Elsevier

Aggression and Violent Behavior

Volume 8, Issue 3, May–June 2003, Pages 283-312
Aggression and Violent Behavior

Marital conflict and health: Processes and protective factors

https://doi.org/10.1016/S1359-1789(01)00067-2Get rights and content

Abstract

Marital conflict has been identified as a risk factor for poor health in marriage partners and their children. However, the mechanisms through which marital conflict influences health have not been fully elucidated. Furthermore, there is variability in health outcomes associated with marital conflict. The current endeavor proposes that the impact of marital conflict on physical health is due, at least in part, to excessive sympathetic arousal and incorporates the Polyvagal Theory to explain how vagal regulation (an index of parasympathetic regulation) may aggregate or attenuate the risk for poor health outcomes in the context of conflict. Examination of intervening variables, such as vagal regulation, allows for elucidation of the relation between marital conflict and health problems in children and adults. Specifically, this paper proposes that individuals with high vagal regulation will be protected from the impact of marital conflict on physical health by the mitigation of detrimental sympathetic arousal, whereas individuals with low vagal regulation will be more vulnerable to the effects of marital conflict on health. Support for this proposition is provided through the presentation of literature on vagal regulation as a protective factor against negative health outcomes in children exposed to marital conflict.

Introduction

The relation between marriage and physical health has been recognized for many decades and explored in various forms. Initially, it was thought that marital status per se was protective of the health of marriage partners. This idea spawned many large-scale studies examining the relation between marital status and health (e.g., Berkson, 1962, Carter & Glick, 1976, Gove, 1973, Ortmeyer, 1974, Verbrugge, 1979). Although these studies partially supported the proposed association between marital status and health, they also indicated that the relation was more complex than previous formulations indicated. Following this first generation of research, a movement developed that continues to the present to explore specific characteristics of marriage that relate to the physical health of the partners and children of the marriages. Presently, missing from this literature to our knowledge is an explication of the physiological processes that can account for the relation and particularly those that act as moderators (i.e., factors that change the relation between risk and outcome variables when present; Baron & Kenny, 1986).

This paper posits to connect some of the gaps in a portion of this body of literature by reviewing research related to the effects of martial conflict on physical health, providing a conceptualization of the physiological processes active in the association, and proposing a physiological model of moderation of the relation. As such, the first aim of this paper is to review empirical explorations of the relations between marital conflict and the physical health of marriage partners and their children. After the review, this paper will present a potential pathway by which conflict may influence health, namely through chronic or excessive sympathetic activation. In this context, the literature related to physiological reactivity (changes from baseline levels of arousal in response to challenging or stressful conditions) to conflict will be presented. Finally, the primary objective will be addressed by explicating the role of vagal regulation as a moderator in the relation between marital conflict and physical health, drawing heavily from the Polyvagal Theory that will be explained in more detail in following section Porges, 1995b, Porges, 1997, Porges, 1998, which implicates sympathetic arousal as more detrimental than parasympathetic arousal.

Although vagal regulation has not been studied among adults as a moderator of the association between marital conflict and physical health, assertion of its usefulness for study is supported by empirical literature in other areas. Validation comes from the implication that vagal regulation can avoid pernicious sympathetic arousal (such as the arousal that occurs during marital conflict) which is linked to the development of health ailments Burns et al., 1992, Cacioppo et al., 1995. Further support stems from research demonstrating that vagal regulation is associated with adaptive emotional regulation (the capacity to manage strong emotion and organize resources towards the attainment of an external goal; Katz & Gottman, 1997) and is protective for children exposed to marital conflict in behavioral problems, peer relations, academics, and physical health domains El-Sheikh et al., in press, Katz & Gottman, 1995, Katz & Gottman, 1997.

Research explicating the role of moderators, such as vagal regulation, in the relations between marital variables (e.g., conflict) and physical health is essential due to the pertinence of the results to a vast population of individuals. Furthermore, there has been a recent call in the literature to examine psychophysiological mechanisms that underlie the relations between social circumstances and health in order to “unravel” the association (Carroll & Sheffield, 1998). In addition, although a robust negative association between marital conflict and health has been established, not all individuals are at equal risk. Therefore, examination of moderating variables improves prediction by identifying those individuals at differential levels of risk.

Of note, this paper is intentionally limited in scope to the critical examination of the influence of marital conflict on physiological predecessors of physical ailments and subsequent incidence of health problems. Absent are reviews of research relating marital variables to disease progress and outcome, as well as the impact of disease states on marriage. These areas, although pertinent, are not as intimately tied to the main premise of vagal regulation as a moderating variable. Thus, they fall outside of the scope of this endeavor.

