Auto-Immune disorder and interpersonal trauma from coercive control: a case example

Journal of Psychiatry Reform vol 12 #10, July 5, 2025

Caroline Giroux, MD, FRCPC

Author information:

Professor of Psychiatry, Psychiatrist, Director of RESTART (Resilience, Education, Supportive Tools for Adults Recovering from Trauma), University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA. [email protected]

There are no conflicts of interest. AI was not used in the production of this article.

Marka*, a professional, mother and married woman in her early forties woke up one morning with several circular bruises on her legs, below the knees. She also had poly-arthralgias. Being a doctor in medicine, early years of her training rushed back to her memory, with names of diseases she never imagined she would embody. The one that had apparently decided to make its way to her life and leave its mark on the parchment of her body was called erythema nodosum. Marka was a textbook case for this auto-immune disorder (AID), in terms of gender (75% of people with AID are women), and age  manifestations. The workup was unremarkable. Lupus was ruled out and the rheumatoid factor was negative. The frustrating verdict: idiopathic. But she wouldn’t accept the path of least resistance by simply leaving it at that. There must be a reason, a precipitating factor, a mechanism. Why was this suddenly happening ? She gradually realized that, to obtain answers, she had to become the physician specialist she was looking for… 

Bedridden for two weeks, with intense joint pains (including her wrists and knees) and needing frequent anti-inflammatory medications, albeit unable to find the exact cause, at least she saw this as a wake-up call for prioritizing her self-care. She made the resolution to stop overloading herself with projects (on a short notice, she had just taken on 2 extra book chapters for a clinical manual she was contributing to after an author abruptly left the project, and her bruises appeared the morning after she submitted all her drafts, as if it were a rebound stress reaction). She would take her general wellbeing seriously from now on, by getting enough rest, meditating, exercising more regularly, eating well, and managing stress. 

Stress. Over the following months and years, she started connecting the tensions in her marriage with her psychological and physiological distress. What she would not let herself name as such for years became clearer: she had been absorbing abrasive comments, suffocating micro-management, silent treatments, and gaslighting from her husband. She started connecting the dots as she saw various symptoms under a different light. For instance, she remembered her migraines a few years prior, which she had never experienced before, and that went away after she left for a 5-day vacation with one of their children to visit family, away from his harassing demands. It was clear that vacation in a relaxing atmosphere at the beach had helped her to reboot. But the root cause eventually injected more poison into her stability after she got back from such trips. Over the span of many years, like a death by a thousand papercuts, she felt the damage from an insidious erosion of her self-esteem, more frequently when in presence of her husband and certain members of his family. She could no longer ignore the similarities between her female patients’ symptoms in the context of domestic abuse and her own. While trying to juggle various responsibilities as she remained a loving, attuned and involved mother of three active children and a conscientious physician educator, Marka had to manage concerning symptoms she experienced with increased frequency: dissociation (her whole body felt numb whenever he raised his voice at her), palpitations, hopelessness, self-doubt, anhedonia, fugue fantasies and absence of enthusiastic consent when he pressured her for sexual intimacy.  She came to realize on her own that her auto-immune condition had materialized as an alert, a disturbing mirror of the dynamics from a toxic marriage: her body was basically attacking itself, from internalizing the negative projections and messages of her hostile, shame-prone and ragingly envious husband. What more powerful metaphor could it be… 

And just like white-collar domestic violence can be subtle and insidious, she remembered noticing symptoms before the dramatic onset of her bizarre condition. Months prior, she had felt some vague pains all over her body, to the point that she thought she had fibromyalgia, a chronic inflammatory condition that is often due to trauma. In retrospect, those pains were probably the immune complexes slowly forming and building up in her system. 

Various studies have highlighted the association between PTSD and increased levels of inflammatory markers.  For instance, being exposed to sexual violence can generate biological responses to stress characterized by inhibiting the hypothalamic-pituitary axis (HPA), altering immune activity, and changing the structure and function of the brain [1]. Kim et al. (2020) demonstrated higher inflammatory markers levels (particularly IL-6) in patients with PTSD [2]. 

Because Marka is passionate about finding answers, as a clinician educator and a lecturer, her research led her to a finding that validated her impression: a correlation has been found between having been in a toxic relationship and the development of auto-immune disorders [3]. And having a predominance of women affected by AID makes sense given that women are statistically more likely to be victimized than men. 

