Patients who appeared physically healthy—meditating daily, eating organic foods, and taking supplements—were among the most severe cases treated by Lissa Rankin, M.D., at her Marin County integrative medicine practice. The shared factor among them wasn’t poor health habits, but unbalanced relationships. Rankin and psychiatrist Jeffrey Rediger, M.D., introduced the term relationsick in their book Relation Sick to explain how chronic over-giving in relationships can trigger physical illness.
The issue often begins with a mistaken belief that self-sacrifice equals love. Rankin draws parallels to Shel Silverstein’s The Giving Tree, where a tree gives everything to a boy until it’s reduced to a stump. Many women, she observes, were raised to view this as virtuous, but psychologically, it reflects a codependent pattern, where one person’s needs repeatedly overshadow their own. Over time, this fawn response, a trauma-driven urge to please others, becomes a cycle of nervous system dysfunction.
Scientific research confirms the connection between relationships and inflammation. Chronic stress, driven by unmet emotional needs, activates the HPA axis, the brain-adrenal system that regulates cortisol and immune responses. Repeated stress responses flood the body with inflammatory cytokines, molecules that trigger immune system alerts. Studies demonstrate that disrupted cortisol levels and an overactive HPA axis correlate with chronic inflammation, a factor in nearly every major illness.
Research links relationship conflict and low social support to altered cytokine production. Chronic stress impairs the HPA axis’s self-regulation, sustaining inflammation. The body’s stress and immune systems are interconnected, with suppressed anger often trapped in tissues rather than expressed.
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However, patients rarely link their symptoms to relationships. Rankin noted that patients would rather try another exercise regimen, a different diet, more supplements, or a pill than face the possibility that their marriage, mother-in-law, or boss was making them sick. The topic was taboo in her practice, making it easier to overlook the underlying cause.
Breaking the cycle starts with a deliberate pause. Rankin and Rediger’s six-step program emphasizes this step first. Instead of automatically saying yes to requests, patients learn to delay responses, from minutes to hours, to determine whether they’re giving from a place of genuine choice or exhaustion. For trauma survivors, this pause can feel impossible, as their “yes” response is as automatic as a reflex.
The pause serves a dual purpose: setting boundaries and reclaiming personal agency. Rankin recognizes that somatic therapy, which addresses the body’s physical reactions, may be necessary to rewire the automatic need to please others. The objective isn’t flawless behavior but heightened awareness, distinguishing between giving that supports well-being and giving that leads to over-functioning.
Chronic inflammation often lacks an obvious source until relationships are examined. The body may signal distress long before the mind recognizes it. Rankin and Rediger’s research indicates that even with ideal diets, exercise routines, and supplements, unbalanced relationships can undermine health. The first step toward improvement isn’t adopting a new supplement plan; it’s identifying the moments when the fawn response takes over.