by Joel Schmidt, MA, Licensed Mental Health Counselor, in Tampa, FL

Overcoming Health Anxiety: Things You Should Stop Doing (and Some You Should Start)

Are you constantly worried about your health? Does even the slightest new and unusual bodily sensation or symptom have you running to the doctor, sure that it must be something serious? Are you often worried that, even though you’re being told by medical professionals that everything is okay, something undetected and undiagnosed is growing inside of you and slowly killing you? Do you find yourself checking stuff a lot — such as your heart rate or different parts of your body — looking for reassurance that nothing is wrong? Are you spending a good deal of time googling symptoms and researching medical conditions that you may or may not have? If so, you’re probably dealing with disordered health anxiety: a health-focused anxiety that can cause a good deal of distress and an endless cycle of worry.

Although it’s never a bad idea to check in with the doctor every so often (get that annual physical!) or to do health screenings as recommended, excessive checking and reassurance-seeking may be making your anxiety worse instead of providing the much-desired comfort you’re hoping to gain from some of your behaviors.

What to Stop Doing

Here are four things you should stop doing (or at least do less of) if you have health anxiety, followed by some healthier ways of coping.

1. Stop googling symptoms.

We google symptoms to seek reassurance, not realizing that this kind of reassurance-seeking is actually increasing and reinforcing our anxiety.

2. Stop obsessing over your fitness watch.

If you have a Fitbit, Apple watch, or any other health tracking wrist device, ditch it if you find yourself constantly checking different measures such as your heart rate, heart rate variability, or ECG results. Like googling symptoms, this sort of behavior keeps us too internally focused and increases the anxiety surrounding health — and only provides very short-term comfort and reassurance.

3. Pay attention to your other checking and reassurance-seeking behaviors and limit them also.

Common checking behaviors include checking the mirror for discoloration of the skin or eyes, looking for new moles or bumps, weighing in or measuring different parts of the body, monitoring your pulse or blood pressure, asking family members or health professionals about your symptoms, and posting questions online for opinions about the health issues you have or suspect you have. Being aware of your body and checking for anything out of the ordinary can be smart and healthy when done as the medical community recommends, but the kind of checking that often comes along with health anxiety is generally excessive and unnecessary.

4. Stop interpreting every new and unusual bodily symptom as a sign of danger.

Our bodies do weird things. Everyone experiences odd pains and sensations every once in a while. It’s normal, and they usually come and go. The average person experiences these things as well but isn’t as internally focused and doesn’t pay the same level of attention to them.

It’s not easy to stop doing these things. It will be uncomfortable, especially at first. What you’ll likely find over time, though, is that stopping these things will liberate you from the prison that health anxiety can create that prevents you from living your life fully.

What to Start Doing

It’s best to replace old habits with new ones. Here are some things you should do instead of the four behaviors above.

1. Check in with your doctor every once in a while.

Get to the doctor to rule out any true medical concerns if you’ve been avoiding this, get your annual physical, do the recommended screenings, and follow through on your doctor’s recommendations. The key here, though, is to follow what your doctor recommends and not what your anxiety dictates. Certainly seek medical help if you suspect something serious, but try to recognize when what you’re doing is just looking for short-term relief and reassurance. The comfort is fleeting and soon enough you’ll be on to the next thing.

2. Talk to a therapist.

Find a therapist that specializes in anxiety disorders – specifically one with experience working with health anxiety. A therapist can help you better understand your health anxiety and teach you some healthier coping mechanisms for dealing with it. They’ll also help you gain insight about how you got here and help you better recognize the thoughts and behaviors that are contributing to your anxiety. Overcoming health anxiety takes work, but a therapist can help you make strides.

3. Recognize that some health anxiety is normal.

As humans, we all have some worry and concern surrounding our health and well-being. When we are struggling with health anxiety, though, our threat detection system is just a little more heightened than it needs to be. This can lead to nonstop false alarms.

4. Be open to the idea of tolerating and accepting a certain amount of uncertainty.

The only thing that would likely bring your health anxiety to zero would be knowing that your risk of experiencing future health-related issues is zero — and that’s just not going to happen. As you start to accept and tolerate some risk above zero, you’ll find that you also start to shift out of anxious thinking and into the kind of life you really want to live.

5. Remember how many times you’ve been wrong about your anxious thoughts.

“What ifs” are at the core of health anxiety — or any other anxiety for that matter. “What if this headache is a tumor growing in my brain?” “What if this stomachache is a sign of something really serious?” “What if this pain in my leg is a deadly blood clot?” How many times have you found yourself having these anxious thoughts and questions? And how many times have you been wrong about those worst-case assumptions? Since you’re reading this, you’ve probably been wrong about most, if not all of them. Let that fact sink in.

6. Shift your focus outward.

One of the hallmarks of health anxiety is an overly strong internal focus. When you notice yourself scanning your body or engaging with and entertaining anxious thoughts, try to shift from an internal to a more outward focus. Find something to do. Call a friend, go for a walk, read a book, and get engaged with the world.

Overcoming Health Anxiety

Living with health anxiety can feel like a rollercoaster. Following this advice will help you get off that ride and free you up to enjoy and make the most of your life. Connect with a therapist who understands what you’re dealing with and start making progress.

In ancient Greece, three doctors would see a patient together. They were the “knife” doctor, the “herb” doctor, and the “word” doctor. The people who “invented” medicine understood there was a connection between the mind and body and practiced accordingly. Our modern-day Western counterparts (surgeons, physicians, and therapists) rarely even speak with one another.

There is increasing evidence the ancient Greeks were right: Our thoughts, feelings, and attitudes can affect our biological functioning, and what we do with our physical bodies can affect our mental state. In fact, until about 300 years ago, most systems of medicine treated the mind and body as a whole. It wasn’t until the 17th century that Western cultures began to see the body and mind as distinct entities. Researchers began revisiting the mind-body connection in the late 20th century, and since then, they have compiled an impressive amount of data that indicates our bodies and minds share a common chemical language and are constantly communicating with each other. In this article, I will introduce just four of the ways research demonstrates this connection between the mind and body.

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Perhaps the most obvious of our examples is the effect of chronic stress, which we often think of as a state of mind, on physical health. Our bodies are designed to handle small doses of mental or emotional stress, and some of it is necessary for us to stay on top of our responsibilities and to remain safe in our environments. But we are not equipped to handle chronic stress without consequences.

