Since Felitti and colleagues (1998) conducted a large study on the role of Adverse Childhood Experiences (ACE) and showed they had a huge lifetime impact on physical and mental health in adulthood, it has become clear that we should address ACE worldwide to really improve both public somatic as well as mental health in the short and longterm. Six out of 10 ACE have to do with child abuse and neglect (CAN) and sexual abuse. The other 4 ACE address household dysfunction: separation or divorce of one’s parents, mental disorder of a family member, addiction problems of a family member and imprisonment of a family member below the age of 18. In case of cumulative ACEs the risk for own somatic or mental health conditions increases significantly (Anda et al., 2006). Also, in case of 4 or more ACE a study shows that an increased prevalence of unresolved-disorganized attachment occurs while absence of emotional support has about the same increased prevalence of unresolved- disorganized attachment (Murphy et al., 2014). An unresolved state of mind is associated with PTSD (Harari et al., 2009) and other mental health problems, as well as problematic parenting (Steele et al., 2016). Though parenting distress and ACE are significantly higher in low SES, increased ACE scores add significant explained variance in parental distress. Also, social determinants of mental health, the so called household items (estrangement, bullying, adequate educational opportunities, stable income, debts, housing insecurity, access to transportation, access to playgrounds and parks, safety, food insecurity, discrimination and racism, social integration and support systems) have been associated with increased risk for adversity in life and poor health outcomes and should therefore be taken into account and addressed (Alegría et al., 2019). 

Coercive control is a pattern of pervasive display of power and control in interpersonal relationships (Stark, 2007; 2009; 2020; 2024). It consists of an act or a pattern of acts of assault, threats, humiliation, and intimidation or other (partner or child) abuse, including physical, sexual, financial or economic and systems abuse, that is designed and used to harm, punish, or frighten their victim (see also https://eige.europa.eu/publications-resources/publications/combating-coercive-control-and-psychological-violence-against-women-eu-member-states; https://www.cps.gov.uk/legal-guidance/controlling-or-coercive-behaviour-intimate-or-family-relationship; https://www.nsw.gov.au/family-and-relationships/coercive-control/what-is-it; https://www.justice.gc.ca/eng/rp-pr/cj-jp/victim/rd17-rr17/p4.html?wbdisable=true). It can be seen at the microlevel in families, at the mesolevel in communities and organisations and at the macrolevel in national and international geopolitical interactions and conflicts.

At the microlevel in families coercive control appears to be more than 50% of domestic abuse and intimate partner violence (IPV) cases, at least in the Netherlands (https://longreads.cbs.nl/the-netherlands-in-numbers-2021/how-many-people-fall-victim-to-domestic-violence/; https://www.cbs.nl/nl-nl/longread/rapportages/2024/prevalentiemonitor-huiselijk-geweld-en-seksueel-grensoverschrijdend-gedrag-2024/samenvatting). A lesser percentage of IPV (estimated 30%) consists of other patterns of interaction that also need another approach to help solve the problem and stop the violence (Van Hoof, van Arum, Avontuur, 2023; 2025). As Monckton Smith (2012; 2021) showed, coercive control has an increased risk to accumulate in murder (specifically femicide and infanticide) and suicide (mostly of the perpetrator, but also victims can decide to kill themselves; https://www.linkedin.com/pulse/beyond-co-occurrence-interplay-coercive-control-suicide-david-mandel-mbfhe/). In her research she identified 8 stages that lead up to murder, the homicide timeline (see https://efjca.eu/doc/Presentation-Jane-Monckton-Smithe-Homicide-Timeline.pdf). Most victims are female, highlighting underlying misogyny, manosphere influence and gender-specific role patterns in society (https://www.rijksoverheid.nl/documenten/rapporten/2024/05/31/patroon-van-dwang-en-controle-is-genderspecifiek), however female perpetrators also exist. In the Netherlands every 8 days a woman is murdered by a man, usually an (ex-)partner (Van Hoof, van Arum, Avontuur, 2023; 2025; Van Hoof, 2025 https://www.ntvg.nl/podcast/56-dwingende-controle). Since women are crucial to survival of humanity, economic income, care for and education of offspring and empathic connections and attachment worldwide coercive control, including CAN and IPV, constitutes a huge, overlooked problem (https://www.unwomen.org/en/what-we-do/economic-empowerment/facts-and-figures#87144; https://www.economist.com/topics/women-around-the-world?utm_medium=cpc.adword.pd&utm_source=google&ppccampaignID=18151738051&ppcadID=&utm_campaign=a.22brand_pmax&utm_content=conversion.direct-response.anonymous&gclsrc=aw.ds&gad_source=5&gclid=EAIaIQobChMI7KL1t8vyjAMV-l5HAR3vBgyjEAAYASAAEgKcRfD_BwE). There is a lack of numbers and insight into the pervasiveness of coercive control worldwide, though stories from international patients in psychotherapy practice highlight its prevalence. In addition, examples from those stories elicited a lot of emotional recognition in a global professional audience as became clear during my presentation on the topic at the IACAPAP 2024 in Rio de Janeiro.  

