What is Gaslighting? What Healthcare Providers Should Know about this Phenomenon.

October is Domestic Violence Awareness Month.  While the general public should be aware of this issue, healthcare providers can be an important part in helping victims receive the help and care they might need.  Learning about the signs and symptoms of different types of abuse is vital in order to be an ideal patient advocate.

The term gaslighting came from a book and film in the 1940s called Gaslight.  In the film, a lady’s husband tries to drive her insane by intermittently dimming the gas lights, but denying that it occurs.  Gaslighting is a form of mental abuse where the victim is manipulated into doubting their own memory, perceptions, or sanity.  It’s a subtle type of abuse that is often missed; the signs aren’t as obvious as physical abuse.  This type of mental abuse is dangerous because it can lead to the victim becoming dependent on the abuser and can greatly harm their mental health.  Unfortunately, it is more prevalent than most people realize.

Due to social expectations that women are supposed to be agreeable towards men,  females tend to be at higher risk for gaslighting.  However, men can also experience this type of abuse.  In general the abuser appears charismatic in public, but is a different person in private.  This makes it difficult for the victim to feel comfortable reaching out for help.

Gaslighting tends to go through three main stages and may be cyclical in nature:

   1.  The Idealization Stage:

  • In this stage, the abuser appears to be quite the gentleman/lady.  They tend to shower the potential partner with attention, gifts, and charm.  This is also known as ‘love bombing.’ They appear incredibly happy and excited with the relationship.  The victim enjoys these intense displays of affection and can become intensely bonded to the abuser.  In fact, this type of relationship has noticeable changes in biochemistry and brain structure.  The ‘love bombing’ releases endorphins, the chemicals that cause pleasure, and can lead to feelings of euphoria.  In a way, the victim becomes addicted to the ‘high’ of the relationship and become emotionally attached the their abuser.   Unfortunately, this loving behavior is an illusion used to encourage dependency on the abuser.

   2.   The Devaluation Stage:

  • In the devaluation stage, the abuser seems to turn cold, unfeeling, and even bitingly cruel.  The victim is constantly criticized, and they begin to feel that they cannot do anything ‘right.’
    • Example: After an argument, the abuser may ask the victim to not act ‘so emotional’ and instead act ‘logically.’  When the victim attempts to do so in the next confrontation, they receive anger and impatience from the abuser.  The abuser may critique the victim’s ‘unfeeling’ and ‘detached’ reaction.  There is no situation where the victim can act ‘correctly.’  
  • The victim becomes confused by the severe change in their partner and will experience increased stress, unhappiness, and depression.  The relationship has severe ups and and severe downs – just like a roller-coaster.  The victim feels like they are ‘walking on eggshells’ in order to prevent another negative interaction.  The victim begins to work harder to please the abuser and to return the relationship to its safe and ‘fairy-tale’ beginning.  This leads to the victim experiencing additional anxiety and despair about the loss of their ‘soul mate.’
    • To cope with the abuser’s rejection and abandonment, the victim can develop unconscious defense mechanisms such as denial, rationalization, trauma bonding, etc.
  • The distressed the victim becomes, the more powerful and important the abuser feels.  This can lead to more blatant verbal and physical violence.  Devaluation of the victim continues through various forms: criticism of the victim’s “neediness,” intelligence, physical appearance, sexuality, life goals, etc.  If the victim attempts to leave the situation, the abuser responds along the lines of ‘I hate you (you need to work harder), but don’t leave me because there will be consequences (threats of violence).’
  • By the end of this stage, the victim feels alone, but is dependent on their abuser.  In essence, the victim becomes a ‘puppet’ to their abuser’s whims.

   3.   The Discarding Phase:

  • In the final phase, the abuser sees the victim’s dependence as a type of victory.  The abuser no longer cares about the victim’s needs or wishes; the fun is over.  As a result, the victim is left stunned and raw with emotion.  They try in vain to ‘fix’ the dysfunctional relationship.  The abuser resists this resolution; the victim is seen as inferior and ‘not worth their time.’

Gaslighting is often found in conjunction with other types of abuse, such as physical or verbal abuse. Abusers may try to convince the survivor that what they remember happening never did.  Particular techniques of gaslighting include:

     Withholding: the abusive partner pretends not to understand or refuses to listen. Ex. “I don’t want to hear this again,” or “You’re trying to confuse me.”

     Countering: the abusive partner questions the victim’s memory of events.  Ex. “You’re wrong, you never remember things correctly.”

     Blocking/Diverting: the abusive partner changes the subject and/or questions the victim’s thoughts.  Ex. “Is that another crazy idea you got from [friend/family member]?” or “You’re imagining things.”

     Trivializing: the abusive partner makes the victim’s needs/feelings seem unimportant. Ex. “You’re going to get angry over a little thing like that?  You’re too sensitive.

     Forgetting/Denial: the abusive partner pretends to forget what actually happened or denies things like promises made to the victim. Ex. “I don’t know what you’re talking about,” or “You’re just making stuff up.”

Signs/Symptoms of Gaslighting 

  • Constantly second-guess yourself.
  • Asking yourself, “am I too sensitive?” multiple times a day.
  • Feeling confused or even crazy.
  • Always apologizing to your partner.
  • Feeling unhappy even though you have many apparently good things in your life.
  • Frequently making excuses for your partner’s behavior to friends/family.  You may withhold information so that you don’t have to explain what’s going on.
  • Knowing something is terribly wrong, but you can’t express what it is.even to yourself.
  • Lying to your partner to avoid put downs and reality twists.
  • Difficulty making simple decisions.
  • Feeling that you used to be a a different person – more confident, more fun-loving, more relaxed.
  • Feeling hopeless and joyless.
  • Feeling as though you can’t do anything right or that you aren’t “good enough” for your partner.

Remember that signs of abuse may present in different ways – a patient may appear depressed, non-compliant, anxious, suicidal, etc.  Interestingly, victims of gaslighting are often misdiagnosed with bipolar disorder due to the cycles of ‘highs’ and ‘lows’ present in their abusive relationship.

Prognosis of Gaslighting 

Leaving an abuser who uses gaslighting can be especially difficult.  Victims often don’t trust their own feelings because of being told that they are “lying, crazy, unstable, etc.”

Many victims will develop Post Traumatic Stress Disorder (PTSD). My next blog post will cover how PTSD presents and what techniques can be used to manage trauma. 

This is the last blog post in my four post series about Domestic Violence Awareness Month. 

My previous posts include:

  1. October is Domestic Violence Awareness Month – Facts YOU Need to Know
  2. Domestic Violence – What Healthcare Providers Should Know
  3. How Does a Healthcare Provider Screen for Domestic Abuse?

Here are some additional resources as well as the references that I have used:

11 Warning Signs of Gaslighting in Relationships

The Effects of Gaslighting in Narcissistic Abuse Syndrome

Post-Traumatic Stress Disorder

Why We Stay: A Deeper Look at Domestic Abuse

What Is Gaslighting?

What Is Gaslighting?

10 Things I’ve Learned about Gaslighting as an Abuse Tactic

Why Gaslighting Is a Form of Abuse that You NEED to Know about



Much of what I have learned about physical therapy and online health/wellness, I have learned from Greg Todd, the founder of Physical Therapy Builder.  He is a fantastic physical therapist whose mission is to help physical therapy students and physical therapists provide patient focused care without becoming overwhelmed.  Greg Todd is also known as a “social media guru,” and I have a lot of thank him for.  I highly suggest his courses, especially Smart Success PT.  In May, I attended Smart Success PT Live, a business, marketing, and branding course by some of the top PT entrepreneurs in the field.



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