Chronic stress can come from things like concern about a loved one’s health or well-being, living in unsafe conditions, money problems, excessive workloads, and so on. The experience of chronic stress causes an increase in heart rate, breathing to quicken, muscles to tighten, and blood pressure to rise. Most symptoms of chronic stress are physical: headaches, stomachaches, muscle tension or pain, sleep problems, chest pain, fatigue, changes in sex drive. Stress also causes an increase in the hormone cortisol, which researchers have linked to serious health issues.

One of the most extreme examples in the literature of how chronic emotional stress can affect the body is informally called “broken heart syndrome.” The experience of stress, due to a failed relationship, grief, or other significantly stressful reason, can cause a part of one’s heart to enlarge and fail to pump as well as usual. This enlargement can lead to temporary but severe heart failure. The New England Journal of Medicine published a study in which hormones such as adrenaline, noradrenaline, and cortisol released in the body due to chronic stress or grief were identified as the culprit for broken heart syndrome. Researchers found treating this kind of heart failure with traditional pharmacology would not be effective, whereas psychotherapy focusing on emotional management might help alleviate the problem.

It is important we recognize the connection between our bodies and minds if we want to feel our best. Therapists could ask people in their care to visit their doctors to check vitamin levels and screen for thyroid or GI issues if dealing with depression and fatigue. Doctors could consider chronic stress as a health hazard and encourage patients to speak with a licensed counselor when appropriate.

Another common example of how the mind can affect the body is the placebo effect. Dr. Lissa Rankin, founder of the Whole Health Medicine Institute and author of Mind Over Medicine: Scientific Proof That You Can Heal Yourself, reported “patients in clinical trials who received sugar pills, saline injections, or fake surgeries, but believe they might be getting the new wonder drug or miracle surgery, get better 18% to 80% of the time.” Conversely, other studies showed many medical students report developing symptoms suggestive of the illnesses they are studying. They are worried they are sick or will get sick, and their bodies comply by getting sick. Fear fills our bodies with harmful cortisol and epinephrine, while positive beliefs relax our nervous systems and allow our bodies to heal.

Now let’s switch from how the mind can affect the body’s ability to function properly to a couple of examples of how the body may affect the mind.

Gut health is an emerging field of medicine that seeks to balance healthy bacteria in the gastrointestinal system and improve digestion and nutrient absorption to increase both physical and emotional well-being. Researchers and doctors are finding new connections with the gastrointestinal tract and mental health all the time. There is a network of 100 million neurons that line the gut which is often called the “second brain.” The gut produces 95% of the serotonin, and 50% of the dopamine, found in our bodies. We have already linked these chemicals to well-being and stress management. A disruption or imbalance of these chemicals and the GI microbiota may lead to depression, while balancing the gut bacteria and improving nutrient absorption may have a positive effect on mental health.

Another way the body can influence how we think, feel, and behave is through body position, posture, gestures, and facial expressions. In a study published in the journal Psychological Science in 2010, people who sat or stood in expansive “power” poses for just one minute not only reported feeling more powerful and confident, but also had an increase in testosterone and a decrease in cortisol.

Conclusion

To review, the mind and body communicate in many ways, and most of them seem to have something to do with a shared chemical or hormonal language. Stress can affect health to the level of causing severe heart problems, and beliefs about our health (as illustrated by the placebo effect) can produce positive or negative results in physical well-being. We also know a healthy gut health can improve mental health, and certain postures may lower cortisol and raise testosterone, causing one to feel more powerful and confident.

It is important we recognize the connection between our bodies and minds if we want to feel our best. Therapists could ask people in their care to visit their doctors to check vitamin levels and screen for thyroid or GI issues if dealing with depression and fatigue. Doctors could consider chronic stress as a health hazard and encourage patients to speak with a licensed counselor when appropriate. All of us can do our best to pay attention to how our bodies and minds are communicating about our health and mental states and start acting on what helps us be well.

References:

1. Cuddy, A. J.C., Wilmuth, C. A., & Carney, D. R. The Benefit of Power Posing Before a High-Stakes Social Evaluation. Harvard Business School Working Paper, No. 13-027, September 2012.
2. Kleisiaris, C. F., Sfakianakis, C., & Papathanasiou, I. V. (2014). Health care practices in ancient Greece: The Hippocratic ideal. Journal of Medical Ethics and History of Medicine, 7, 6.
3. Rankin, L. (2012). Mind Over Medicine: Scientific Proof That You Can Heal Yourself. Carlsbad, CA: Hay House.
4. Templin, C., Ghadri, J., Diekmann, J., et al. (2015, September 3). Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. New England Journal of Medicine.
5. U.S. Department of Health and Human Services. (2014, October 8). What Is Broken Heart Syndrome? National Heart, Lung and Blood Institute. Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/broken-heart-syndrome

Traumatic stress involves a threat to a person’s life or physical integrity. It can have a profound impact on the brain, nervous system, and peripheral bodily systems. The impact of trauma on our emotional and mental health is discussed at length in the literature. However, trauma’s impact on the peripheral body (the peripheral nervous system, as well as the muscles and internal organs it connects to) is less understood. Said impact is often not considered in primary health care or even a therapist’s office.

Physicians and therapists need to understand that trauma impacts more than emotional and mental health. While the mechanism is not fully understood, we know from large, population-based studies that traumatic stress is a factor in chronic diseases such as cardiovascular disease (CVD). An investigation that was conducted across diverse populations showed that people experiencing depression, posttraumatic stress disorder (PTSD), and anxiety are at an elevated risk of dying from cardiovascular disease.

How trauma affects the heart

Trauma is associated with behavioral factors that affect heart health and lead to an increased risk for CVD. Individuals with a history of trauma are more likely to:

• Begin smoking.
• Have low levels of physical activity.
• Abuse illicit substances and/or alcohol.
• Refuse to take medicines prescribed by doctors or follow doctors’ orders after a cardiac event.

In addition, evidence suggests there are biological effects of traumatic stress that occur independently of behavior. For example, individuals with past trauma show elevated biological markers of inflammation. In other words, traumatic stress increases inflammation in the body. In turn, inflammation has been shown to increase the risk of CVD. The effects of traumatic stress on inflammation and the subsequent link to CVD is likely to play a key role in the causal connection between trauma and CVD.

The effects of trauma on inflammation seem to hold over time. A study designed to assess trauma and inflammation looked at a sample of 1,021 individuals aged 40-90 years. Higher lifetime trauma exposure was linked to increased levels of biological markers of inflammation at baseline and after five years.

