The Hidden Link Between Chronic Compliance and Autoimmune Disease
What if what we've been taught to see as a virtue—being accommodating, nice, selfless—is actually harming our health at the most fundamental level?
What if the body keeps the score not just of obvious trauma, but of all the times we've said "yes" when our whole being wanted to say "no"?
The Paradox of the "Good Woman"
As women, many of us were taught from an early age that our value lies in making others comfortable. In anticipating needs. In swallowing our anger. In being, above all else, "nice."
We've been conditioned to believe that compliance is synonymous with goodness. That self-sacrifice is the highest form of love. That putting ourselves last is somehow noble.
This socialisation isn't harmless. It isn't merely a set of behavioural expectations—it's a fundamental disconnection from our authentic selves. And emerging research suggests this disconnection may be making us physically ill.
When the Body Rebels: Autoimmunity and The Compliant Self
Autoimmune diseases—conditions where the immune system attacks the body's own tissues—affect approximately 50 million Americans. Of those, nearly 80% are women.
For decades, this striking gender disparity has been primarily attributed to hormonal differences. But what if there's more to the story? What if the psychosocial expectations placed on women—particularly the expectation to accommodate others at our own expense—is literally turning our bodies against themselves?
Dr. Gabor Maté, in his groundbreaking book "When the Body Says No," proposes exactly this. Through decades of clinical practice, Maté observed a striking pattern: individuals with autoimmune conditions often exhibited specific personality traits, including:
Excessive concern with the emotional needs of others
Repression of healthy anger
An overwhelming sense of responsibility
Persistent self-neglect
Difficulty saying "no"
Sound familiar? These are the exact traits that define what trauma specialists now call "the fawn response"—a survival strategy where we attempt to avoid danger by pleasing others, often at great cost to ourselves.
The Science Behind the Connection
This isn't just theoretical. Recent research has begun to illuminate the physiological mechanisms connecting chronic compliance and autoimmune dysfunction.
A 2023 study published in Frontiers in Immunology demonstrated that chronic psychological stress—particularly the kind associated with suppressing authentic emotional responses—significantly alters immune function. The researchers found that women who regularly suppressed anger or disagreement showed elevated inflammatory markers and disruptions in T-cell function—both implicated in autoimmune processes.
Another 2024 study in the Journal of Psychoneuroendocrinology found that women with autoimmune conditions showed distinctly different stress response patterns compared to healthy controls. Specifically, they exhibited what researchers termed "threat response incongruence"—physiological stress activation (increased cortisol, inflammatory cytokines) without corresponding psychological acknowledgment of stress or threat.
In other words, their bodies were registering danger while their conscious minds overrode those signals to maintain social harmony.
This creates what immunologists call a "confused immune response"—where the body, detecting a persistent but unaddressed threat, eventually turns its defensive capabilities inward.
The Neurological Impact of Chronic Compliance
The implications extend beyond autoimmunity. A 2022 neuroimaging study revealed that chronic suppression of authentic responses actually changes brain structure and function. Researchers found reduced gray matter volume in the anterior insula and anterior cingulate cortex—regions crucial for interoception (the ability to sense your body's internal state) and authentic emotional processing.
Essentially, the more we override our authentic responses to accommodate others, the less access we have to our internal signals—creating a vicious cycle of self-disconnection.
This disconnection has been linked to conditions beyond autoimmunity, including:
Chronic fatigue syndrome
Fibromyalgia
Irritable bowel syndrome
Migraine
Certain neurodegenerative disorders
As Dr. Maté often emphasises: "The body says no when the mouth can't say no."
Culture, Gender, and Disease
It's impossible to discuss this topic without acknowledging its gendered nature. Women aren't inherently more compliant than men—we're socialised into compliance and then punished (socially, professionally, romantically) when we deviate from it.
A fascinating 2023 cross-cultural study examined autoimmune disease prevalence in women across societies with varying degrees of gender equity. The findings were striking: societies with greater gender stratification and stricter behavioral expectations for women showed significantly higher rates of autoimmune disease among female populations.
This suggests that what we're facing isn't simply an individual psychological pattern but a systemic issue—one that literally gets under our skin and into our cells.
The Autonomic Nervous System: Where Compliance Becomes Physical
To understand how chronic people-pleasing affects our physical health, we need to look at the autonomic nervous system—particularly the concepts of polyvagal theory developed by Dr. Stephen Porges.
Our nervous systems have evolved sophisticated responses to threat. The sympathetic branch activates our fight/flight response, while the parasympathetic branch allows for rest and restoration. A third branch, the ventral vagal complex, enables social engagement and connection.
The fawn response—this pattern of chronic compliance—creates a particular kind of autonomic dysregulation. We're simultaneously activated (detecting threat) and suppressing that activation (to remain socially engaged). This creates a physiological contradiction that, over time, taxes our immune function, hormonal regulation, and even neurological health.
