It has been known that women comprise nearly 80% of autoimmune sufferers. But there’s new evidence to show that the reasons are more than just biological.

Emerging research says that suppressing anger puts people at higher risk of autoimmune diseases. With women being more inclined to do so, it follows that women are at higher risk due to behavioral conditioning. Dr. Gabor Mate, a physician, explained that women tend to internalize the “socially determined role” of being agreeable, which worsens the problem. Psychologist Maytal Eyal notes that this self-silencing tendency in women is linked to several other health complications too – including depression, HIV, cancer, and even premature death. It’s worth looking at the link between gender, emotions, and autoimmune diseases in particular, given the disproportionate occurrence rates across genders.

Autoimmune diseases occur when the body’s immune system fails to distinguish between foreign pathogens and its own cells. This could lead to the body creating antibodies against specific organs and systems, or non-specific antibodies that attack one’s own body. There are many kinds of autoimmune conditions, including specific ones like thyroid diseases, rheumatoid arthritis, and irritable bowel syndrome or multi-system ones like multiple sclerosis, systemic lupus, and more.

We’ve known for a while that female sex hormones are linked to a higher risk of autoimmune diseases in people: A process known as X chromosome inactivation predisposes women, non-binary people and trans men, who are born with two X chromosomes, to autoimmune diseases. Sex hormones play a significant role too, as testosterone decreases immune responses, which leads to a lower likelihood of autoimmune complications in people with testosterone. The opposite is true of estrogen; even pregnancy causes a spike in immune and inflammatory responses due to a “foreign” body in the uterus, which sometimes acts as a trigger for autoimmune conditions.

Autoimmune diseases also have psycho-emotional roots, thanks to hormonal changes in response to stress. Psychological stress impacts the immune system, whether by suppressing it or dysregulating it. Studies have shown that, at any age, psychological stress can cause changes in estrogen and testosterone levels, leading to a chain of events that could trigger conditions like lupus. “Autoimmune diseases in women are most likely due to changes in estrogen levels during mental, physical, premenopausal, post-menopausal, and pregnancy-induced stress,” one study reports.

A 2015 Frontiers study showed that traditional gender socialization is more advantageous to men in terms of health outcomes. Stress is a huge part of it: women experience more chronic and more threatening stressors than men, with stress hormones like cortisol and catecholamines triggering dysfunction in the immune system. Catecholamines elevate pro-inflammatory cytokines, and “abnormally high concentrations of pro-inflammatory cytokines are related to several conditions and risks including cardiovascular risk factors and coronary heart disease, diabetes mellitus, inflammatory and autoimmune diseases, depression and schizophrenia.”

It thus follows that people experiencing multiple axes of systemic exclusion – like Black and Brown women – are more prone to stress, and thereby more prone to autoimmune diseases. In 2022, researchers from the University of Pittsburgh found that women of colour who suppress their anger are 70% more likely to develop carotid atherosclerosis, which is linked to a higher risk of heart attacks.

Stress is a function of societal constructs around gender roles. “In a patriarchal society like India, girls are urged to smile more, speak in a polite manner, and hide their own emotions out of consideration for the pleasure of others,” note researchers Anmol Shekhar Srivastava and Dr. Jaya Bharti. “It is now known that many ‘women's ailments,’ such as various types of disordered eating, autoimmune disorders, chronic fatigue, and pain, are influenced by suppressed, repressed, misdirected, and disregarded anger,” they add, in an analysis of women’s anger. Further, as Soraya Chemaly notes in the book Rage Becomes Her, anger is the most significant emotional contributor to pain.

In short, suppressed anger’s indirect link to autoimmune conditions in women is roughly as follows: traditional gender roles prompt women to be caregivers by elevating others’ needs over their own, which is linked to more stress (and even mental illnesses), which is linked to a higher likelihood of immune dysregulation. While the research making a direct, quantitative and causal connection between higher rates of autoimmune disorders and stress-induced suppressed rage is still developing, there’s a clear enough consensus that overall, self-silencing is bad for women’s health, especially immunity.