More and more evidence is indicating that the quality of personal relationships is a very significant factor in healing and prevention of chronic illness.

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Key Research

• A Global Perspective: At the MBDC we studied patients in eight different countries. Across all of these countries, symptoms were worse if family relationships were characterized by high conflict, and symptoms were less severe if family relationships involved depth and support (Gerson MJ, Gerson CD, et al (2006). Social Sciences & Medicine, 62, 2838-2847).
• The absence of social support is the second most significant factor in predicting how long we live, second only to a history of cigarette smoking.
• Wounds heal slower in the presence of marital tension, as proven by Janice Kiecolt-Glaser and her research team ((2005) Archives of General Psychiatry 62,1377-1384).
• Blood pressure, stress hormones and heart rate are affected by marital tension (Kiecolt-Glaser JK, Newton TL (2001), Psychological Bulletin, 127, 427-503).
• The quality of heart patients' marriages predicted their recoveries as well as the pumping ability of their hearts. Heart patients who were more negative with their spouses were 1.8 times as likely to die within 4 years as those who were given less negative ratings. (Coyne J (2001), The American Journal of Cardiology 88, 526-529).

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Marriage & Health: His and Hers

• In the early 1970s, a strange pattern in life span data began cropping up: married people tended to live longer than their single, divorced, and widowed counterparts. As a result, several studies have focused on the pathway leading from the marital relationship to physical health.
• The "marriage benefit" is still seen today, as married people are consistently less likely to have surgery and to die from all causes including stroke, cancer, heart attacks, pneumonia, and accidents. The most striking evidence has found that middle-aged men are about twice as likely to die if they are unmarried.
• It is possible that healthier people are more likely to marry and stay married and/or married people have more material resources, less stress, more social support, and less risky health habits than single people. Marriage (as well as gay couples in committed partnerships and unmarried heterosexual couples who have been together for years) acts as a balm against stress and loneliness (each associated with poor health). Additionally, supportive behaviors in marriage (i.e. spouses who help each other stick to healthy diets and exercise regimens, as well as keeping up with annual medical check-ups) serve to improve health.
• A good marriage can give a person a "reason to stay alive" since a commitment to your spouse may help you with the will to get better even when your own determination to yourself wavers.

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Studies On Health and Quality of Relationships

• The most important factor in the health benefits of marriage is the quality of the relationship (i.e. bad marriages do not have the same protective benefits as good, stable partnerships). Marital tension makes people vulnerable to health problems.
• The quality of heart patients' marriages predicted their recoveries as well as the pumping ability of their hearts. (Coyne, J. The American Journal of Cardiology, 2001). Heart patients who were more negative with their spouses were 1.8 times as likely to die within 4 years as those who were given less negative ratings.
• Dr. Janice Kiecolt-Glaser has found that marital arguments cause changes in the endocrine and immune systems. During and after stressful interactions, epinephrine and cortisol levels (stress hormones) rise and stay elevated for more than 22 hours. Blood pressure and heart rate also increase with relationship stress.
• A 1998 study showed that women who were unhappy with their marriages experienced increases in blood pressure readings just from thinking about fights they had had with their husbands.
• The tensions and arguments of marriage can often lead to depression (Many studies have found increases in depressive symptoms among those who have reported marital discord compared with those who have not reported discord).
• There is an association between criticism from spouses and joint pain in women with rheumatoid arthritis (and the converse: positive interactions or less negativity resulted in less arthritic symptoms).

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Marriage and Pain Perception

• Patients who reported increased marital satisfaction after undergoing joint "Coping Skills Training" with their spouse were more likely to have less pain after treatment, suggesting that it is important for the spouse to play an active role through engaging in candid discussions about pain and coping with their pain-experiencing spouse, rather than increasing solicitous attention to pain symptoms, inadvertently reinforcing pain behaviors. (Keefe et al, 1996)
• There are gender differences in pain perception and tolerance, with women showing less tolerance and more pain perception than men; thus, the effects of a negative marital relationship is likely to be more consequential for wives than husbands. Among patients with chronic low-back pain, marital dissatisfaction was associated with greater self-reported pain and disability among female patients but not males (Saarijarvi et al, 1990)
• Marital satisfaction plays a key role in patients' interpretations of their spouses' responses to their pain. Thus, it is only in couples that report global satisfaction in marriages that "solicitous" behaviors toward pain are perceived as truly meaningful. In dissatisfied marriages, patients may question the motivation of their spouses' behaviors or interpret them as unhelpful. (Turk et al, 1992; Kerns et al, 1990)
• In a sample of female patients with chronic pain, higher marital quality was associated with perceptions of the spouse as more solicitous and distracting and less punishing in response to pain behaviors. (Kerns et al, 1990)

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Gender Differences

• Women are more vulnerable to relationship-related health problems (the negative effects of poor marriages). One 15-year study showed that having unequal decision-making power in marriage was associated with a higher risk of death for women, though not for men. However, the converse is also true: companionship in marriage and equality in decision-making were associated with a lower risk of death for women.
• The physiological effects of marital stress are stronger and last longer in women.
• Domestic violence is the most drastic illustration of how a bad marriage or relationship can have extremely negative health consequences.
• The protective effects of marriage are notably stronger for men than women. Women are more likely than men to attempt to control others' health. Men typically see their wives as their main source of support and their sole confidant (especially about personal problems or difficulties).

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Women & Relationship Stress

• There are gender differences in pain perception and tolerance, with women showing less tolerance and more pain perception than men. The effects of a negative marital relationship are likely to be more consequential for wives than husbands.
• Women who were unhappy with their marriages experienced increases in blood pressure readings just from thinking about fights they had had with their husbands. (Kiecolt-Glaser, 2001).
• There is an association between criticism from spouses and joint pain in women with rheumatoid arthritis (and the converse: positive interactions or less negativity resulted in less arthritic symptoms. (Kiecolt-Glaser, 2001).
• Among patients with chronic low-back pain, marital dissatisfaction was associated with greater self-reported pain and disability among female patients but not males (Ray, O, American Psychologist, 2004, 59:29-40).

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Conclusions on Relationships & Health

• Married people have reliably better physical health profiles than unmarried people.
• Marital happiness contributes far more to global happiness than any other variable, including satisfaction with work and friendships.
• Being married is more beneficial for men's health than women's health.
• Physiological studies show that marital conflict is likely to have a greater negative impact on the health of women than men.
• While women on average experience more stress from marriage than men, they also derive more emotional benefits from a truly satisfying marriage.
• Marital happiness contributes far more to global happiness than any other variable, including satisfaction with work and friendships.

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What can you do?

• Highlight the strengths of your coping and ask your partners/parents/friends to do so as well. Tell them about your strengths, for example, how you regulate your diet, plan your day in terms of possible urgencies, etc. They should respect, even admire, your efforts.
• Ask your partners/parents and friends what their beliefs are about IBS. People often have erroneous ideas and you can help inform them about what is true and what is false. Their beliefs affect their attitude towards you, for example, thinking "If you only relaxed more, you'd be fine."
• Think about how family members dealt with illness — parents and siblings. Was there a sense of competency in your home? A lot of anxiety and catastrophe around illness? It matters because this is the view of illness that became part of you.
• Ask the people you are close to with help in "putting your illness in its place" (McDaniel, SH, Hepworth, J and Doherty, WJ. Medical Family Therapy 1992, New York, Basic Books). You need special care sometimes and inviting distractions at other times.
• Finally, if family relationships are significantly unsatisfying and stressful, family therapy with a trained and qualified professional can be extremely helpful.

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