Family Drama Is Bad for Your Health

Keep this in mind over the holiday season: A new study reveals family tension takes a toll on health over time

Illustration: Matija Medved

Thanksgiving dinners are frequently fraught affairs. The yearly family gatherings start out politely enough, but a few glasses of wine later, exchanges can turn nasty as buried resentments rise to the surface or conversation turns to politics.

New research suggests those dustups over dessert can take a toll. A study that followed 2,800 American adults over two decades found stressful family relationships were associated with poorer self-reported health years later.

Surprisingly, this association was absent for tension within marriages or other intimate partnerships. These first-of-their-kind results suggest acrimony among parents, children, and siblings may be more hazardous to your long-term health than squabbles with your spouse.

“It is very important not to ignore these strained family relationships,” says lead author Sarah Woods, director of behavioral health at the University of Texas Southwestern Medical Center. “They might have robust ramifications for your physical health.”

The study, published in the Journal of Family Psychology, was designed to expand the research on relationships and health beyond the role of domestic partners.

“We were worried that, as researchers, our focus was too narrow,” Woods explained in an interview. “There’s no evidence that once we turn 18 or get married, our other family relationships become less powerful or important.”

In an attempt to widen their lens, Woods and colleagues Jacob Priest and Patricia Roberson analyzed data from the Midlife Development in the U.S. project. It tracks a nationally representative sample of American adults as they pass through their middle years.

People in the study completed extensive surveys upon enrollment (when their average age was 45), a decade later, and again a decade after that.

“It’s a beautiful dataset to test exactly these questions,” says Woods, who noted that much research tends to focus on the beginning or end of life as opposed to the middle. “The purpose of this study is specifically to capture the many different roots of aging health.”

Using a scale of one to four (often to never), people in the study answered four questions about family-related emotional stress, including queries like: “Not including your spouse or partner, how often do members of your family make too many demands on you?” and “How often do they criticize you?” (The study did not address the question of abuse.)

The men and women then answered four questions about supportive behavior by family members, including “How much do members of your family really care about you?” and “How much can you open up to them if you need to talk about your worries?”

Similar questions were then asked about the participants’ spouse or romantic partner, including “How often does he or she make you feel tense?” and “How much does he or she appreciate you?”

“We found that greater family strain was associated with a greater number of chronic health conditions, and worse self-related health, 10 years later.”

The study participants then listed the number of chronic conditions they experienced over the past year, including headaches, backaches, and stomach problems. They also rated their overall health on a scale of one to five.

After taking into account several factors known to influence health, including age and education, Woods and her colleagues compared the participants’ answers with those they gave a decade afterward. A striking pattern emerged.

“We found that greater family strain was associated with a greater number of chronic health conditions, and worse self-related health, 10 years later,” Woods reported. Initial family stress levels predicted poorer health at year 10; year 10 stress levels predicted poorer health at year 20.

There was also some positive news: Family support reported at the 10-year mark was associated with better self-rated health at year 20. This suggests that as we age, and as our medical conditions grow more serious, an encouraging family environment can make a real difference.

“A lot of management of health issues involves behavior change, such as exercise or diet,” Woods says. “It can be really helpful to involve other family members in that so that you’re not the only member of the family who is watching what they’re eating, or trying to be more active.”

The oddest result — one that contradicts some previous research — is that the study found no association between intimate-partner stress and later health conditions.

“We were surprised,” Woods says. “We’re not exactly sure what to make of it. It might be that testing health effects at this level of detail highlights associations we haven’t been able to see clearly before.”

She does have some educated guesses as to why family stress may matter so much. “Most of us are embedded in family relationships for a longer amount of time (than we are with a wife or husband),” she says. This duration can make for very intense bonds, the toxic variety of which can negatively impact our health.

In addition, “In the United States, we do a lot of partnering, separation, and re-partnering,” she says. When the stress of a marriage becomes too difficult to live with, people have the option of getting divorced.

Patricia Thomas, a sociologist with Purdue University’s Center on Aging and the Lifespan, agrees. “Family ties are harder to sever, so you may live with more strain from family members but still feel obligated to interact with them,” she says.

“Also, this finding doesn’t mean that intimate partners aren’t important at all,” adds Thomas, who was not involved in this study. “Strain in intimate partner relationships was related to greater strain in family relationships. This speaks to how intimate relationships affect one’s other social relationships, which can, in turn, affect your health.”

The study did not examine precisely how family stress can harm one’s health, but previous research by Woods and others points to two possible pathways: direct and indirect. The direct way is through creating stress, which has been shown to cause a physiological reaction that puts wear and tear on the body. The indirect way is through coping mechanisms, which can include such unhealthful behavior as overeating and heavy drinking.

Is there a way to protect against it? Woods suggests the relatively common practice of marriage counseling could be expanded to include counseling other people in close family relationships.

“Bringing in professional support to help heal some of the hostility could be really helpful,” she says. “I’m a family therapist, as are my co-authors. Anecdotally, we’re seeing more clients who want to bring in their adult children.”

And if the other person isn’t interested? Woods recommends an individual regimen aimed at “modulating stress reactivity,” such as meditation. If you can’t extricate yourself from a difficult relationship, you can learn how to prevent the stress of interactions from building up in the body.

The population Woods and her colleagues studied was 91% white; their follow-up plans include replicating these results with a more diverse sample. “We’d also like to test interventions to maximize supportive family relationships, and minimize strained relationships,” she says.

But first, there’s Thanksgiving, which Woods and her colleagues all plan to spend with their families.

Here’s hoping everyone’s holidays are cheerful and conflict-free.

Tom Jacobs is a California-based journalist who focuses on psychology, behavior, creativity, and the arts. He was the senior staff writer of Pacific Standard.

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