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DR PHILIPPA KAYE: It's an insidious form of domestic abuse... and many don't even realise they're a victim of it. Here are the six warning signs everyone needs to know
Dr Philippa Kaye, GP with a particular interest in women's and sexual health
After more than 20 years as a GP, I've sadly come to know the subtle signs of domestic abuse.
And while physical violence is one form it can take, it's not the only way in which it manifests.
I'm talking about coercive control.
An abuser who does this might monitor their partner's social media, texts and calls, dictate 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 behaviour, 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 a third of women globally are directly affected by domestic abuse.
One in six men in England and Wales will be affected in their lifetime, according to the latest Government figures.
Just as anyone can be affected, anyone can also be the perpetrator.
The problem is, in some cases, it's not entirely obvious, even to the victim, that they're being abused — and no more so when it's coercive, controlling behaviour.
These are the six vital warning signs of I think everyone should know...
1. Stopping you from seeing friends and family
Friends and family are your support system — something a controlling partner may try to take away.
It could be making you share a social media account, moving far away so you cannot visit your family or by monitoring phone calls.
If an abusive partner has limited contact to those you are close to, it makes it even harder to speak out and receive the support that you need.
ONS statistics show in in the year ending March 2023 there were 43,774 offences of coercive control recorded by the police in England and Wales (excluding Devon and Cornwall).
Domestic abuse is defined as any controlling, coercive or threatening behaviour, violence or abuse. This can be physical, psychological, sexual, emotional, financial and more
But the number of cases is likely to be far higher as not all are reported.
While the vast majority of perpetrators were male, either gender can be the abuser or the victim.
The first thing is to try and recognise that abuse is happening, and you don’t have to be a healthcare professional to look out for each other.
2. Monitoring your every move even online
One patient Natalie, not her real name, is an example of how a partner monitoring your phone calls, social media and emails is coercive control.
I had known her for many years, sometimes I saw her with her husband, sometimes not, about a variety of issues over the years.
But then there started to be some alarm bells.
She contacted me via an online consultation and requested that we do not respond by email or text, only by phone call to the landline.
That in itself is not necessarily concerning but, when we spoke, I asked why.
She replied because her husband read her phone and emails and she wanted it to be private.
Not necessarily abuse, if both partners agree to sharing their emails, but this wasn’t clear.
When I saw her again and she wanted a prescription sent to a different pharmacy from the one she usually went to.
She told me she was worried her husband would see her going into the pharmacy at a different time to their regular monthly pick up of medications.
It began to seem like something wasn't right.
As time progressed, she confided that she had become isolated from her friends and family.
There had been arguments between them and her partner, or he had made her question their friendship in some way.
He listened in on phone calls and read her emails.
He rang her many, many times a day while tracking her phone to see where she was.
Written down it seems clear, and yet, Natalie didn't see an issue for a long time.
3. Depriving 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 all signs you are in a controlling relationship.
They might monitor how much you eat, sleep, how much time you spend in the bathroom and whether you seek medical care or not.
As a GP recognising domestic abuse is part of healthcare.
It's about recognising the person who seems uncomfortable in the presence of her partner.
Perhaps he answers for her. She'll shift in her chair, flinch or — often almost imperceptibly — shrink away from him.
It's one reason I have been concerned about the shift to remote consolations.
Because, while phone and video appointments are useful, I worry about the things which are more difficult to ‘see’ down the phone.
So much of communication is non-verbal, with the pauses, glances away and shifting in your chair all conveying information.
In addition, online access to GP health services can provide perpetrators with the opportunity to simply extend their control.
Patients could be forced into sharing sensitive medical information, such as, domestic abuse, safeguarding, sexual health, and medical conditions.
If I do suspect there is an abusive relationship, I will try to engineer a moment to speak alone.
4. Repeatedly putting you down and degrading you
People say they feel worthless and useless when they are in a coercive relationship. This is especially the case when am abusive partner constantly degrades you.
As an outsider sometimes you may witness abuse, it could be physical or verbal such as aggressive or controlling behaviour, or humiliating verbal abuse.
Other times you might not witness the abuse itself, you might notice the effect it has.
Someone may seem fearful of their partner, or family member, and it might be hard to speak with them alone. You may see signs of physical abuse such as bruises, or someone could develop depression, anxiety or other issues.
Creating a safe space can encourage someone to talk to you, talking alone and making it clear you are there for them, or that you are worried about them.
If a friend or loved one discloses abuse, be it coercive control or another kind to you the first, and perhaps one of the most important, responses is to listen and believe them.
Too many people, often women, are dismissed or their experiences belittled. Imagine gathering the courage to reveal what has been happening only to not be heard.
Listen and perhaps remind them that it's not their fault and that they are not alone.
It can take time, not just until someone confides in you but also until they 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. Controlling your finances
My patient, Natalie, I discovered had no bank account of her own and had to ask her partner for money.
He made her feel that she needed him, that this control was actually him looking after her and that she could not manage without him.
The more independence she lost, the more she relied on him, and the more frightening any threats from him became.
An abusive partner may take their partners money, place all the bill or debts in their name or even stop them from working.
In Natalie's case her partner controlled how much money she spent and what she spent it on.
This is financial abuse is just another way of restricting freedom and the ability to leave a relationship.
When we care about someone it can be hard not to get frustrated, but it's so important not to judge them for not leaving a coercive relationship. Instead, try to focus on building up their confidence and independence.
If you can signpost to support groups and networks such as Refuge and encourage them to contact them for support.
6. Manipulating what you eat
People in coercive and abusive relationships may feel they do not have any autonomy over their own body.
If you have been put on a controlling diet you may feel your body is not your own.
You may be forced to count calories, adhere to a specific diet or strict exercise regime.
I have seen women who have been told repeatedly that if they gain weight that their partner will leave them or, that their partners are trying to look out for their health.
Over time they have felt so worthless and have been made to feel they are incapable of managing alone, that they agree with their partners decisions.
Women whose partners literally removed food from their plates at a restaurant with a comment that they don't need it, who monitor their calorie intake and exercise and are made to feel that they don't even have control over what they eat.