Complex trauma

Complex trauma and its related condition, Complex Posttraumatic Stress Disorder (C-PTSD), is different than PTSD. The cause of PTSD can be a one-time incident or group of incidents such as combat, a natural disaster, or a car accident. Meanwhile, complex trauma results from exposure to ongoing trauma over an extended period of time. Child abuse or neglect and ongoing interpersonal (relationship) trauma tend to meet the criteria for complex trauma.

The data suggest that taking steps to take better care of our bodies is extra important if we have a history of trauma. Prolonged trauma over the course of childhood results in a different cluster of symptoms and outcomes. It is sometimes more difficult to diagnose and treat. Clients with a history of prolonged trauma are exposed to elevated risk for CVD on multiple levels. Studies have found that the cumulative effects of prolonged trauma are associated with elevated levels of inflammation and have the most potent effects on one’s physical health.

What can be done today?

Studies show patients with CVD demonstrate higher biological markers of inflammation following acute mental stress as well as higher levels of circulating stress hormones. In addition to the ongoing physiological effects, childhood trauma exposure is also associated with unhealthy behaviors that further increase the risk of developing CVD.

In some cases, gaining a better understanding of how state-of-mind and health habits affect our bodies in a concrete way (such as cardiovascular risk) motivates us to make changes. The data suggest that taking steps to take better care of our bodies is extra important if we have a history of trauma. Similarly, taking steps to care for our mental health can mitigate the damage that PTSD and C-PTSD can inflict.

Therapeutic interventions are effective for PTSD and related symptoms. A trained professional can teach you strategies to deal with difficult emotions such as fear, worry, anger, and sadness. They can also help you with emotion regulation by providing the support necessary for healing.

Dealing with trauma needs to be a holistic venture, where the body, emotions, and mind are all addressed and nurtured. In addition to taking steps to improve physical health, individuals are also encouraged to seek therapy to protect their heart on every level possible.

References:

1. de Assis, M. A., de Mello, M. F., Scorza, F. A., Cadrobbi, M. P., Schooedl, A. F., de Silva, S. G., … & Arida, R. M. (2008). Evaluation of physical activity habits in patients with posttraumatic stress disorder. Clinics, 63(4), 473-478.
2. Feldner, M. T., Babson, K. A., & Zvolensky, M. J. (2007). Smoking, traumatic event exposure, and post-traumatic stress: A critical review of the empirical literature. Clinical Psychology Review, 27(1), 14-45.
3. Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018). Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?. World Journal of Psychiatry, 8(1), 12-19.
4. Hendrickson, C. M., Neylan, T. C., Na, B., Regan, M., Zhang, Q., & Cohen, B. E. (2013). Lifetime trauma exposure and prospective cardiovascular events and all-cause mortality: findings from the Heart and Soul Study. Psychosomatic Medicine, 75(9), 849-855.
5. Kop, W. J., Weissman, N. J., Zhu, J., Bonsall, R. W., Doyle, M., Stretch, M. R., … & Tracy, R. P. (2008). Effects of acute mental stress and exercise on inflammatory markers in patients with coronary artery disease and healthy controls. The American Journal of Cardiology, 101(6), 767-773.
6. Kuhl, E. A., Fauerbach, J. A., Bush, D. E., & Ziegelstein, R. C. (2009). Relation of anxiety and adherence to risk-reducing recommendations following myocardial infarction. The American Journal of Cardiology, 103(12), 1629-1634.
7. Martens, E. J., de Jonge, P., Na, B., Cohen, B. E., Lett, H., & Whooley, M. A. (2010). Scared to death? Generalized anxiety disorder and cardiovascular events in patients with stable coronary heart disease: The Heart and Soul Study. Archives of General Psychiatry, 67(7), 750-758.
8. von Känel, R., Hepp, U., Kraemer, B., Traber, R., Keel, M., Mica, L., & Schnyder, U. (2007). Evidence for low-grade systemic proinflammatory activity in patients with posttraumatic stress disorder. Journal of Psychiatric Research, 41(9), 744-752.

How do you feel right now? Great? Okay? Not so good?

If you aren’t feeling your best, taking a moment to HALT is one of the best things you can do for your overall mental and physical health.

“Halt” translates to “stop” in German. But HALT is also an acronym that stands for Hungry, Angry, Lonely, and Tired. When one or more of these areas are out of balance, it is more likely we will struggle with health and overall well-being as a result. I encourage you to take a moment to reflect on whether you are feeling any of these things.

Let’s break each area down.

Hunger

Think about how poorly you feel when you are hungry. When your blood sugar gets low, you may get a headache, become irritable, or find it difficult to concentrate. These effects are the result of the brain releasing certain chemicals that interfere with the production of serotonin, a feel-good chemical.

We might jokingly say we are “hangry,” but this is a real thing. Hunger can put the body in an imbalanced state that can lead to mood swings, affect our ability to make decisions, and lower our impulse control. When you get physically hungry, it’s important to refuel your brain and body with nutritious food. If you know you are going to have a long workday, drive, or carpool ride, plan ahead. Assemble meals and snacks that include fruits, nuts, cheese, yogurt, or protein bars. It’s also important to stay hydrated. Water and decaffeinated teas offer many health benefits. [fat_widget_right]

Hungry can also refer to how we feel emotionally. Sometimes our everyday tasks and schedules take a toll on our mood and well-being. If you are bored with your routine, consider doing something to mix it up. Spend time with someone you haven’t seen in a while. Take an impromptu car trip! You might even consider trying an activity you have never done before—research shows that the human brain produces dopamine, a feel-good chemical, when we experience things for the first time.

If you aren’t feeling your best, taking a moment to HALT is one of the best things you can do for your overall mental and physical health.

If your emotional hunger persists for more than several weeks, it may be time to assess your routine. It’s one thing to experience a draining period while pushing through to meet a deadline, but quite another when the thought of work or facing certain people only inspires dread. If this is the case, it may be time to explore making some changes. If your activities of daily living are negatively being affected or if you often turn to unhealthy behaviors or substances to cope, the support of a therapist or counselor may be beneficial.

Anger

When we are angry or experiencing negative emotions, we may not be able to think rationally. If you feel angry, take some time to calm down first. Try to talk through what you are feeling with someone. Then you may feel better able to address the problem. If the issue is a chronic one, it can be helpful to break it down into manageable tasks. If you are able to take even one step forward, you are likely to feel less hopeless and helpless about the situation.

