When Coercive Control Remains Hidden, Distress Becomes a ‘Diagnosis’

Credit: Met Gallery, Open Source, John Alexander, Repose, 1895

A WiseWOMAN Studio essay

Dee Donaldson | Clinical Psychologist | Founder, WiseWOMAN Studio

The Exhaustion That Looks Like a Mental Health Problem

There’s a very particular kind of exhaustion for many women that looks, from the outside, like a mental health problem. It tends to show up in the body first. Weight that falls away without trying, or appears without any obvious change in appetite. Sleep that becomes impossible to sustain, two hours here, three there, so that you feel like you are moving through your days with a peculiar floating quality, feeling vague and foggy, while simultaneously also feeling agitated and hyper-alert. A memory that feels scattered, not so much that most other people seem to notice, but enough that you find yourself losing the thread mid-sentence, uncertain whether you’re remembering something that happened or something you feared might happen if you dropped any of the balls you’ve been trying to keep in the air. There’s an emotional edge that sits just under the skin, so that the mildest comment from a colleague or a friend can leave you braced for potential catastrophe for hours, while something that previously would have mattered (should have mattered) to you — your child’s first laugh, a piece of news that would once have interested you — barely registers as much as it used to.

A doctor looking at the overall clinical picture will usually diagnose stress, burnout, anxiety, or hormonal changes. A therapist, presented with a client who seems to struggle to explain her issues in a coherent narrative, might consider a psychiatric disorder; anxiety, depression, ADHD, borderline personality, or any number of explanatory diagnoses that pathologise the ‘problem’ inside her. None of those conclusions is necessarily wrong, not exactly, as an observation about her state. However, what they do miss is the source of her problems.

The Labels That Point in the Wrong Direction

Most women who have been in a coercively controlling relationship have also been given a diagnosis. Sometimes more than one. Sometimes a kaleidoscope of labels that shift as she fails to improve with pharmaceutical or psychological treatments in the

These labels are offered as explanations. In practice they are a form of misdirection. They send both the treating clinician and the woman herself in entirely the wrong direction.

Whilst many medical and mental health professionals have become adept at identifying the more obvious signs of domestic violence, many continue to miss the subtle cues of the harms accrued from exposure to covert coercive control: the ongoing psychological and emotional abuse that gradually erodes her sense of self and her agency over time. The daily microaggressions that keep her body in a stress response state. In part, these unintentional misdirected diagnoses are due to the nature of coercive control blurring the ability of the woman living inside the abuse to recognise it herself in the first place. If she can’t see it, how can she explain it to someone else?

There is also the referral pathway to consider, particularly in terms to how and why she is presenting for support from medical and mental health practitioners. Coercively controlling partners frequently suggest or actively encourage their partner to seek help for ‘their’ problems; initially framing it as concern, before weaponizing the diagnostic labels as a place to dismiss or lay blame for the relationship concerns she has expressed or the distress she is feeling. After all, it’s because a professional has found her to be mentally ill, weak, or crazy. She is sent to deal with, what is now framed by a coercively controlling partner as being, her problem.

The system that are intended to be designed as support, when presented with a distraught woman and her worried partner, will often accept that framing at face value. It’s a reasonable response to what’s visible (or worse still, now documented in her health records). Sometimes doctors have limited time with a patient and therapists’ may default to familiar explanatory diagnostic criteria. What may not be visible at first glance — what is, by design, kept out of view — is what’s happening behind the front door of her home, in the daily microaggressions of her life.

What Living Under Control Does to Memory

Her fragmented recall. The self-doubt. Her emotional dysregulation. All documented in the patient file or the referral as being a defining label of her experience and

Trauma-informed practice is a term that is often used to ‘brand’ a service, but which is actually an individual clinician’s understanding and interpretation of a person’s presentation (including physical symptoms, cognitive issues, and dysregulated behaviours). A truly trauma-informed clinician views person’s ‘symptoms’ through the lens of that person’s experiences, culture, gender and context. They understand that, first and foremost, each person is the sum of what has happened to them, not what is wrong with them. For the women living inside coercive control, that looks very much like a mind and body that has been traumatised by the intentional deprivation of her autonomy, isolation from important relationships that accept her as she is, and a daily living environment in which her competence is consistently questioned.

