to be explicitly described and explained.
The authors build an argument for the links between coercive control and mental distress. In the results section, their interpretations mostly reflect closely what survivors said, amplifying survivors’ voices. However, in the discussion, they re-frame survivors’ descriptions of the mental health impacts of coercive control using diagnostic language.
For example, in the discussion section, the authors interpret reports of substance use as being “self-destructive” (p. 580), while survivors have argued that this is a self-protective coping mechanism that reduces distress when faced with extreme and often long-term and inescapable terror (Sweeney et al., 2018). The authors also interpret in the discussion that survivors had an “inability to trust” (p. 580), yet survivor-led research has shown that survivors do have an ability to trust but due to repeated experiences of betrayal and relational harm they may need evidence of trustworthiness before entrusting (Alyce, Taggart & Turton, 2024).
The diagnostic language used by the authors is mostly their own interpretation and often isn’t reflected in the quotes from survivors. Framing survivors’ experiences through biomedical ways of understanding distress, conflicts with a long history of feminist scholarship and survivor activism that suggests a focus on ‘symptoms’ can pathologise survivors (i.e., locate the problem within them) and miss the contextual and social factors at play (Faulkner, 2017; Sweeney et al., 2019; Tseris, 2013; Wasco, 2003). This is particularly important given that the authors claim the study is informed by feminist research principles.
It also means that the paper focuses on difficulties and didn’t capture survivors’ strengths and the ways they mitigated the impact of coercive control on their mental health. The latter is equally important for the person-centred and trauma-informed mental health support that the authors advocate for in the paper. Involving survivors meaningfully in all stages of the research, and particularly the interpretation of the data, would have strengthened this paper by ensuring its interpretations aligned with survivors’ priorities and expectations, as well as the participatory principles that the researchers refer to in their methods.
It is important that intimate partner violence research reflects survivors’ expectations and priorities.
Implications for practice
Based on these findings and linking them with personal experience and the wider literature, clinicians and practitioners should:
- Recognise that psychological tactics of coercion and control are just as, if not more, distressing than physical tactics.
- Understand that the subtleness of coercive control, particularly when there is no physical violence, can be very disorientating and make it difficult for women to articulate the source of their distress.
- Be alert to hints or clues that indicate that women are feeling trapped in a relationship or as if a relationship is gradually and progressively eroding their sense of self and their well-being.
- Understand that perpetrators may use social, economic, and cultural disadvantage to entrap and control women; the power of coercive control often lies in perpetrators exploiting social inequality.
We need to recognise that psychological tactics of coercion and control are just as, if not more, distressing than physical tactics.
Statement of interests
My work focuses on amplifying the voices of survivors of violence, trauma and abuse and I carry out research from the perspective of myself having lived experience. I write this blog from that position. Part of my work, informed by lived experience and working with survivors, focuses on making sure that the language that we use to describe survivors’ experiences of mental distress aligns with survivors perspectives, priorities, and meanings. This often means being very careful that our language does not re-enforce narratives or ideas that may undermine survivors’ own ways of understanding their difficulties or distress. I want to make this perspective transparent because I recognise that it has shaped my interpretation of the strengths and limitations of this paper and my approach to writing this blog.
Links
Primary paper
Lohmann, S., Felmingham, K., O’Donnell, M., & Cowlishaw, S. (2024). “It’s Like You’re a Living Hostage, and It Never Ends”: A Qualitative Examination of the Trauma and Mental Health Impacts of Coercive Control. Psychology of Women Quarterly, 03616843241269941.
Other references
Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative research in sport, exercise and health, 11(4), 589-597.
Braun, V., & Clarke, V. (2021). One size fits all? What counts as quality practice in (reflexive) thematic analysis?. Qualitative research in psychology, 18(3), 328-352.
Braun, V., & Clarke, V. (2023). Toward good practice in thematic analysis: Avoiding common problems and be (com) ing a knowing researcher. International journal of transgender health, 24(1), 1-6.
Cargo, M., & Mercer, S. L. (2008). The value and challenges of participatory research: strengthening its practice. Annu. Rev. Public Health, 29(1), 325-350.
Faulkner, A. (2017). Survivor research and Mad Studies: the role and value of experiential knowledge in mental health research. Disability & Society, 32(4), 500-520.
Myhill, A., & Hohl, K. (2019). The “golden thread”: Coercive control and risk assessment for domestic violence. Journal of interpersonal violence, 34(21-22), 4477-4497.
Milligan, R. (2022). The Lancet Psychiatry Commission on Intimate Partner Violence and Mental Health #IPVmentalhealth. The Mental Elf, July 2022.
Peeren, S., McLindon, E., & Tarzia, L. (2024). “Counteract the gaslighting”–a thematic analysis of open-ended responses about what women survivors of intimate partner sexual violence need from service providers. BMC women’s health, 24(1), 110.
Sweeney, A., Perôt, C., Callard, F., Adenden, V., Mantovani, N., & Goldsmith, L. (2019). Out of the silence: towards grassroots and trauma-informed support for people who have experienced sexual violence and abuse. Epidemiology and psychiatric sciences, 28(6), 598-602.
Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: relationships in trauma-informed mental health services. BJPsych advances, 24(5), 319-333.
Tarzia, L. (2021). “It went to the very heart of who I was as a woman”: The invisible impacts of intimate partner sexual violence. Qualitative health research, 31(2), 287-297.
Tarzia, L., & Hegarty, K. (2023). “He’d Tell Me I was Frigid and Ugly and Force me to Have Sex with Him Anyway”: Women’s Experiences of Co-Occurring Sexual Violence and Psychological Abuse in Heterosexual Relationships. Journal of interpersonal violence, 38(1-2), 1299-1319.
Tseris, E. J. (2013). Trauma theory without feminism? Evaluating contemporary understandings of traumatized women. Affilia, 28(2), 153-164.
Wasco, S. M. (2003). Conceptualizing the harm done by rape: Applications of trauma theory to experiences of sexual assault. Trauma, Violence, & Abuse, 4(4), 309-322.
World Health Organization. (2021). Violence against women prevalence estimates, 2018: global, regional and national prevalence estimates for intimate partner violence against women and global and regional prevalence estimates for non-partner sexual violence against women. World Health Organization.
