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'Self-Silencing' Can Be Potentially Deadly for Women

TUESDAY, Sept. 24, 2019 -- Do you rarely express anger at those close to you? Is it difficult for you to reveal negative feelings in your relationships?

New research suggests that might make you more vulnerable to having a stroke.

In a study of women aged 40 to 60, those who suffered from "self-silencing" had an increased risk of having plaque in their carotid arteries.

Repressing one's feelings when they might threaten relationships or one's security, and appearing outwardly agreeable "while inner feelings grow angry and resentful is what is meant by self-silencing," said Dana Jack, a professor of psychology at Western Washington University who has pioneered research on this theory.

The study couldn't prove cause-and effect, but "women who felt less able to talk about their needs or feelings in their intimate relationships had a 14% higher likelihood of showing the most plaque in their carotid artery," explained lead researcher Karen Jakubowski, a postdoctoral fellow at the University of Pittsburgh. "Women with no observable plaque turned out to be more able to express themselves in their relationships, compared to the women who had more plaque."

That additional plaque could potentially lead to heart attack, stroke and other cardiovascular trouble, the researchers noted.

Jack wasn't involved in the new study, but she developed the scale used to help measure self-expression in close relationships.

"If you are self-silencing, you are disconnecting, but you're disconnecting not only from the other person but also from yourself," Jack explained.

"Most often, we reconfirm ourselves through talking to others, through voicing. But with self-silencing, women get really confused about what they really feel. 'Is there something wrong with me that I feel angry? Should I be more mellow?' This is what sets up the stress that can lead to physical problems," she said.

In the self-silencing study, 304 women filled out a questionnaire based on Jack's scale. They also completed self-reports on demographics, medical history, depression and physical measures such as blood pressure, height and weight.

"Past studies have found that women who report more self-silencing also report more symptoms of depression and anger, both of which have been related to cardiovascular disease," Jakubowski noted.

"When thinking about why self-silencing is related to plaque, future studies may look at depression, conflict in relationships or sleep problems as linking self-silencing and plaque. Depression and poor sleep are risk factors for carotid plaque," she said.

Not everyone, of course, goes on to have a heart attack or stroke. "But women at these ages who do not have other medical issues, such as diabetes, rarely have a cardiovascular event," Jakubowski said, "and this puts them at higher risk."

So why worry about this? "Studying the development of plaque may give us a sense of who's more at risk for later cardiovascular events, when we can do something about it," Jakubowski noted. "These results suggest the importance of supporting women toward greater self-expression of their feelings and needs in their intimate relationships, which may be important for their cardiovascular health in midlife."

The findings were to be presented Tuesday at the North American Menopause Society's annual meeting, in Chicago. Such research is considered preliminary until published in a peer-reviewed journal.

"This study shows the physical effects of stress, and demonstrates that we really need to be taking into account how self-silencing works in the body," Jack added.

More information

There's advice on preventing a stroke at the American Stroke Association.

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Posted: September 2019

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