That very specific type of relationship trauma doesn’t always look like the significant events that we commonly associate with domestic violence or the development of post-traumatic stress. The harmful damage of coercive control is complex relationship trauma that is similar to the harm that happens to children who are neglected or abused by parents or primary carers. Regardless of the developmental stage of the human, the harms of living in a relationship with someone who consistently overrides your psychological and emotional needs is devastating. Through systematic ongoing neglect and deliberate cruelty delivered in an unpredictable but observable pattern (when you know what to look for), it is a psychological and emotional assault on the normal attachment system required for each human to feel safe and secure. And it can happen to any human.

Chronic psychological stress degrades memory consolidation. It disrupts the neural pathways involved in executive function; in planning, in sequencing events coherently, in the kind of calm, organised recall that police, court systems and health professionals interpret as ‘credibility’. When a woman sits across from someone and isn’t able to give a chronological account of what’s happening in her relationship (as is expected of her) — when the story comes out in fragments, when she over explains and contradicts herself, when she trails off mid-sentence and looks at the ceiling as though searching for something she can’t find — she is very often dismissed as an unreliable historian or witness. She becomes viewed through a lens of pathology: that something is, indeed, wrong with her, just as her partner had been repeatedly telling her. However, in doing so, we fail as helping professionals, by inadvertently is something wrong with her.

Her difficulties, nevertheless, in explaining or describing her experiences are not confusion about what occurred. They are the neurological signature of living under sustained threat and the deprivation of her own autonomy. Her mind, meanwhile, has been working incredibly hard to survive a problem that human minds haven’t evolved the capacity to solve neatly or to meet the balance of proof required for court or to be summarised in time frames that match clinician appointment schedules.

A human mind simply can’t hold two contradictory thoughts: this person loves me and this person is harming me, at the same time. Not for long. Not without cost. So it does what each of our minds do under unbearable pressure: it resolves that tension, usually by minimising the harm. By finding the explanation that makes the situation more tolerable — that it happened because he is stressed, because she misunderstood him, that he didn’t mean it, that she is more sensitive than she should be, that he was right — that she is the problem.

Rather than that resolution being an indication of weakness, it is in fact a cognitive survival adaptation to an impossible situation; one that human evolution has established in order to remain safe within a tribe, within a family structure, with someone who is supposed to protect her. When observed from the outside, what it can look like is exactly like denial. Exactly like instability. Exactly like someone who can’t be trusted to accurately report her own experience. In reality, she often can’t, without first being supported to identify, to recognise, and to connect the dots of coercive control directly to her ‘symptoms’ and the distress she is experiencing.

Research published this year by Goodman-Williams and colleagues confirms what practitioners in this field have observed for a long time: women with complete memory loss following trauma are 55% less likely to report to police than those with full recall.¹ The mechanism they describe is directly relevant beyond the focus of the research study on sexual assault. When a woman can’t provide a confident, coherent account, she is less likely to take action. Of course she isn’t — who of us would? She is also less likely to be believed when she does and, critically, those to whom she tries to describe her experience or report what is being done to her are more likely to conclude that the problem is with her perception rather than with the situation. This is particularly problematic if those she is reporting to do not, themselves, fully understand the trajectory of living inside a coercively controlling relationship. She has been, in this sense, set up to fail.

Rebecca – a case study

Rebecca is a teacher, a role she loved and was, by every account, very good at. She is married to Brian. Together they have a child just over a year old. When Rebecca first came to see me at my private practice, she described feeling irritable, feeling uncertain who to trust, that she no longer felt like herself, of having a sense that she was failing at everything that once had come to her so easily. She was losing weight despite not having changed her eating habits. She wasn’t sleeping. She struggled to recall the sequence of events in during the increasing arguments with her husband, arguments that were largely related to Rebecca seeking further practical household and parenting support since she’d returning to work after maternity leave.

Brian used, with some regularity, suggestions that Rebecca was losing her mind the way her sister had. He’d questioned whether, just like her sister, Rebecca also had borderline personality disorder, and had begun to suggest that if the arguments continued perhaps he would just have to leave rather than continue putting up with Rebecca’s complaints.

By the time I met with Rebecca, she had succumbed to one of the most psychologically costly things a person can do. She had accepted someone else’s account of her as being more reliable than her own. She didn’t initially say: Brian is doing this to me. She said: I don’t know, maybe I’m just not coping.

What Brian had accomplished, over three years, was the progressive dismantling of Rebecca’s confidence in her own perception. He’d begun punishing Rebecca with stonewalling when she raised concerns, turning each complaint back into an indictment of her character and her mental health. The effect was a woman who arrived anywhere she went seeking support — to her GP, her best friend’s kitchen table, searching her symptoms on Google — already having argued herself out of her own experience. The perpetrator of the harm didn’t need to be in the room. The doubt he had installed was effectively travelling with her, hidden even from herself.

