Can Too Much People Pleasing Raise Your Risk of Autoimmune Disease?

Women are taking to social media with a bold directive: “Be a bitch or get an autoimmune disease.” The implication is that regular self-sacrifice causes chronic stress, which can do serious harm to the body. “People pleasing is probably the no. 1 cause for women’s autoimmune diseases,” wrote industrial engineer Ronak Pakzad on X.

The antidote, some women are saying, is to stop worrying about others and put yourself first: Stand-up comedian Pearl Rose, for example, shared on X that she “started being a bitch and my eczema was GONE.”

While doctors acknowledge a connection between chronic stress and a higher risk of developing an autoimmune disease, they say the reality is more complicated.

What Is the Theory Behind the ‘Be a Bitch or Get an Autoimmune Disease’ Trend?

It’s hard to know where this trend originated, but it taps into frustration at the societal expectation that women be “nice” and prioritize other people’s needs over their own, no matter the mental or physical cost.

Women are historically taught to be subordinate and put others first, says Rachel Gabelman, PhD, a clinical psychologist at The Ohio State University Wexner Medical Center in Columbus. “Although society has made great progress in this area, we have been taught as girls that we should be nice, quiet, and play with our dolls, whereas ‘boys will be boys’ — they will be loud, rambunctious, and wrestle,” she says. “We learn to be accommodating, seek approval from others, try not to rock the boat. This often leads us to feel that we shouldn’t be assertive and advocate for what we really need and want.”

“The body keeps score when it comes to stress and trauma,” Dr. Brinen says. In other words, all that stress can add up.

Is There Any Evidence to Back Up the Claims About People-Pleasing?

Some users have included scientific data to support their claims that people-pleasing can cause autoimmune disease. Artist Alida Sun, for example, cited on Instagram a paper published in 2021 that surveyed 290 women about how often they “self-silenced” and compared their responses with several health markers.

Experts Say the Connection Is Complicated

Doctors say it’s a leap to suggest that people-pleasing behavior in women can cause autoimmune diseases. “Stress does affect the immune system — that is well-known,” says Stanley A. Schwartz, MD, PhD, division chief of allergy, immunology, and rheumatology at the University at Buffalo in New York. “But it’s a very complex issue.”

Autoimmune disorders are often caused by a mix of genetics, environmental factors, and unknown elements, he says.

“Although stress is a physiological response in the body — and yes, there is a stress-health connection — the claim that autoimmune conditions are caused by stress or even that people pleasing — one particular stressor — increases the risk of autoimmune conditions is going from one end of a spectrum to the other,” Dr. Gabelman says. “This claim also leads women to feel responsible for developing an autoimmune disorder, that they brought this on themselves. This is absolutely not the case.”

Brinen also has concerns about labeling women who are assertive as a “bitch,” noting that it only perpetuates stereotypes about women. While Brinen encourages women to speak up about their concerns, he says that scare tactics aren’t a good idea. “We can make change without telling women they're going to get an autoimmune disease,” he says.

What the Trend Gets Right

Too much self-sacrifice is bad for you, Brinen says. “It's not good for your mental wellness to give in to everyone else's needs all the time,” he says. Healthy boundaries are important.

He recommends reflecting on your own needs and whether you feel resentful when you accommodate others. “Being assertive about, ‘This is what I can and can’t do’ is important for your mental health,” he says. “There's a link between your mental and physical health.”

The Bottom Line

While chronic stress is linked to numerous illnesses, including autoimmune conditions, it’s not the only reason people develop these diseases. Doctors say that linking autoimmune conditions to people-pleasing in women is inaccurate.

“There can be several causes of autoimmune conditions, and there may even be more than one gene involved,” Dr. Schwartz says. “Unfortunately, you can’t predict who will develop them or even how to prevent them.”

Importantly, Brinen stresses that you shouldn’t think of speaking up about what you need as “bitchy.” Instead, it’s simply about taking care of yourself.