When in the midst of anger, it is generally a good idea to wait at least two hours (and maybe even speak to someone in person) before touching technology. In other words, no texting, tweeting, e-mailing, or posting! You don’t want to impulsively put something out in cyberspace that you may regret later when you are in a more rational state.

Loneliness

We all experience loneliness at times in our lives. Even when people surround us, we may not be actively interacting with them. What’s more, with all of our modern technology, many of us are plugged in electronically but not connected emotionally. Think about the number of times you may have made a problem much worse in your head by imagining the situation into a catastrophe. Once you actually talked out what was wrong, you gained a much more positive perspective.

It’s generally a good idea to reach out every day and connect face-to-face with other people, whenever possible. Isolation can be a breeding ground for depression and unhealthy choices. Even brief encounters can help reduce feelings of loneliness and have a positive impact on well-being.

Tiredness

Making sure we get enough sleep at night can help improve not only our physical well-being, but also our emotional health. When we are physically and emotionally tired, we are often more likely to engage in more negative thinking patterns and interactions. How much sleep is “enough”? Experts recommend seven to nine hours. Anything less than six can have damaging effects, such as an increased risk of accidents, diabetes, heart disease, depression, and obesity.

It’s also important to practice good sleep hygiene. I know sleep hygiene is a funny phrase. It doesn’t mean you’re a dirty sleeper. It refers to the habits that make restful sleep more conducive. These habits include getting up and going to bed around the same time each day, reducing distractions that interrupt sleep (pets, television, or the phone), monitoring caffeine and sugar intake, managing stressors, and limiting exposure to bright lights (light interrupts the biological process that allows melatonin levels to rise and help us drift off to sleep).

In Conclusion

When you find yourself getting upset, or if you just feel a bit off: HALT. Take a moment to do an internal assessment. Are you hungry, angry, lonely or tired? If so, take the steps necessary to address your needs. Note if you often tend to be out of balance in one area. Be intentional about correcting that area. By proactively making sure you never get too hungry, angry, lonely or tired, you can help protect yourself against many illnesses and mental health symptoms.

References:

1. Dean, N. (2018, February 26). The Importance of Novelty. Brain World. Retrieved from http://brainworldmagazine.com/the-importance-of-novelty
2. Hunger hormone increases during stress, may have antidepressant effect. (2008, June 16). UT Southwestern Medical Center. Retrieved from https://www.sciencedaily.com/releases/2008/06/080615142252.htm
3. LaMotte, S. (2017, September 27). Sacrificing sleep? Here’s what it will do to your health. CNN. Retrieved from https://www.cnn.com/2017/07/19/health/dangers-of-sleep-deprivation/index.html

“If we could somehow end child abuse and neglect, the eight hundred pages of the Diagnostic and Statistical Manual of Mental Disorders (and the need for the easier explanations such as DSM-IV Made Easy: The Clinician’s Guide to Diagnosis) would be shrunk to a pamphlet in two generations.” —John Briere

Conversion disorder is not one of the better known mental health conditions. Google search inquiries, perhaps the most reliable way of measuring public interest in the internet age, show only a fraction of the interest generated by bipolar, OCD, or schizophrenia. The DSM-5 uses a more explanatory name: “functional neurological symptom disorder.” But this name is even less known. Ironically, conversion disorder is the modern term for one of the oldest and most famous—though now rather taboo—concepts in mental health: hysteria.

Over two thousand years ago, the cultures most interested in medical knowledge—ancient Egypt and Greece—observed that a person’s physical symptoms sometimes seemed unconnected to the usual causes. Of course, it must be said that the ancient Greek theory of illness and health, based on imbalances in the “four humors,” did not provide the most solid basis for identifying what was and wasn’t a “normal” symptom. Nevertheless, Greek scientists were correct in observing that symptoms like shortness of breath, partial paralysis, and pain were sometimes not prompted by a physical injury or illness and would recede when the patient calmed, even without medical treatment.

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However, this accurate observation was taken on a walk down a blind alley—something common in the premodern age. Doctors observed that these “phantom” symptoms were far more common in women. (This has been repeatedly confirmed by modern studies.) But doctors at the time used the observation to make the factually inaccurate inference that the symptoms must be specific to women. If these mysterious symptoms were peculiar to women, the next step in the logic ran, they must be caused by something specific to women, or the womb, known in Greek as the hyster. Thus the concept of hysteria was born. In one of intellectual history’s odder chapters, bizarre theories of the wandering uterus playing havoc by pressing against internal organs were formulated and debated by some of the greatest minds of premodern medicine. Even stranger was the long-running medical debate on whether masturbation should be prescribed as a cure for hysterical symptoms or whether marriage was the proper prescription.

Conversion Disorder Today

Fast-forward to the 19th century. The new science of psychiatry at last produced the insight that these symptoms were caused by brain disturbances, not reproductive system issues. The broad category of hysteria was divided into several more defined categories. The most extreme of these became known as hysterical neurosis, conversion type. Finally, after decades of limping along without any particular reason, “hysterical” was dropped. The diagnostic name became “conversion disorder.” The condition was characterized by the presence of neurological symptoms without an identifiable organic cause.

Whether pain originates physically (from an outside source), from a neurological dysfunction, from a mental health condition, or even from the power of suggestion or auto-suggestion, it all consists of the same thing: electrical signals in the brain.

The symptoms of conversion disorder are diverse. They include pain, paralysis, numbness, fits, and even temporary blindness. One of the most interesting features of this condition is that before diagnosis, all other possible reasons for the pain must be ruled out. Doctors must confirm that a patient is not feigning or deliberately inducing the symptoms. They must also make certain the symptoms do not stem from a neurological disease. Practically speaking, this is extremely difficult. As a result, conversion disorder is one of the hardest mental health concerns to diagnose, often leading to vigorous debate on the rate of misdiagnosis.

Conversion disorder also raises an interesting philosophical issue about the nature of pain and other unpleasant physical symptoms. We tend to distinguish between “real” and “imaginary” pain. If a rock falls on your foot and you experience a sharp pain, then that is real pain. But if you experience the same sensation in the absence of any outside stimulus, you might consider that pain imaginary.

The reality, however, is that all pain exists within the nervous system. The sensation of feeling pain, in any part of your body, is an illusion the nervous system creates to make you respond in a certain way. Whether pain originates physically (from an outside source), from a neurological dysfunction, from a mental health condition, or even from the power of suggestion or auto-suggestion, it all consists of the same thing: electrical signals in the brain.