After a particularly bad argument during which Rebecca became so heightened as Brian berated her whilst she was doing the dishes, he called her crazy, and threatened to leave again, and Rebecca, in her frustration, smashed a cup in the sink. Brian called the police. When Rebecca finally found herself sitting across from someone who might help, a local police officer, she presented exactly as she had been conditioned by Brian’s psychological abuse to present: uncertain, self-contradicting, quick to minimise the harm she was experiencing. Brian on the other hand, when asked, responded calmly, coherently and appeared to be genuinely worried about his wife’s mental health. The officers left the home, suggesting that she seek professional help to avoid further police involvement. Rebecca felt she had no place left to turn.

These scenarios are familiar to me as I was once the person sitting across from distressed women and I was also someone who was drawing the wrong conclusions from it. A police officer, trained to assess credibility and to trust only the ‘evidence’ in front of me, responding to exactly what I was shown. The tearful, fragmented woman. The measured, concerned partner. I thought I was reading the situation accurately. I very likely wasn’t. It took years to understand that what women like Rebecca were actually showing was the results of psychological indoctrination by their partner, and a performance in the other. Only one person in that room had rehearsed their part, and it wasn’t Rebecca.

Why WiseWOMAN Studio Begins With Women

In New South Wales, four in five people killed by an intimate partner are women. Ninety-nine per cent of those women were the victim in the relationship, not the perpetrator.² These figures are not unique to Australia. The pattern holds across the United Kingdom, New Zealand, Canada, and the United States, with minor variation. The data is not ambiguous, and it isn’t contested in reliable, evidence-based research.

This is why WiseWOMAN Studio resources begin with an explicit focus on women. Not because coercive control is a problem exclusive to heterosexual relationships, or because men are not affected. The Relationship Clarity Mapping framework — including the coercive control screening tool, the online program, and the soon-to-be-released Patterns of Control book — applies wherever the entitlement dynamic that sits underneath the intention of coercive control behaviours is present. These resources were developed to respond to the question of who is most acutely harmed. The data answers it, women in intimate partner relationships are. And Relationship Clarity Mapping provides those women with the tools to begin to address it. It allows for the fog to clear, and for the patterns to be made visible.

Where Clarity Begins

What changes when the pattern of coercive control is seen clearly is only the beginning. It is only one thing — but it is the right ‘first’ thing when confusion is preventing clarity, or recovery after a coercive relationship has ended. The Relationship Clarity Map provides a structured tracking tool. It documents the pattern externally and as observed, across incidents, over time. It connects a controlling partner’s behaviour to a woman’s experience in a form that can be returned to, revised, shown to others, held up against the conditioned internal voice that tells her: you imagined it, you overreacted, you’re the problem.

When the pattern is documented outside the unreliable archive of a memory that has been systematically undermined, the question changes. It moves from ‘did this happen, or am I imagining it?’ to ‘here is when it happened, here is what preceded it, and here is how it harmed me.’ That shift doesn’t make everything simple or straight forward. It doesn’t undo the years of harm, or the grief that follows. And it doesn’t remove the risks that may arise if, once the pattern is seen, a decision is made to leave. But it is where clarity begins — and clarity is what makes the next step, whatever that step needs to be, feel possible rather than impossible. It returns the agency for that decision back to its rightful owner. To her.

The ‘diagnosis’ or police ‘findings’ may have been accurate in theory and at surface level. The explanation was wrong.

Each of us must dig deeper and learn to connect the dots of coercive control.

If you recognise this pattern, the free coercive control screening tool is a starting point. Link in bio, or find it at the WiseWOMAN Studio website.

WiseWOMAN Studio is an educational resource for adult women aged 18 and over. It is not a clinical service, not therapy, and not a domestic violence crisis service. If you are in immediate danger, please contact emergency services or your local DV support service.

Note: All client details are de-identified and generalised across a case composite of the many women I have worked with over the last 25 years across policing and as a clinical psychologist. Any resemblance to any individual is coincidental only.

© Donna-Marie Donaldson | WiseWOMAN Studio

References

1. Goodman-Williams, R., Smith, S., Volz, J., & Hanna, A. (2026). Police reporting after sexual assault: Victim and assault characteristics that predict reporting among victims who seek medical forensic care. Journal of Interpersonal Violence. Advance online publication. https://doi.org/10.1177/08862605261455557

2. NSW Domestic Violence Death Review Team. (2024). Domestic Violence Death Review Team Report 2021–2023. Coroners Court of New South Wales.