A 2023 study in the Journal of Behavioral Medicine found that women who consistently overrode their authentic responses showed distinct autonomic signatures: elevated sympathetic activation coupled with forced social engagement signals—a combination that predicted inflammatory dysregulation with remarkable accuracy.
From Good Girl to Autoimmune Patient: The Path We Don't See
Consider this all-too-common progression:
A young girl learns that her emotions, particularly anger, are "too much"
She develops hypervigilance to others' needs as a way to maintain connection
This hypervigilance becomes automatic, operating below conscious awareness
Her authentic signals (hunger, fatigue, displeasure) become progressively muted
Physical symptoms begin: fatigue, pain, digestive issues
Medical providers suggest it's "just stress" or "all in her head"
Symptoms intensify until reaching diagnostic threshold
An autoimmune diagnosis confirms "something is wrong," but the root cause—the profound self-disconnection required to maintain chronic compliance—remains unaddressed
As Dr. Maté writes: "The physiology of one generation becomes the psychology of the next." Girls raised by mothers who couldn't say no often become women whose bodies eventually say no for them, through illness.
Healing the Compliant Self
Understanding this connection isn't about blaming ourselves or adding one more thing to fix. It's about recognizing that our bodies have been trying to communicate something important all along.
The path forward isn't about becoming selfish or abandoning care for others. It's about expanding our capacity to include ourselves in that care. About recognizing that true generosity cannot emerge from self-abandonment.
Recent therapeutic approaches that show promise for addressing this pattern include:
Somatic experiencing and other body-based therapies that help restore nervous system regulation
Internal Family Systems work that addresses the "good girl" or "people-pleaser" parts with compassion
Mindfulness practices specifically focused on interoception—rebuilding the brain's capacity to detect and honor internal signals
Women's circles and other community-based supports that validate the social roots of this pattern
A 2024 clinical trial published in Clinical Psychology Review found that women with autoimmune conditions who participated in therapy specifically addressing people-pleasing patterns showed significant improvement not just in psychological wellbeing but in immunological markers and disease activity.
A Different Kind of Self-Care
This understanding asks us to reimagine self-care not as bubble baths and spa days (though those have their place), but as the radical act of staying connected to our authentic needs and responses—even when, especially when, they're inconvenient to others.
It means recognising that every authentic "no" is a medicine for our nervous system. That healthy boundaries aren't selfish but essential for health. That our bodies need us to be real, even when our conditioning tells us to be nice.
As Gabor Maté so eloquently puts it: "The attempt to escape from pain is what creates more pain."
Perhaps the path to healing begins not with trying harder to get better, but with the simple, revolutionary act of listening to what our bodies have been trying to tell us all along.
A Deeper Exploration
If you recognize yourself in these patterns—if you've been the accommodating one, the peacekeeper, the one who anticipates everyone else's needs while dismissing your own—know that you're not alone. This pattern, what trauma specialists call "the fawn response," affects countless women, often invisible beneath the praise we receive for being "so helpful" and "such a giver."
To explore the somatic roots of this pattern and embodied pathways toward authentic presence, join my upcoming masterclass: "When Pleasing Becomes Protection." Together, we'll examine how this adaptation lives in your nervous system and practical steps toward reclaiming your authentic voice—not just for your emotional wellbeing, but for your physical health.
Because your body has been telling the truth all along. It's time we started listening.
Shalini Cameron is a somatic psychotherapist specialising in working with women navigating the intersection of trauma, chronic people-pleasing, and physical health challenges. Her masterclass "When Pleasing Becomes Protection" explores the fawn response and its impact on wellbeing.
References
Dantzer, R. (2023). Neuroimmune interactions in the regulation of inflammation and autoimmunity. Frontiers in Immunology, 14, 231-245.
Davies, K., et al. (2024). Stress response patterns in women with autoimmune disease: Threat response incongruence as a potential mechanism. Journal of Psychoneuroendocrinology, 67(3), 104-119.
Levine, P. A. (2015). Trauma and Memory: Brain and Body in a Search for the Living Past. North Atlantic Books.
Maté, G. (2019). When the Body Says No: Understanding the Stress-Disease Connection. Wiley.
Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. W. W. Norton & Company.
Ramirez, J., et al. (2023). Women's autonomic responses to social threat: Implications for inflammatory regulation and autoimmunity. Journal of Behavioral Medicine, 45(2), 78-92.
Richardson, T., et al. (2022). Neuroanatomical correlates of emotional suppression: A voxel-based morphometry study. Neuropsychologia, 172, 108256.
Walker, L., et al. (2024). Addressing people-pleasing behaviors in women with autoimmune disease: A randomized clinical trial. Clinical Psychology Review, 91, 102132.
Yasmin, S., et al. (2023). Cross-cultural analysis of gender stratification and autoimmune disease prevalence: A global health perspective. Journal of Women's Health, 32(4), 412-429.