Now, this is not to suggest that there is no point in distinguishing between different forms of pain. In fact, identifying what causes the nervous system to act in a certain way is a critically important step toward effective treatment. I do want to suggest, however, that we consider changing our attitude about what constitutes an injury.

Everyone would agree that a parent who caused their child a serious physical injury was guilty of inflicting an injury. But what about emotional wounds, such as those resulting from trauma? Children who experience abuse, frequent conflict in the home, neglect, or other trauma may experience physical symptoms that last a lifetime and are no less “real” for being indirectly caused.

A growing body of research indicates conversion disorder may be strongly linked to childhood trauma. Indeed, it may be the case that many diagnosed cases of conversion disorder are really symptoms of underlying C-PTSD, which can manifest itself in a variety of ways. Future research may help shed more light on the interesting phenomenon of conversion disorder.

If you experience symptoms that have no clear cause, I encourage you to seek support from a medical and/or mental health professional.

References:

1. Akyüz, F., Gökalp, P. G., Erdiman, S., Oflaz, S., Karşıdağ, C. (2017). Conversion disorder comorbidity and childhood trauma. Archives of Neuropsychiatry, 54(1), 15–20. Retrieved from http://www.noropsikiyatriarsivi.com/en_makaleOzet?id=829
2. Ali, S., Jabeen, S., Pate, R. J., Shahid, M., Chinala, S., Nathani, M., & Shah, R. (2015). Conversion disorder— Mind versus body: A review. Innovations in Clinical Neuroscience, 12(5-6), 27–33.
3. Allin, M., Streeruwitz, A., & Curtis, V. (2005). Progress in understanding conversion disorder. Neuropsychiatric Disease and Treatment, 1(3), 205–209.
4. Ford, J. D., & Courtois, C. A. (2014, July 9). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1, 9. http://doi.org/10.1186/2051-6673-1-9
5. Stone, J., Smyth, R., Carson, A., Lewis, S., Prescott, R., Warlow, C., & Sharpe, M. (2005, October 27). Systematic review of misdiagnosis of conversion symptoms and “hysteria.” British Medical Journal, 331(7523), 989. Retrieved from https://www.bmj.com/content/331/7523/989

Many people reach adulthood without ever receiving adequate or accurate information about how their bodies work. As a result, many—women in particular—suffer in silence over symptoms they are embarrassed by. These hidden symptoms are often associated with vaginal, gynecological, and sexual issues. It’s time to remove the cloak of silence from one of these specific issues, called vaginismus.

Vaginismus: What Is It?

Vaginismus is the involuntary tightening of pelvic floor muscles that surround the vagina; this can make penetration very painful, if not impossible. It may prevent people from using tampons or menstrual cups, having a pelvic exam, or engaging in sexual intercourse. Some describe the experience as their vagina turning into a brick wall upon anticipation or initiation of penetration.

Vaginismus is believed to be one of the more common sexual issues a woman may experience (Spector & Carey, 1990). The condition occurs in about 1-6% of women (van Lankveld, Granot, Weijmar Schultz, Binik, Wesselmann, Pukall, Bohm-Starke, & Achtrari, 2010). Vaginismusawareness.com reports that 2 out of every 1,000 women have vaginismus. Many experts in women’s sexual health believe these numbers are underestimated due to the shame surrounding this condition and other difficulties obtaining accurate numbers.

Stigma, Isolation, and Frustration

Often accompanied by emotions such as shame, embarrassment, fear, frustration, and sadness, vaginismus may cause many to put off seeking medical care and live with the condition alone and in silence. Once, a woman shared with me that she felt broken because she wasn’t capable of engaging in one of the most primal of instincts, consensual sex. But those who experience this concern have no need to feel shame or embarrassment. In fact, there is hope for ending vaginismus. Some sources suggest that most of the clinical trials investigating treatments show success rates to be around 95% effective. [fat_widget_right]

Vaginismus is often characterized by determining if it is primary or secondary. Primary vaginismus occurs when a sexually active individual has never experienced pain-free vaginal penetration. The term “secondary vaginismus” is used when an individual has had vaginal penetration without pain in the past and suddenly develops the condition.

The Society of Obstetricians and Gynecologists of Canada (SOGC) also finds it helpful to determine if vaginismus is situational or global. “Situational” means the issue occurs in certain circumstances only, such as during sexual intercourse but not when using a tampon. “Global” is when the condition is pervasive and occurs in any situation where vaginal penetration is present.

What Can Cause Vaginismus?

Root causes of vaginismus are usually a combination of non-physical and physical triggers. Often, vaginismus involves fear or anxiety that any kind of vaginal penetration will be painful. Medical issues like urinary tract infections, yeast infections, endometriosis, vulvodynia, menopause, vaginal dryness, pelvic surgeries, and childbirth may lead to pelvic pain and vaginismus. Vaginismus can also be caused by traumatic experiences, including sexual abuse and rape.

Once, a woman shared with me that she felt broken because she wasn’t capable of engaging in one of the most primal of instincts, consensual sex. For anyone experiencing this concern, there is no need to feel shame or embarrassment.

The pubococcygeus (PC) muscle group in the pelvic floor plays the biggest role in vaginismus. Typically, a negative feedback loop produces a conditioned response for the PC muscle to tighten or contract when fear of pain is present. The pelvic floor tries to protect from injury by tightening the PC muscle, but in reality, this contraction makes the situation worse. Therapy for vaginismus is, therefore, a combination of mind and body interventions that remove the conditioned, involuntary contraction response of the PC muscle group.

Since vaginismus can have many causes, it is important to see a gynecologist for a proper diagnosis. This will help determine if any medical causes need to be addressed and allow you to develop the best customized treatment plan for pelvic floor healing.

There Is Hope: Treatment and Resources

There are many treatment approaches for vaginismus. These treatments usually take a multi-faceted approach, using methods such as graded exposure with vaginal dilators, physical therapy with or without biofeedback, therapist-assisted relaxation training, cognitive behavioral therapy (CBT), and relationship and sex counseling.

Often, counselors work closely with physical therapists that specialize in dealing with pelvic floor muscles and related issues to treat vaginismus. These specialists are often called pelvic health or women’s health physical therapists (PHPT). Pelvic health physical therapists may use biofeedback, which can help them identify the muscles that are contracting and thereby discover how to relieve the tension. These physical therapists, who often work to treat the entire body with relation to pain, can be invaluable resources in rehabilitating the pelvic floor muscles.