Section snippets

Marital status and health

The progression of research exploring the association between marriage and health fits well with the spirit of Fincham's (1994) heuristic distinction between research that documents a direct, general relation (first generation) and that which attempts to explain the association and specifics of the relation (second generation). First generation research examining marital status and health established that married individuals have better concurrent physical health and reduced mortality risks

Marital conflict and health

Marital conflict has been found to be longitudinally predictive of health among adults (particularly men) who divorce and those who remain married to an extent that elevated conflict is associated with greater risk of health ailments among both groups (Jones, 1992). Furthermore, among married individuals, cohesion, which included a question regarding marital conflict, was more consistently and robustly associated with the health and well-being of the partners than other measures of marital

Conceptual frameworks

The protection hypothesis is one first-generation theory used to explain the relation between marital status and health. The protection hypothesis stems from the stress/social support framework and it asserts that marriage affects health by decreasing vulnerability to stress, providing material resources, facilitating health promoting behaviors, and/or increasing the availability and/or quality of social support Berkman & Syme, 1979, Gove, 1973, Kobrin & Hendershot, 1977, Ortmeyer, 1974,

Marital conflict, physiological processes, and health

Given the connection between marital conflict and health, the question arises: through what mechanism does conflict influence physical health in such a manner that it could at least partially account for the relation between marriage and the health outcomes reviewed? It has been proposed that risk factors such as marital conflict are associated with sustained, repetitive, and possibly extreme reactivity in endocrine and cardiovascular domains (Smith & Christensen, 1992) and result in health

Conflict characteristics and health

Although marital conflict is generally arousing, specific characteristics of conflict such as negativity and hostility have been found to be associated with exaggerated physiological responses as demonstrated in immune, cardiovascular, and endocrine domains. These physiological changes, although beneficial in a physically threatening situation, are potentially harmful when chronic or frequent and are proposed to be the link between negative aspects of the marriage and disease states (Uchino,

The Polyvagal Theory

In the literature, the physiological components of emotion have traditionally been attributed to the influence of the sympathetic nervous system (SNS). This pervasive attribution is most apparent in the nomenclature of the components of the autonomic nervous system as the sympathetic, meaning “with feeling,” and the parasympathetic, meaning “guards against feeling” (Porges, 1997). This view of emotional arousal as exclusively sympathetically based not only limits the explication of the richness

The protective function of the vagus

This three-tiered conception of emotional responding provided by the Polyvagal Theory leads to the assertion of this paper that individuals who are more adept at regulating emotion via the NA vagus are able to produce an adaptive behavioral response (e.g., flexible, appropriately aroused, and soothable) in the context of marital conflict (a chronic stressor). In addition and more pertinent, these individuals also avoid the metabolic expenditure and health risks associated with resorting to

Vagal regulation and response strategies

When faced with stressful events, vagal regulation may facilitate the use of coping strategies including motion, attention, emotion, and communication (Porges, 1995b). As previously mentioned, the NA vagus is anatomically and functionally linked with several other cranial nerves involved in the expression of emotion (Porges, 1995b). Regarding anatomy, the glossopharyngeal and accessory nerves, which control the pharyngeal and neck muscles, also originate in the NA Porges, 1995b, Porges, 1997.

Summary and conclusions

Based on this literature, it is apparent that characteristics of marriage, particularly conflict, have impact on the health of individuals. Conflict generally results in physiological arousal, particularly arousal of the SNS. Chronic and sustained SNS arousal is associated with decrements in immune functioning. Such processes likely account at least partially for the relation between marital status and health. Therefore, individuals with adaptive vagal regulation may not only avoid this

References (136)

  • A. Baum et al.

    Stress as a psychophysiological process

  • O.V. Bazhenova et al.

    Vagal reactivity and affective adjustment in infants. Integrative neurobiology of affiliation

    Annals of the New York Academy of Sciences

    (1997)
  • T. Beauchaine

    Vagal tone, development, and Gray's motivational theory: toward an integrated model of autonomic nervous system functioning in psychopathology

    Development and Psychopathology

    (2001)
  • L.F. Berkman et al.

    Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents

    American Journal of Epidemiology

    (1979)
  • J. Berkson

    Mortality and marital status

    American Journal of Public Health

    (1962)
  • M.H. Borstein et al.

    Child and mother cardiac vagal tone: continuity, stability, and concordance across the first 5 years

    Developmental Psychology

    (2000)
  • J.F. Brosschot et al.

    Anger inhibition, cardiovascular recovery, and vagal function: a model of the link between hostility and cardiovascular disease

    Annals of Behavioral Medicine

    (1998)
  • P.C. Brown et al.

