How Unbalanced Relationships Trigger Stress & Inflammation In The Body
You may picture people struggling the most to be angry, frazzled, and a little unraveled. But some of the sickest patients Lissa Rankin, M.D., treated in her Marin County integrative medicine practice looked like the picture of wellness.
In the new book, Relation Sick, that Rankin co-wrote with psychiatrist Jeffrey Rediger, M.D., the two described that the women they saw who meditated, practiced yoga, worked with personal trainers, drank green juice, did detox cleanses, and took tons of supplements, were still some of the sickest people they ever worked with.
What connected these women was their relationships. They were relationsick.
What it means to be "relationsick"
The term relationsick describes how unbalanced relationships can make us physically ill. At the center is a pattern of giving far more than you receive, and mistaking that imbalance for kindness.
Rankin uses Shel Silverstein's "The Giving Tree." The tree gives a boy her apples, then her branches, then her trunk, until she's a stump still managing his loneliness. Many of us, especially women, were raised to see the tree's unboundaried giving as the highest form of love. However, when you look at it through a psychological lens, Rankin says it exemplifies a narcissistic boy with a codependent partner. She says this over-giving is fawning, which many consider a trauma response.
How fawning turns into illness, step by step
Rediger & Rankin laid out how fawning becomes toxic. It usually starts with relational trauma, sometimes combined with religious indoctrination or the use of spirituality to bypass painful feelings, which conditions someone to fawn over others. Over time, that leads to chronic nervous system dysregulation, which Rediger describes as basically living in fight or flight.
That dysregulation activates the HPA axis, the system linking your brain and adrenal glands that runs your stress response. According to Rankin, repeated stress responses then raise cortisol, adrenaline, and other stress-related chemicals, along with inflammatory cytokines, the molecules your immune system uses to sound the alarm.
Research supports this. One review found1 that chronic stress impairs the HPA axis's ability to regulate itself, disrupting cortisol and creating a state that promotes inflammation. Another linked disrupted cortisol 2to an overactive HPA axis and chronic inflammation.
Chronic inflammation is a cause of, or worsening factor in, almost every illness. The mind, nervous system, and immune system are connected, meaning being in a toxic relationship can physically make people sick. Research on close relationships points the same way, linking relationship conflict and low social support to changes in how the body releases inflammatory cytokines.
Why suppressed anger matters
Many people who are relationsick have a lot of pent-up anger, but the anger itself isn't the problem, Rankin said. It's a sign that a boundary may have been crossed, Rediger explained, so it's there for a reason. The trouble comes when anger has nowhere to go and gets repressed into the tissues.
However, many patients don't want to confront the fact that their relationships may be the problem. The topic was taboo in her practice, Rankin said. Patients would rather try another exercise regimen, a different diet, more supplements, or a pill than face the possibility that their marriage, mother-in-law, or boss was making them sick.
The pause practice that can help break the pattern
Being relationsick isn't a sentence to a life of chronic illness—it's preventable and treatable. Rankin and Rediger created six steps from fawning to freedom. The first, and often the hardest, is learning to pause.
Instead of saying yes the moment someone asks something of you, take anywhere from 10 minutes to 24 hours to check in with yourself. Which parts of you are a yes, a no, or a maybe? What are you actually resourced to give, and where does giving tip into over-functioning? That pause is the starting point for setting boundaries.
This pause can feel nearly impossible for trauma survivors, Rankin acknowledged. For some people, the automatic yes is as reflexive as a knee jerking when a doctor taps it, and breaking it may take somatic, or body-based, therapy.
The takeaway
You can do everything right for your health and still feel unwell if your relationships are out of balance. Your personal life may not be the first place you look when it comes to the cause of chronic disease, but Rediger and Rankin believe our bodies often tell us what's going on long before we're consciously aware of it.
If you worry you are in a toxic or unbalanced relationship, start by noticing if and when you fawn over others. And the next time someone asks for something, pause before you answer. Give yourself permission to have needs and to fulfill them.