Dr. Peter Pacik designed a treatment program for more severe forms of vaginismus, and it received FDA approval for further study in 2010. He uses a combination of Botox injections to the vaginal muscles affected most and progressive dilation under anesthesia, followed by counseling services. This combined treatment approach has yielded high rates of success.

In addition, the website community Vaginismus.com is dedicated to providing resources and education about vaginismus. Those who prefer to work independently can also find out how to purchase a book on the topic and dilators. However, given the multimodal nature of vaginismus, it is recommended to have some professional supervision as you work on healing.

If you are struggling with painful or difficult vaginal penetration, or if vaginal penetration is impossible, know that there is hope. Although lack of awareness about vaginismus extends from the general public to even a portion of the medical community, there are many medical professionals who are aware of the condition and can help you address it. Above all, it is important to remember: you no longer need to struggle alone. Treatment is available, and there is no reason to feel shame!

References:

1. Spector I. P., & Carey M. P. (1990). Incidence and prevalence of the sexual dysfunctions: A critical review of the empirical literature. Archives of Sexual Behavior, 19(4), 389–408. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2205172
2. Vaginismusawareness.com. (n.d.). Retrieved from http://www.vaginismusawareness.com
3. Van Lankveld, J. J., Granot, M., Weijmar Schultz, W. C., Binik, Y. M., Wesselmann, U., Pukall, C. F., Bohm-Starke, N., & Achtrari, C. (2010). Women’s sexual pain disorders. Journal of Sexual Medicine, 7(1), 615–631. doi: https://doi.org/10.1111/j.1743-6109.2009.01631.x
4. When sex hurts–Vaginismus. (n.d.). The Society of Obstetricians and Gynaecologists of Canada. Retrieved from https://sogc.org/publications-resources/public-information-pamphlets.html?id=27

Dear GoodTherapy.org,

I’m a 27-year-old dental student with no serious medical issues other than sports injuries. Over the past few years, I have developed these thoughts about getting/being sick. I am constantly paying attention to my body. Any little thing I notice, I freak out. I am frequently going to the doctor for one thing after another and can’t seem to control my brain immediately thinking the worst. And every time I go, I am perfectly healthy.

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I also think that because I am believing in these fake ailments, it’s causing my brain to create symptoms! It’s frustrating because I don’t know how to stop feeling like this even though I know it’s mostly in my head. At this point, my girlfriend and family are getting sick of me asking things like “This isn’t cancer, right?” or “I’m going to be okay, right? It’s not going to kill me or anything?”

My main question is why am I always thinking of the worst-case scenario with my health? Why can’t I just have a sore throat and think “I must have a cold” instead of “I must have a rare infection that’s going to eventually kill me”? Any help would be awesome because as of now I feel myself worrying about being sick more than actually enjoying my life. Thank you. —Worried Sick

Submit Your Own Question to a Therapist

Dear Worried Sick,

You’ve asked a great question, and you are not alone in asking it: Why do you seem to always think of the worst-case scenario when it comes to your health, and what can you do differently so you are not immediately thinking the worst? The answer to this question is very much tied to understanding what may be behind this in the first place.

How you describe your concerns is consistent with what is conceptualized in the DSM-5 (the most recent version of the Diagnostic and Statistical Manual) as illness anxiety, as well as what prior to this would have been considered hypochondriasis (debilitating worry about having a serious illness). Regardless, please know there are things you can do to keep the worry from getting the better of you.

It’s worth stating this about anxiety more generally: some people are more prone to either anxiety or hypervigilance (heightened awareness about small sensations or possible threats, in this case health-related symptoms) than others. This can happen for any number of reasons, and it’s okay if you tend to be that way. What you are doing, essentially, is making sense of your experiences and protecting yourself from perceived threats of danger. While this can be adaptive—as doing so can tune you in to something that is wrong—it may become a problem when your interpretations are in overdrive. Furthermore, when you worry excessively, there is a negative filter operating on your thoughts which further intensifies and reinforces the worry.

You can learn how to modify your thoughts through psychotherapy. By seeking help for this, you can learn and practice skills to help you reduce hypervigilance and significantly reduce the tendency to immediately think the worst.

The bottom line is thoughts are powerful. When we experience a symptom such as pain, fatigue, or bloating, many people try to better understand and make sense of the experience, and depending on our thoughts, this may work for us or it may signal our thoughts are in overdrive. Additionally, constantly paying attention to bodily symptoms—and perhaps even creating symptoms, as you indicated—is a pattern worth changing. When we think the worst, this sends us down a dark path leading to debilitating anxiety. Furthermore, the way we think significantly affects the way we feel. So it makes sense that if we are thinking the worst about our health, we will feel bad. We are focusing on even the slightest discomfort or sensation and then feeling distressed over the worry around what it could mean. Clearly, you have realized that health-related anxiety or worry can become extremely uncomfortable.

By modifying the thoughts you have around bodily sensations, you can change your level of comfort. You will, in fact, be able to do just as you want—to be able to enjoy your life. Imagine how powerful a small shift in a thought can be. Instead of “This means I have a rare infection that will kill me,” try something else. Perhaps, “It is possible this is something that warrants medical attention, but it is also possible this will go away on its own.” You can learn how to modify your thoughts through psychotherapy. By seeking help for this, you can learn and practice skills to help you reduce hypervigilance and significantly reduce the tendency to immediately think the worst.

Here are some other tips that are important to consider:

• Beware of conducting your own health-related research. Many individuals who experience illness anxiety find they spend a lot of time online researching suspected conditions or symptoms. I suspect you know this already, being a dental student, but sometimes reading about things that “could” happen serves as an unnecessary trigger for anxiety. Be mindful of the amount of time you spend conducting such research, as well as how you feel while reading information (especially compared to times when you are not reading about symptoms). I suspect such information may spike anxiety in you. If so, consider whether this is useful for you to do.
• Consider new ways of coping and reframing. You mentioned you gather that the people close to you are already getting annoyed by you regularly seeking reassurance. This is one mechanism you have developed as a pattern to manage anxiety. Another is to frequently make medical appointments for these symptoms, which is essentially doing the same thing. You want reassurance that everything is okay. Because neither of these practices is sustainable in the long run, you’ll have to learn additional coping and reframing skills so you can adequately assess when it may be appropriate to seek reassurance.
• Implement relaxation as a regular practice. What usually helps you reduce anxiety? Finding a healthy outlet for stress and anxiety can be a useful tool to have at your disposal, regardless of the stressors you face.

Glad you’ve reached out!

