Dr. Schubiner Why does TMS occur more commonly in women?

Forest · Jun 5, 2012

I came across this blog post by Howard Schubiner and I thought it did a really good job at explaining how stresses and our personality traits can attribute to our symptoms. One thing that I liked about this post was that Dr. Schubiner mentioned sometimes just taking time for ourselves and learning to say no to the demands of others can be really helpful in overcoming TMS. In the end, recovery comes down to identifying and understanding what stress we have and how to handle the pressures in our lives.

Here is the post by Dr. Schubiner. I am re-posting it here with his permission. I would love to hear some of your thoughts about it.

Gender issues and MBS—Why does MBS occur more commonly in women?–MBS Blog #16

Scientists have known for many years that women are more likely to develop certain illnesses, which we now understand to be caused by Mind Body Syndrome. These disorders are irritable bowel syndrome and migraine headaches, which are seen about three times more frequently in women than in men. Irritable bladder syndrome (christened Interstitial cystitis by modern medicine), TMJ disorder and fibromyalgia are diagnosed in women about 4 to 6 times more commonly than in men. An interesting comparison is back pain, which is seen equally between women and men (actually woman even have slightly higher rates of low back pain than do men; approximately 29% in women versus 25% in men). Researchers have been silent for the most part on why these differences occur. The usual fall back position is that it must be genetic. But these are not primarily genetic disorders (see MBS blog #8 for details on the genetic aspects of MBS). They are learned and they develop due to stress and emotional reactions to stress over a lifetime.

I have been pondering the discrepancy between women and men in the MBS set of disorders and I have some thoughts that might help to explain the differences. I must state at the outset that no one really knows the answer and my thoughts are just that; thoughts to get the field started, so that hopefully we can learn enough to make some definitive conclusions at some point.

First of all, we know that certain factors lead to the development of MBS. Those are who are exposed to childhood traumas, such as emotional, physical and/or sexual abuse, fear, shame and guilt are particularly susceptible to MBS later in life. The reason for that appears to be a resetting of the autonomic nervous system to become over-reactive. When stresses occur in our lives during situations in which we are powerless and vulnerable, they are more likely to create MBS. It is not only the life stresses that create MBS, but it is also the pressures that people put upon themselves; these internal pressures are extremely important as they magnify the life stresses greatly and are difficult to get away from since they are self-imposed. Finally, there are certain societal expectations and learned “sickness roles” that can play a part in the development of MBS.

Given this background in the features leading to MBS, how might these factors affect women and men differently? Childhood trauma affects both genders of course, but females are more likely to be victims of sexual abuse and they are often more likely to feel powerless in family situations of violence and abuse. Girls may grow up close to their mothers and therefore may have inadvertently “learned” that headaches or abdominal pains are common medical conditions in their family. Vulnerability and lack of power are often seen in women who are in work situations. Sexual harassment on the job, lower pay for the same work, and decreased ability to obtain promotions are common occurrences for women and can contribute to MBS. Society expectations of women should be capable of doing are increased and this can lead to increased pressure on women to be excellent at their jobs, at being a mother, a daughter, a sister, a wife, a student, a homemaker, a cook, a chauffeur, and all of the activities and responsibilities of modern life.

Note the situation one of my patients described at the time she developed MBS. “I was thirty-three years old and pregnant with my second child. We were living in the inner city as part of a church that was called to seek racial reconciliation. I was deeply committed to doing all I could to address the injustice that surrounded me. I was being encouraged to accept more and more leadership in the church, and did so as I longed to be a role model for the younger women in our midst. So not only was I trying to work part-time outside the home addressing gross injustice, I was also trying to carve out enough space to be a great ‘stay-at-home-mom’ like my mother. And the same time, there was the longing within to create a beautiful home, cook great healthy meals, be the perfect wife, and then on top of that, be a gorgeous sexy woman that a man likes to come home to.” This perfectly describes the tremendous pressures put upon modern women by society and by themselves.

When we consider self-imposed pressures, there are some research studies that have looked at the personalities of women as compared to men in societies all over the world. In one study of over 17,000 people from 55 different countries, women reported higher levels of being extroverted, agreeable, conscientious and worrying. In another study of over 23,000 people from 26 countries, women reported being more warm, open to feelings, agreeable and worrying, while men were more assertive and open to new ideas. These studies support the concept that women are more likely to put more pressure on themselves. They appear to have a higher level of conscience, of obligation, of duty, of “the shoulds” (as Dr. Sarno calls it) or of the super-ego (as Freud called it). Higher levels of self-imposed pressures are critical factors in the development of MBS. In addition, in these studies, the women who had higher levels of these traits were those from modern urban societies, rather than those from more traditional rural societies.

I have often noted that women with MBS are more likely to be more self-critical, self-blaming, feel more obligation, have a stronger sense of duty, worry excessively, take responsibility for external problems, be more caring about others, and be less likely to do things for themselves. I have found that when women take more time for themselves and begin to do more things for themselves and learn to “say no” sometimes to the needs or demands of others, their MBS symptoms rapidly improve.

Here is a quote from a woman who completed my MBS program. “In order to heal yourself from fibromyalgia and other TMS symptoms, you have to look at the truth in your life, no matter what it is. If you live an illusion, you will never reach the end you seek. In this program, I have learned the truth about my life and myself. I have learned things that I needed to learn and have made difficult, yet important, decisions about my life and my relationships. To have health in our bodies, our minds need to be at peace. As I have found peace, I find I like myself more and I find that my body is healthy again. Thanks to this program, my bodily pain, my headaches, and my fatigue are so much better.” She learned that she was important and that she had to make decisions for herself and take control of her life. She had to do things that might have been difficult, but that were for herself, even if they made some other people upset. She needed to free herself from some of the self-imposed pressures.

In my opinion, these are the reasons that women have higher rates of MBS than men. It is not because they are weak or “crazy,” it is because they are often kinder and more caring, and are more likely to have both external and internal pressures.

To your health,

Howard Schubiner, MD
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veronica73 · Jun 5, 2012

Well, I don't think women are any nicer than men, but women are socialized to be "people pleasers" which is a big TMS trait.

BruceMC · Jun 5, 2012

Perhaps, my gender precludes my having decided opinions on this issue, but experientia docet ('experience teaches') me this: Of the three women I know who have fibro and IC, all three of them are 'people pleasers' and likewise, at one time or another, have striven to be "super moms". Of course, I don't have all the facts - only little bits of information I've taken note of in passing - but would have to agree with Dr Schubiner that they all have put a great deal of pressure on themselves to be good and perfect in their social roles as wives and mothers.

Beach-Girl · Jun 8, 2012

I think Dr. Schubiner is right on here. I also agree with Veronica. But I think we (women) are raised as people pleasers or we're not. I was. Couldn't do enough to please my mother. I don't even realize it sometimes. This is a great post. Thanks Forest for posting it.

BG

BruceMC · Jun 8, 2012

If these are 'feminine traits' so be it, but I have realized throughout the course of the SP and Dr. Schubiner's Unlearn Your Pain exercises that I did try - albeit unsuccessfully - for many, many years to please my parents by accomplishing a lot in business and academia. And then again, while taking care of my later mother with dementia from 1997 to 20001, I was trying with all my might to please her. Sounds like a self-effacing pattern that predisposed me from TMS pain I'd say, especially when there's no one in the family left to please anymore but myself!

veronica73 · Jun 8, 2012

I felt like always being "nice" was encouraged by my church growing up, and I think that was more influential to me than any gender-related pressures. People pleasing definitely comes up in men too; I think my boyfriend is more of a people pleaser than I am.

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