Ignoring how you feel in a relationship could come with a physical cost

Early findings point to why "self expression and assertion" in relationships are so important. 

Unsplash / Gus Moretta

There are lots of reasons people hide the way they feel, whether it’s to preserve the feelings of others or because it’s simply part of their job. New research indicates that in the context of close relationships, doing so can come with a physical cost. Hiding how you feel doesn’t mean those feelings go away. Instead, they can damage the body.

Scientists from the University of Pittsburgh reveal that “self-silencing” — which is the inhibition of feelings to preserve a relationship — can take a toll on cardiovascular health. These findings haven’t been published yet but will be presented Thursday at the North American Menopause Society Annual Meeting in Chicago.

In a sample of 305 women, a team of scientists found that women who self-silenced were more likely to have plaque buildup in their carotid arteries. That’s a major artery in the neck that allows blood to blow from the heart to the brain.

Lead study author and postdoctoral scholar at the University of Pittsburgh Karen Jakubowski, Ph.D., tells Inverse that self-silencing is very different from emotional suppression. Emotional suppression means not showing emotions outwardly to regulate how you feel internally. Self-silencing is the decision not to communicate your needs or emotions for the sake of another person — usually another party in an intimate relationship.

“Self-silencing is not a form of emotion regulation – rather, it is one’s learned tendency to inhibit expression of feelings or assertion of needs within intimate relationships as a means to protect or preserve the relationship,” Jakubowski says.

Both women and men self silence, but they do so for different reasons, and have different consequences as a result. 


While Jakubowski’s study focuses on women, it’s true that men also self-silence. For example, in a 2010 paper published in the journal Psychology of Women Quarterly researchers compared the self-silencing tendencies of 155 male and 329 female cancer caregivers and found that both groups self silenced — although they gave different reasons for doing so.

Women saw self-silencing as a “requisite for coping” but men saw it as a “normal aspect of masculinity” and as a way to maintain a positive front to cope with a difficult situation. That paper also suggested that there could be different mental and physical consequences of self-silencing for men and women.

Jakubowski’s work dives deep into the women’s side of things. In particular, she looked at the cardiovascular health of 304 women who were on the verge of menopause, or had already entered menopause, and asked them to indicate how much they related to statements like “caring means putting another person’s needs before my own” and “I rarely express anger to those who are close to me.”

"Past studies have found that women who report more self-silencing also report more symptoms of depression and anger."

Even after controlling for socio-demographics, depression, or heart health, they found that self-silencing women had 14 percent greater odds of having plaque buildup in their carotid arteries.

Importantly, these results don’t mean self-silencing definitely causes these health issues. Instead, Jakubowski proposes that they may be part of a chain reaction. Self-silencing likely contributes to anger, sleep issues, and depression, which have previously been linked to the development of heart disease. That link will need to be evaluated further in the future.

Jakubowski emphasizes that people who suffer from self-silencing aren’t bad at communicating — there are lots of reasons why someone may decide not to express how they feel to a partner. But she notes that clinicians can play a role by supporting women to embrace “greater self-expression in their relationships” or helping people recognize a healthy relationship is one that allows for “self-expression and assertion.”

At this point, her research suggests that, regardless of what causes self-silencing, its effects could be hazardous in the long-run. While we don’t completely understand why this connection exists now, it does speak to just how powerful emotions can be, especially when we neglect them.

Partial Abstract:
Design: 304 late perimenopausal and postmenopausal nonsmoking women aged 40 to 60 participated in a study of cardiovascular health at midlife. Women completed the Silencing the Self Scale which measures self-expression in intimate relationships (e.g. “Caring means putting the other person’s needs in front of my own” and “I rarely express my anger at those who are close to me”). Women also provided self-reports (demographics, medical history, depression) physical measures (blood pressure, height, weight) and underwent phlebotomy (lipids) and ultrasound imaging of the carotid artery to quantify carotid plaque. Cross-sectional associations between self-silencing and carotid plaque (0,1, ≥2) were assessed in multinomial logistic regression models adjusted for age, race, education, blood pressure, body mass index, low-density lipoprotein cholesterol, medications (for blood pressure, lipids, diabetes) and depression.
Results: Women were on averaged aged 54 years; 72.5% identified as Non-Hispanic white, 22% African American, 5.4% other ethnicities. Forty-six percent showed evidence of plaque and 24% had a score of ≥2. Greater self-silencing was related to increased odds of plaque ≥2 [OR (95% CI) = 1.14 (1.02, 1.28), p=.02] adjusting for covariates (Figure 1).
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