Best wishes,

Marni Amsellem, PhD

I don’t like to admit it, but it’s true: generally speaking, women can’t handle their liquor as well as men. Although there are always exceptions, research indicates women are more sensitive to the effects of alcohol. More specifically, it hits them harder and faster.

One of the main differences between men and women related to drinking has to do with dehydrogenase, a metabolizing enzyme that helps the body get alcohol out of its system. This enzyme helps men process alcohol more efficiently, allowing them to drink more and not feel the effects as quickly. Women generally have less of the enzyme than men, so more of what women drink enters their bloodstream as pure alcohol.

Women tend to weigh less than men, and on average, women’s bodies contain less water and more fatty tissue than men’s. Because fat retains alcohol while water has a diluting effect, alcohol remains at higher concentrations for longer durations in a woman’s body, exposing her brain and other organs to more alcohol.

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It would seem feeling the effects faster simply leads to not being able to drink as much as quickly. However, a dangerous biological factor comes into play for females.

Females are at greater risk than males for developing serious alcohol-related physical problems. Once a drink is consumed, it goes through the digestive tract where it is dispersed through water in the body. The more water that is available, the more diluted the alcohol gets. Again, on average, women weigh less than men. As a result, women’s bodies are more exposed to the toxic byproducts the body releases when it breaks down alcohol. Thus, a female is at significantly higher risk for developing organ damage such as alcoholic hepatitis and cirrhosis. Females are also more likely than males to die from these conditions.

But the potential damage does not stop at the liver. Because women’s bodies are more exposed to alcohol’s toxins, they are more likely to experience alcohol-related brain damage and loss of cognitive function. Women who drink heavily also have an increased risk of thinning bones, falls and hip fractures, infertility and miscarriage, premature menopause, high blood pressure, heart disease, and cancer, especially of the breast, head, and neck.

While men have higher rates of alcohol use disorder diagnoses, women experience the physical damage from drinking significantly more quickly than men do. Consider a man and a woman who both drink heavily. Over time, statistically, the woman will begin to have more severe health problems within five years, while it may take 20 years for the same health issues to show in a man.

Another biological factor that affects the sexes differently is hormones. The fluctuations in hormone levels during a woman’s menstrual cycle may affect how she metabolizes alcohol. The intoxicating effects of alcohol will set in faster when a female’s estrogen levels are higher. This typically occurs just before her period.

These biological factors explain why women may become intoxicated after drinking less and are more likely to suffer adverse consequences after drinking smaller quantities for fewer years than men.

Alcohol, in a cruel turn, increases estrogen levels. A woman taking estrogen-added birth control pills will become intoxicated faster and stay that way longer. The medication slows the rate at which the body eliminates alcohol. Her hangover may also be worse than a male counterpart’s. These biological factors explain why women may become intoxicated after drinking less and are more likely to suffer adverse consequences after drinking smaller quantities for fewer years than men.

As my previous article reported, while drinking, men tend to experience more impairment in judgment than women do. And as noted above, a woman is likely to feel alcohol’s effects more quickly and for a longer period. These two biological realities can lead to a dangerous outcome: sexual assault. Each year, one in 20 women is sexually assaulted. Research confirms there is an increased risk when both the attacker and the victim consume alcohol prior to the assault.

A final way in which alcohol affects the genders differently is in seeking help. While the stigma of women drinking may be decreasing, there still appears to be stigma around getting help. Women are more likely to attribute their problems to depression, anxiety, or family troubles rather than drinking. This creates a ticking time bomb of sorts. Behavioral health care providers must be trained to look beneath the presenting issue and help women see the first step may be to address the alcohol use. Once the drinking is under control, other issues may be more easily recognized and resolved.

Conclusion

Due to biological differences, women, on average, experience the effects of alcohol use in different ways than men. Weight, body fat, enzymes, and hormones are all factors that increase the likelihood a woman will experience physical problems related to drinking more quickly than a typical male.

By remaining aware of their respective risk factors, women and men alike may make more educated decisions regarding drinking and ward off potential consequences.

References:

1. B.R.A.D. (2013). Women and Alcohol. Retrieved from http://www.brad21.org
2. Centers for Disease Control and Prevention. (2016). Fact Sheets – Excessive Alcohol Use and Risks to Women’s Health. Atlanta, GA: CDC.
3. Connery, H. S. (2011). Alcohol Use and Abuse – Harvard Medical School Special Health Report.
4. National Institutes of Health: The Office of Research on Women’s Health, Office of the Director, and the National Institute on Alcohol Abuse and Alcoholism. (2015). Alcohol: a Women’s Health Issue. NIH Publication No. 15–4956.

Dear GoodTherapy.org,

For years now, I’ve had a problem with grinding my teeth, and it only seems to be getting worse. I think it might be hereditary because my mom says she grinds her teeth, too. It used to only happen at night, but lately it’s almost constant, and I have to consciously stop myself from clenching my jaw even during normal daily tasks (like writing this letter, for example).

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I know things like biting cheeks and the skin on your lips can be linked to anxiety or other mental health issues. Is it the same with grinding teeth or jaw clenching? So far, amazingly, my dentist says my teeth haven’t been affected too much—but they always still try to sell me on expensive mouth guards. I’ve tried store-bought mouth guards and had a retainer for a while, but obviously they’re not really stopping the jaw tension even if they’re protecting my teeth. Sometimes I fall asleep biting my tongue and wake up with really pronounced indents from my molars. And I think sometimes the tension is related to how stressful my dreams are. But I don’t always remember my dreams, so I can’t say for sure.

Anyway, do you have any suggestions for things I can try? I wake up with a dull headache from this nearly every morning, and I’d really like to stop popping painkillers. I do think I have a more-stressful-than-average life, but honestly I prefer staying busy, and I don’t think my stress level is likely to change. Besides, I know people who lead lives with far more responsibilities and stress who don’t have this issue. Any ideas? —Ground Down

Dear Ground Down,

You’re not alone in this! Many people grind or clench their teeth, often in their sleep but also often in the daytime as well. Fortunately, there are many things you can try to help yourself overcome this issue and prevent more significant damage as a result of teeth grinding. I will provide some suggestions of things you can do, but first I’ll share a little more information about grinding teeth, how and why it happens and persists, and the role of anxiety in clenching or grinding teeth.