Because of the chronic nature of the stress in the vicinity of her husband, she was living in fear of having a recurrence. Even though it had taken her a while to label this abuse (after all, he was not calling her names), it was clearly intimate partner violence, consisting of intellectual or psychological abuse (arrogant attitude, ridiculing her opinions, incessant criticism of her thoughts, feelings and people she loved), spiritual abuse (putting her belief system on trial, sabotaging her sources of joy), interfering with her sleep and basic self-care because he insisted on pursuing an endless argument, and financial control, to name a few. Eventually, the abuse intensified after he lost his employment. He became more rigid and controlling, imposing restrictions, denigrating and dehumanizing her in front of their children, engaging in emotional manipulation and guilt-tripping, and monitoring her whereabouts. It was pure psychological torture; she felt depressed, disempowered and also had more panic symptoms. She started writing as an outlet. She was starting to identify with the character played by Julia Roberts in the movie Sleeping with the Enemy. Marka was drained by her spouse’s hypervigilant jealousy, double-binds and dysregulated thought processes in the form of irrational, dead-end debates. Setting boundaries with him or giving him feedback on his toxic behaviors like his extreme need to dominate and win had only made things worse. He was not taking responsibility for his destructive attitudes. She was also worried about his excessive spending while not demonstrating he was looking for a job. He even became upset when she announced she was opening a personal bank account to make sure he would not spend all of their assets. Marka was confronted with the sad reality that he wouldn’t change, because he had no insight, expressed no empathy nor accountability. It was soul-crushing to see someone she cared about who couldn’t transcend such a level of ego fragility and self-hate. Because his need to control and his attacks likely came from a place of deep insecurity and disorganized attachment style. But she couldn’t be this man’s emotional processor anymore. She had to protect herself and her health. She stayed as long as she could for her children, but she knew she had to flee, because it is traumatic for children to witness domestic abuse. Not only does it rob them of their childhood and sense of safety, but it models destructive attachment templates for their future relationships.  

This case illustrates a phenomenon called coercive control.  Coercive control is characterized by negative behaviors which intimidate, threaten, and humiliate a person or restrict a person’s liberty. In addition to being a known risk factor for experiencing other forms of violence, research has linked coercive control to symptoms of psychological distress and suicidality [4]. The term “coercive control” was coined by Evan Stark, a forensic social worker. Stark’s work moved away from solely focusing on physical violence in domestic abuse, highlighting instead the insidious nature of coercive control as a form of psychological and emotional abuse. He described it as an “invisible cage” created through micromanagement, emotional manipulation, aggression, and humiliation [5]. 

Marka learned after separating from her tyrannical husband that there was a name for the systemic, multimodal abuse she had endured. It further solidified her hypothesis that her frightening medical conditions (migraines, auto-immune disease) had been the culmination of all the permutations of the abuse she had endured. She knew she had developed PTSD and chronic inflammation. And individuals with PTSD often have comorbid inflammatory or auto-immune disorders [6].  She is now divorced, trying to rebuild herself and heal her invisible wounds. She modified her diet, prioritizing plant-based, anti-inflammatory food items. She expanded her exercise regimen and since her divorce, she joined a group of runners, and she already participated in one 15k.  She also expanded her meditation practice by joining silent retreats more often and creative outlets as a mixed media artist. In almost ten years, there has not been any recurrence of the erythema nodosum. She believes she decoded the latter accurately, therefore the symptom carrying the message lost its relevance. Now, she even experiences gratitude for what she considers an enlightening episode. She continues to try to give meaning to her difficult marriage and to work at transforming her hardship by advocating for survivors of trauma, because she discovered quickly that her story is not unique, and many high-functioning women have been affected by silent gender-based violence behind closed doors. Marka hopes that her children will develop awareness and find good souls on their path, just like she did, if one day they express the desire to revisit their childhood and heal their own wounds. She is determined to support them and other people who have survived similar hostage situations. Like others all around the world, she is raising awareness by generously sharing her story for this article, so that society will take measures to hold perpetrators accountable and raise the younger generations with core values such as self-acceptance, kindness, compassion, respect and gratitude, thereby eradicating the very serious form of human injustice that coercive control represents. 

In conclusion, coercive control and other forms of interpersonal trauma and toxic stress affect the whole person and can generate neuroimmunoendocrinological imbalances. These alterations may persist in the long term, even with the improvement of the symptoms, probably generating an immunological imprint that can lead to future clinical consequences [1].  But the awareness of the mechanisms leading to chronic inflammatory conditions or auto-immune diseases after traumatic events brings the possibility of correcting those imbalances, using holistic approaches, hence, changing the trajectory from illness to empowerment and healing. And as physicians, therapists and holistic practitioners, helping one person at a time can have a ripple effect leading to the healing of the whole society by dismantling oppressive structures and preventing several forms of interpersonal trauma. When we offer safe spaces for our patients to break the silence, we help them move beyond their sense of aloneness as together, we open the door to recovery and transformation.

*The name and certain details of this patient’s story have been changed to maintain anonymity. 

References: 

1. D’Elia AT, Juruena MF, Coimbra BM, Mello MF, Mello AF. Increased immuno-inflammatory mediators in women with post-traumatic stress disorder after sexual assault: 1-Year follow-up. Journal of psychiatric research. 2022 Nov 1;155:241-51.
2. Kim TD, Lee S, Yoon S. Inflammation in post-traumatic stress disorder (PTSD): a review of potential correlates of PTSD with a neurological perspective. Antioxidants. 2020 Jan 26;9(2):107.
3. Northrop, C. Dodging the Energy Vampires, Northrup C. Dodging Energy Vampires: An Empath’s Guide to Evading Relationships that Drain You and Restoring Your Health and Power. Hay House, Inc; 2018 Apr 17. 
4. Lagdon S, Jordan JA, Devine P, Tully MA, Armour C, Shannon C. Public understanding of coercive control in Northern Ireland. Journal of family violence. 2023 Jan;38(1):39-50. Public Understanding of Coercive Control in Northern Ireland – PubMed 
5. Warren L. The invisible cage: Psychology’s role in the criminalisation of coercive control. Australian Psychological Society, April-May 2021, The invisible cage | APS 
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