Ali* initially came to therapy for disordered eating. She was a young and diffident woman. She described recurrent cycles of restricted eating followed by attempts to exercise it away. We used cognitive behavioural therapy for eating disorders to unpick her “food rules” – the underlying beliefs which can drive eating disorders, such as “the less I eat the better” or “carbs are bad”.
As we worked on understanding and shifting her beliefs and behaviours around food, we noticed that most of her assumptions around eating, shape and weight coincided with the start of her relationship with her ex-partner. She told me he was a “gym junkie” and spent hours working out and encouraged her to do the same. “He got angry if I ate carbs,” she said, “and created a couples meal plan for us so I could shred and look hot when we were out together.”
Slowly, she spoke of other forms of control: encouraging her to dress in a “sexier” manner than she felt comfortable with, jealousy if he saw her talking to another man, watching her bank transactions to see where she was going, and insisting on going to all her social events so he could get to know her friends. “But he’d always start an argument, or would say he didn’t like them,” she told me. “And then I had to stop seeing them to prove my loyalty to him.” He used her fears about being an inexperienced sexual partner to coerce her into a range of sexual acts, telling her that what he wanted was “normal” and she was not being a good partner if she refused.
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As she spoke to me, I saw the shift in her eyes when she realised the pattern which had slowly emerged over three years: coercive control.
After this realisation, her eating stabilised. Food was one of the initial mechanisms of control he used to start shaping her body and personality, and her difficulties with eating were a symptom of the trauma she had experienced.
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Unlike physical violence, coercive control can be easy to miss as it is a pattern of repeated subtle behaviours and usually inflicted with the victim’s seeming agreement. At other times the coercion is more overt and can involve threats such as taking away children, or inflicting violence if sexual demands are not met. Regardless of the level of severity of this behaviour, the impacts can create psychological harm for victims.
Like many other victims of coercive control, Ali had very poor self-esteem and was racked with anxiety. She second-guessed herself and was overly deferential and eager to please, reporting she “felt frozen” when she believed she displeased someone. Her beliefs about herself and about relationships were distorted (“I have no radar”, “all relationships are unsafe”). These are all typical responses demonstrated by people who have experienced coercion or violence in intimate relationships.
Our work together encompassed a few stages. First, we worked together to understand what coercive control is, and used a simple ABC model derived from CBT to help Ali understand how certain statements or behaviours by her ex bypassed her instinctive radar and influenced her to give in to him by creating feelings of insecurity and anxiety. We looked at the way she experienced his approval as a potent reinforcer for compliance as it signalled that the danger of relational rupture or loss was over.
We named the distinction between her emotions/thoughts and reality, allowing her to separate from the belief that she was “not enough”. We also adapted cognitive processing therapy for PTSD techniques to help her understand and reframe her “stuck points” (eg the trauma of her distorted beliefs about how she failed herself through her “poor radar”). We also looked at the characteristics of healthy relationships, and helped her create a checklist for herself of the signs of healthy relationships so she could date with more confidence.
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Together, we also worked on Ali’s anxiety. This predated her former partner though had considerably worsened after the relationship. We utilised a cognitive behavioural approach and looked at the beliefs which fuelled her anxiety (“my friends don’t like me because I withdrew from them while with my ex”) and how she responded to these beliefs, such as by refusing to go to gatherings or engaging in safety behaviours like drinking. We did some behavioural “experiments” to challenge her beliefs and to learn new ways of coping, and also brainstormed ways she could talk to her friends about the relationship with Ian. She was pleasantly surprised to find that her friends understood and were supportive of her once they knew the context.
Recovery was not a linear journey, but these small steps allowed Ali to stop blaming herself, to feel more confident in her body and to show up in the world just as she was, without focusing on pleasing a partner.
*all clients are fictional amalgams
In Australia, the Butterfly Foundation is at 1800 33 4673. In the UK, Beat can be contacted on 0808-801-0677. In the US, help is available at nationaleatingdisorders.org or by calling ANAD’s eating disorders hotline at 800-375-7767. Other international helplines can be found at Eating Disorder Hope