    Social influence, marriage, and the heart: cardiovascular consequences of interpersonal control in husbands and wives

    Health Psychology

    (1992)
  • B. Burman et al.

    Analysis of the association between marital relations and health problems: an interactional perspective

    Psychological Bulletin

    (1992)
  • J.W. Burns et al.

    Anger expression, hostility, anxiety, and patterns of cardiac reactivity to stress

    Behavioral Medicine

    (1992)
  • J.T. Cacioppo

    Social neuroscience: autonomic, neuroendocrine, and immune responses to stress

    Psychophysiology

    (1994)
  • J.T. Cacioppo et al.

    Heterogeneity in neuroendocrine and immune responses to brief psychological stressors as a function of autonomic cardiac activation

    Psychosomatic Medicine

    (1995)
  • J.T. Cacioppo et al.

    Individual differences in the autonomic origins of heart rate reactivity: the psychometrics of respiratory sinus arrhythmia and preejection period

    Psychophysiology

    (1994)
  • S.D. Calkins

    Cardiac vagal tone indices of temperamental reactivity and behavioral regulation in young children

    Developmental Psychobiology

    (1997)
  • R.A. Carels et al.

    Blood pressure reactivity and marital distress in employed women

    Psychosomatic Medicine

    (1998)
  • D. Carroll et al.

    Social psychophysiology, social circumstances, and health

    Annals of Behavioral Medicine

    (1998)
  • H. Carter et al.

    Marriage and divorce: a social and economic study

    (1976)
  • T. Casales

    Neuromechanisms of asthma

    Annals of Allergy

    (1987)
  • R.D. Clover et al.

    Family functioning and stress as predictors of influenza B infection

    The Journal of Family Practice

    (1989)
  • S. Cohen et al.

    Types of stressors that increase susceptibility to the common cold in healthy adults

    Health Psychology

    (1998)
  • E.M. Cummings et al.

    Developmental psychopathology and family process

    (2000)
  • R.A. Dienstbier

    Arousal and physiological toughness: implications for mental and physical health

    Psychological Review

    (1989)
  • Y. Donchin et al.

    Cardiac vagal tone predicts outcome in neurosurgical patients

    Critical Care Medicine

    (1992)
  • J.A. Doussard-Roosevelt et al.

    The role of neurobehavioral organization in stress responses: a polyvagal model

  • J. Doussard-Roosevelt et al.

    Behavioral sleep states in very low birth weight preterm neonates: relation to neonatal health and vagal maturation

    Journal of Pediatric Psychology

    (1996)
  • J.A. Doussard-Roosevelt et al.

    Vagal regulation of heart rate in the prediction of developmental outcome for very low birth weight preterm infants

    Child Development

    (1997)
  • N. Eisenberg et al.

    The role of emotionality and regulation in children's social functioning: a longitudinal study

    Child Development

    (1995)
  • M. El-Sheikh

    Children's emotional and physiological responses to interadult angry behavior: the role of history of interparental hostility

    Journal of Abnormal Child Psychology

    (1994)
  • M. El-Sheikh

    Children's responses to adult–adult and mother–child arguments: the role of parental marital conflict and distress

    Journal of Family Psychology

    (1997)
  • M. El-Sheikh et al.

    Individual differences in preschoolers' physiological and verbal responses to videotaped angry interactions

    Journal of Abnormal Child Psychology

    (1994)
  • M. El-Sheikh et al.

    Availability of control and preschoolers' responses to interadult anger

    International Journal of Behavioral Development

    (1992)
  • M. El-Sheikh et al.

    Coping with adults' angry behavior: behavioral, physiological, and verbal responses in preschoolers

    Developmental Psychology

    (1989)
  • El-Sheikh, M., Harger, J., & Whitson, S. M. (in press). Exposure to parental conflict and children's adjustment and...
  • J.E. Emde

    Marital communication and stress

    Dissertation Abstracts International

    (1992)
  • C.K. Ewart et al.

    Communication behaviors that affect blood pressure: an A-B-A-B analysis of marital interaction

    Behavior Modification

    (1983)
  • C.K. Ewart et al.

    High blood pressure and marital discord: not being nasty matters more than being nice

    Health Psychology

    (1991)
  • R. Fenwick et al.

    Health consequences of marital-status change among the elderly: a comparison of cross-sectional and longitudinal analyses

    Journal of Health and Social Behavior

    (1981)
  • F.D. Fincham

    Understanding the association between marital conflict and child adjustment: overview

    Journal of Family Psychology

    (1994)
  • M.V. Flinn

    Family environment, stress, and health during childhood

  • N.A. Fox

    Psychophysiological correlates of emotional reactivity during the first years of life

    Developmental Psychology

    (1989)
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