Clenching or grinding teeth without awareness, also known as bruxism, affects many (the incidence at any one time is around 10% of the population) and can range in severity from mild (no physical evidence of consequences) to severe. More notable effects of grinding or clenching include facial pain, tired jaw muscles or the development of jaw disorders, sensitive or damaged teeth, damage to tongue or inside of mouth walls, headaches, or earaches. It has been found to happen more frequently during periods of high stress, though it can become habitual and happen regardless of stress level. It also appears to have a hereditary link and happens more frequently in women than men.

Teeth Grinding and Anxiety

Does this mean you have anxiety? It’s hard to accurately assess that without information that can only be gleaned by talking to you in person. I recommend making an appointment with a therapist near you to discuss the issues you may be experiencing.

Certainly, grinding or clenching teeth can be one manifestation of holding tension and responding to stress, and many individuals who experience anxiety (and depression) do also grind their teeth. Grinding teeth does not necessarily mean you are experiencing anxiety (or depression), however. That said, one way to treat this is by using many of the same behavioral techniques you might use to help manage anxiety.

How Can Teeth Grinding Be Treated?

The first step in overcoming grinding or clenching teeth is to become aware of the issue. How did you discover you were doing this? Have you experienced headaches or tightness in your facial muscles? Has your dentist remarked about damaged teeth or suspect you might be grinding or clenching? Are you hearing from your partner that you are grinding teeth in your sleep? Ask yourself questions about the frequency and nature of this behavior. When are you grinding or clenching your teeth? Are you doing other activities at the same time (e.g., sleeping or working)? Do you notice you are feeling stressed when you are clenching your teeth? You may want to keep a journal for a period of time to track this behavior and when it occurs. This information can inform your strategies to help overcome these behaviors.

Essentially, a pattern has developed over time. For example, you have trained yourself to engage in teeth clenching if you automatically start clenching your jaw when doing things like typing on your keyboard or stepping out into the winter cold. Now is the time to break this habit, before you notice more significant consequences. 

Essentially, a pattern has developed over time. For example, you have trained yourself to engage in teeth clenching if you automatically start clenching your jaw when doing things like typing on your keyboard or stepping out into the winter cold. Now is the time to break this habit, before you notice more significant consequences.

Be aware of your mouth position. Believe it or not, there is a correct way to position your jaw. With your lips closed, you want to keep a gap between your top and bottom jaw, which can he assisted by placing the tip of your tongue just behind your front teeth on top. This may take some practice and regularly checking in to modify your habit of how you typically position your mouth. If, as you are reading this, you notice you are clenching your jaw, start to make a change. Begin by opening your mouth as if you are about scream, which is a great stretch for these muscles, followed by adopting the correct mouth position. This correct position will likely reduce tension in the jaw.

Implementing Relaxation Is Key

How do you know whether you are holding tension in your body? It is not always obvious. One thing to do is to scan your body for tension. Deliberately think about every muscle group in your body. Are muscles in your back or shoulders holding tension? Muscles in your jaw? Take a deep breath in and exhale. Let go of the tension where you notice you are holding it. Various relaxation techniques, centered on mindful breathing, can be especially effective. You may want to end every day by scanning your body for tension. You may want to do some yoga stretches. Additionally, try placing a warm washcloth on the muscles of your jaw to relax them before bedtime.

There are some suggested “don’ts” as well. Because this is a habit, be mindful of nonfood items you may “chew” on. Chewing pencils, straws, toothpicks, etc. may increase your tendency to engage in that behavior when you are not aware of it. Be aware of your chewing all around. Also, some experts would recommend reducing caffeine, nicotine, or alcohol before bed.

Other strategies to consider are what your dentist has been suggesting to you. If relaxation strategies and retraining your behavioral patterns are not the approach you would like to try, many individuals do utilize bite plates and find that custom plates are useful. If you are reluctant to try this approach, first try the behavioral strategies suggested above.

Knowing potential damages or consequences can be enough to motivate many to try to make a change. It sounds like you are quite motivated to overcome this on your own. Good luck!

Kind regards,

Marni Amsellem, PhD

Marriage later in life may cause middle-aged women to gain weight, but those who divorce may see improvements in their health, according to a study published in the Journal of Women’s Health. The study tracked marital status and various health measures to explore how marriage affects health.

Health Effects of Marriage in Middle Age

The study evaluated data on 79,094 postmenopausal women who participated in the Women’s Health Initiative Observational Study. Participants ranged in age from 50-79 and were evaluated over the course of three years. Researchers tracked the participants’ weight, waist circumference, blood pressure, smoking history, use of alcohol, exercise habits, and diet.

They then divided women into three groups: women who married or entered a long-term relationship during the study; those who separated or divorced during the study; and those whose marital status did not change—remaining either single or married—during the study period.

All of the women who were unmarried when the study began gained some weight during the study, which is not uncommon as women age. However, women who got married gained an average of two additional pounds more than their unmarried peers. Women who got married and those who remained single both experienced drops in diastolic blood pressure, but single women experienced a greater drop. Single women also drank less alcohol than those who married.

[fat_widget_right]Women who divorced lost weight and increased their physical activity. Women who remained married, by contrast, gained an average of two pounds and saw a decline in physical activity.

Is Marriage Good for Women?

Researchers have long debated the health benefits of marriage. While most research suggests marriage improves men’s health, the data on women is less clear. One study linked marital problems to health issues such as high blood pressure and an increased risk of heart attack for women, but not for men. Another study found married women did not gain the health benefits that married men gained. Women who divorced in their twenties were also less likely than those who stayed married to experience metabolic syndrome.

A study of more than 800,000 married people found married men and women with cancer were more likely to survive.

References:

1. Change in marital status post-menopause may impact health. (2017, February 6). Retrieved from https://medicalxpress.com/news/2017-02-health-postmenopausal-women-divorce.html
2. Knapton, S. (2015, June 11). Marriage is more beneficial for men than women, study shows. Retrieved from http://www.telegraph.co.uk/science/2016/03/14/marriage-is-more-beneficial-for-men-than-women-study-shows/
3. Kutob, R. M., Yuan, N. P., Wertheim, B. C., Sbarra, D. A., Loucks, E. B., Nassir, R., . . . Thomson, C. A. (2017). Relationship between marital transitions, health behaviors, and health indicators of postmenopausal women: Results from the Women’s Health Initiative. Journal of Women’s Health. doi:10.1089/jwh.2016.5925
4. Tamkins, T. (2009, March 6). Unhappily ever after: Why bad marriages hurt women’s health. Retrieved from http://www.cnn.com/2009/HEALTH/03/06/marriage.women.heart/index.html?_s=PM%3AHEALTH