High-control groups & your health decisions

Children

Adults

Steven Hassan’s BITE Model starts with behavior control, including regulating a person’s “physical reality.” That can mean rules about food, sleep, sex, clothing and whether you need permission for major decisions.

ICSA notes that harm in cultic groups can be physical as well as psychological, financial and social, and that children have been injured.

Adults have the right to make their own health decisions, including saying no to treatment. The American Medical Association says doctors should make sure a patient can make an independent, voluntary decision.

In a high-control group, “refusing” care may not be a free choice at all. It can come from fear, guilt or rules handed down from above.

The BITE Model lists regulating diet, including food, drink, hunger and fasting, and the manipulation and deprivation of sleep. Both can be used to wear people down.

The National Heart, Lung, and Blood Institute (NHLBI) says lack of sleep can make it harder to make decisions, solve problems, remember things and manage your emotions.

The BITE Model lists controlling when, how and with whom a member has sex. ICSA notes members of cultic groups have been exploited sexually as well as financially.

The BITE Model describes labeling some feelings as wrong or selfish, and teaching ways to block homesickness, anger and doubt. People who leave are sometimes said to have been “brainwashed by a counselor.”

Researchers found that group ideology can shape whether people feel able to seek help. Former members said shame, and fear of not being understood, made it hard to talk to professionals.

The CDC defines neglect as failing to meet a child’s basic physical and emotional needs, including healthcare, food, schooling and having their feelings responded to.

In a study of 172 children who died after care was withheld for religious reasons, most had conditions that were very treatable. The deaths came from 23 different groups in 34 states, which shows this is about a pattern of control, not one group.

Signs a child’s health may be at risk

• A child is often hungry, very tired or losing weight
• Clear symptoms or injuries go untreated
• Doctor, dental or school visits are blocked or kept secret
• The child seems afraid to talk about how they feel

If you think a child is being harmed or their health is being neglected, the Childhelp National Child Abuse Hotline can help you think it through and make a report. Call 1-800-422-4453, 24/7.

The AMA says patients should get clear information about the risks, burdens and benefits of every option, including not having treatment. Then the decision is yours.

If someone you love is refusing care because of a group, it can be frightening. Langone advises focusing on specific changes you notice and on reducing conflict. Sometimes improving the relationship is the most important goal.

What helps

• Ask open questions about how they are feeling
• Keep in touch, even if conversations are short
• Offer practical help, like a ride or company at an appointment
• Share concern about their health, not attacks on their beliefs

What usually backfires

• Calling them stupid or brainwashed
• Mocking their faith or values
• Ultimatums like “It’s us or them”

Talk with a clinical provider or therapist if…

• A group is telling you not to get care you think you need
• You feel exhausted, hungry or unwell because of group rules
• You feel guilt or fear about seeing a doctor or therapist
• You’ve left and are struggling with sleep, eating, panic or trust

Free, confidential help (U.S.)

• 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org, 24/7
• Childhelp National Child Abuse Hotline: call 1-800-422-4453, 24/7
• Crisis Text Line: text HOME to 741741, 24/7
• National Domestic Violence Hotline: call 1-800-799-7233 or text START to 88788, 24/7
• RAINN National Sexual Assault Hotline: call 1-800-656-4673, 24/7

Outside the U.S., Find A Helpline (findahelpline.com) lists free, confidential helplines in many countries.