When Family Feels Like the Enemy

Emotional conflicts between spouses or among close kin can take a toll on physical health.

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Clarified on 12/3/07: A recent British study referred to in this article appeared in the October 8 issue of Archives of Internal Medicine.

Ah, the holidays. Here come the glazed hams, the gifts—and the in-laws. While the season brings people together, some gatherings can be wrought with familial tension. And when households brim with testy spouses, moody teens, and button-pushing uncles, the inevitable bickering can't be good for anyone's health. Recurring spats, in fact, may be downright harmful.

Although close relationships are often wellsprings of health-enhancing support, accumulating evidence indicates that persistent domestic conflict deals a blow to the body—and especially the heart. In one of the latest studies, researchers found that British adults who were in adverse close relationships were 34 percent more likely to suffer coronary problems, ranging from chest pain to deadly heart attacks, than those who weren't. Numerous American studies have produced similar findings. Last year, for example, a long-term analysis of more than 1,000 marriages found that strained matrimonies take a clear toll on physical health over time, hitting the elderly the hardest.

Negativity-plagued relationships are toxic in part because of the effects of chronic stress, says Sheldon Cohen, a Carnegie Mellon University psychologist. In addition to damaging the heart, ongoing stress can deplete the immune system—creating openings for colds, cancers, and other maladies—and also lead to depression and risky coping behaviors like excessive drinking.

People who endure persistent interpersonal problems are more at risk than those reeling from an isolated blowup, Cohen says. But spouses aren't the only potential source of unrelenting trouble. In the recent British study, 20 percent of adults identified someone other than a romantic partner as the object of their closest relationship, according to the report in the October 8 issue of Archives of Internal Medicine.

Fortunately, strategies for minimizing feuds within the family are similar to those that can resolve conflicts with in-laws, coworkers, neighbors, and others, says Redford Williams, a behavioral scientist at Duke University. One technique he recommends is this: Before lashing someone with a sharp-tongued comment, step back and evaluate a brewing dispute. Say it's your turn to host the annual holiday family feast. Frazzled, juggling food prep for 20 people with a maniacal effort to scrub everything clean, you finally feel pleased by your home's facelift. Then the doorbell rings. In strides your 84-year-old aunt, craning her neck to eyeball the surroundings. "Well you certainly don't pay much attention to keeping your house tidy," she barks, flinging her coat over your outstretched arms. "If we did what came naturally, we'd either explode or keep fuming for the rest of the day," Williams says. Instead, he suggests, ask yourself four questions: Is this situation important? Is it appropriate to be feeling angry? Can this person be changed? Would it be worth trying to change the situation?

If yes comes to mind in all four cases, it's time to assert yourself, he says. Tell her what she just said upset you, explain why, and ask her to be more sensitive to your feelings. If even one question yields a no, however, don't rise to her bait. Instead, take a few deep breaths and avert a futile argument.

After years studying the strain hostility and anger place on the heart, he and his wife, also a doctor, have developed a system called Williams LifeSkills. A 2005 study found that when people with heart disease used Williams's techniques, their anger levels, average blood pressure, and blood pressure elevation when angry all went down; their depression and anxiety diminished; and they reported being more satisfied with family and friends.

Not all conflict is bad, according to Harvard University lecturer Tal Ben-Shahar, author of the new book Happier: Learn the Secrets to Daily Joy and Lasting Fulfillment. "Negativity is normal, as long as it's outweighed by positivity," he says. "No negativity at all is actually a bad sign" that people may be avoiding serious issues.