Because of its prevalence and impact coercive control constitutes a huge intergenerational public health problem. It gives fuel to an eternal violence-trauma-unresolved disorganized attachment perpetuation, which in turn generates conflicts and disruption in all layers of society. It also impacts child protection measures and the possibilities for mental health treatment (Avontuur, 2024; Avontuur & van Hoof, 2024; Mandel, 2024). Above all it plays an overlooked or negatively twisted, distorted role in court rulings. Despite international court rulings and treaties (e.g. EVRM, Treaty of Istanbul, Children’s Rights act) that call for assessment of IPV in conflict divorce and in any child protection measure, this is not the case in most countries. Positive exceptions can be found in the UK, Australia and Canada. Since coercive control until recently has been barely recognized as such, at least in the Netherlands, this means that victims, both adults and children, become victimized again by systems that neglect the one-sided directed violence and don’t stop the perpetrator from exercising negative influence through targeted acts and systems abuse (judicial, financial, economic, child protection services, careproviders, social institutions, etc.). 

Awareness creates visibility and offers opportunities for change and stopping the intergenerational cycle of violence and traumatization.

1. Providing and sharing information and psychoeducation: increasing awareness of the existence of coercive control to professionals;
2. Providing and sharing information on how to increase destigmatisation and empowerment for victims of CC, CAN, IPV;
3. Providing and sharing information on how to use lived experiences of victims of CC, CAN and IPV in mental health practice; 
4. Gathering and sharing tips and tricks for best practices and improvement of recognition of CC and application of measures; 
5. Gathering and sharing stories from professional practices per country 
6. Gathering and sharing stories about own experiences of professionals with CC, including CAN and IPV (intervision); 
7. Answering the question of what is needed for professionals/IACAPAP members to be able to better do their work personally and professionally, and to be strengthened in recognition of CC, including CAN and IPV, and being able to act upon it to bring down the consequences of ACES and to break patterns;
   
   Longterm goals might be: 
8. Helping professionals to start national registration systems and/or Safety/Rape centers on CC including CAN and IPV; 
9. Collecting research data per country worldwide; 
10. Calling for action per country worldwide;
11. Collaboration with lawyers and advocates on CC, CAN and IPV, e.g. at the European Council/Division of Violence against Women and UN.
     

Marie-José van Hoof, MD, PhD, MSc, will serve as the Coordinator for the Coercive Control SIG. 

About the Coordinator for the Coercive Control SIG

• Mrs. M.J. van Hoof, MD, PhD, MSc
  CEO and medical director @iMindU GGZ (mental health institute)
  Child and adolescent and adult psychiatrist, psychotraumatherapist, orthopedagoge
• Coordinator's profile
   

To become a member of the Coercive Control SIG, please complete the membership application form via this link and send us a copy of your CV to info@iacapap.org. 

Should you have other questions, please contact us at info@iacapap.org.