Chronic Stress & Chronic Illness: when neurodiverse marriage makes us sick

Among neurotypical partners who identify with experiencing Ongoing Traumatic Relationship Syndrome (OTRS), a strong correlation exists between chronic stress and the development of chronic illness. Those who suffer from OTRS experience various adverse complexities within their neurodiverse relationship. Over time, the turmoil of unremitting marital discord takes a serious, and sometimes irreversible, physical toll.

Neurodiverse spouses often have differing social, emotional, and interactional expectations for marriage. The neurology of a neurotypical partner necessitates emotional reciprocity, affective attunement, and mutuality in their relationship, for a felt sense of well-being.  A neurotypical spouse expects partnership in every dimension of life together. When mismatched relational needs, differing standards for practical concerns, and toxic conflict patterns emerge in a neurodiverse marriage – the OTRS neurotypical partner is persistently flooded by chronic stress. 

Autistic characteristics may unintentionally create trauma, or chronic stress for the neurotypical partner, due to associated impairments affecting social, emotional, interactional and practical necessities for the neurotypical spouse. Additionally, characteristics of neurodiverse marriage itself often contribute to the stress load. Examples of autistic and neurodiverse marriage characteristics include the following: 

Relational stress: poor perspective-taking, insufficient theory of mind, rigid thinking, difficulty predicting the impact of personal choices upon others, low flexibility, resistance to change, communication impairments, alexithymia, blunted affect, missed non-verbal cues, misreading social cues, difficulty generalizing expectations, non-initiation of celebration for birthdays or special occasions, hurtful or intimidating actions during meltdowns, abandonment during shutdowns, hyper-defensiveness, discounting the spouse’s feelings or experience, financial withholding or overspending, prioritizing special interests over quality time, authoritarian or permissive parenting, triangulation with children or family members, deprioritizing the spouse in favor of other non-family relationships, hyper or hyposexuality, sensory aversions that thwart intimacy, preferring to use porn instead of participate in marital sex, passivity or disinterest in date nights or romance, avoidant or reactive behaviors, rejection dysphoria, valuing autonomy over mutuality, lack of curiosity about the partner’s thoughts or feelings, transactional mindset, resistance to being influenced into compromise, inadequate emotional attunement

Practical stress: inequitable distribution of chores, disparity of responsibilities, impaired executive functioning, avoidance or procrastination of obligations, forgotten or ignored commitments, faulty working memory, overly rigid or too loose standards, time blindness, prompt dependency, poor supervision during parenting time, interactional difficulties with children which reduce parenting reliability, financial mismanagement, lack of capacity for strategic planning, poor self-monitoring, requiring repetition of instructions or reminders of agreements, difficulty inferring expectations, distractibility, disparity with peripheral parenting obligations, requiring explanation and justification for a simple request or preference or instruction, lack of basic skills for daily necessities (cooking, cleaning, feeding or bathing children, etc), haphazard or absent caretaking during illness, inadequate urgency during crisis, accommodating meltdowns or shutdowns that disrupt the needs of others, incapacitation from sensory overload

With so many stressful dynamics in the marriage, conflict inevitably follows. Below are examples of conflict mismanagement between partners (of any neurotype) which compound the relational and practical stress. 

Conflict stress: circular arguments, right-fighting, hyper-defensiveness, adversarialism, criticism, contempt, countering, blame-shifting, high reactivity (yelling, screaming, shouting, storming off), avoidance, withholding, stonewalling, side-stepping accountability, aggressive/passive/passive-aggressive communication, punishing, justifying, minimizing, intimidation, threats, reversing victim and offender roles, weaponized incompetence, avoiding conflict resolution, unrepaired ruptures

Listing the above circumstances inadequately captures the impact. A neurotypical spouse isn’t just experiencing adverse events in a singular sense of an isolated incident. The stress is compounded by the cumulative load, and aftermath considerations, along with often frantically trying to mitigate recurrences. As an example, poor supervision of children isn’t a momentary concern. The autistic partner may have every intent of carefully parenting. When incidents happen, there may be dozens of discussions clarifying the expectations of what it means to supervise children appropriately. Perhaps moments of inattentiveness still end well, but it was a close call to a catastrophic possibility. The neurotypical spouse carries around the fear of future incidents, creating hypervigilance (which wreaks havoc on the nervous system). Autism can be considered a poor prediction disorder, and generalizing between situations is challenging, so the neurotypical partner lives with the ever-present anxiety of wondering whether the autistic spouse will successfully apply protective knowledge in parenting moments that need it. Hypervigilance adds to a sense of obligation to be present at all times, in hopes of buffering those singular moments that could result in unintentional harm to a child. This isn’t a maligning of autistic character; there is almost always a well-intended parent behind occurrences that can happen to anyone. But in neurodiverse marriages where there is a heightened difficulty of managing distractibility, executive functioning, processing time and response, along with prediction of danger or child behavior, it is reasonable to hypothesize that perhaps a higher level of concern is warranted. Thus, a neurotypical spouse carries this awareness in their body, activated frequently, and making strategic decisions that likely overtax functioning, prevent down time, and create disparity of emotional and physical labor. Going to the grocery store by oneself becomes a decision that feels like Sophie’s Choice, if there are previous instances that endangered a baby or child when the neurotypical partner wasn’t home.

Now, imagine that one stressor multiplied by every other compounded scenario simultaneously occurring within the neurodiverse marriage. As much as an autistic spouse needs extra accommodation for regulating stress from overstimulation – it’s often overlooked that the neurotypical spouse is also running on sky-high cortisol.

Both spouses might agree that the patterns in their marriage are problematic. Yet, the dynamic may continue unabated, and the neurotypical spouse suffering from Ongoing Traumatic Relationship Syndrome eventually develops physical symptoms from the chronic emotional distress. 

Unrelenting stress and nervous system activation is intensely wearisome for the body. Chronic anxiety, hypervigilance, and a sense of perpetual crisis flood the body with adrenaline and cortisol. Continuous exposure to stress can lead to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is crucial for keeping our body in homeostasis. When the HPA axis is disrupted, it impacts the body’s immune response, cardiovascular health, neuroendocrine and metabolic function, and the autonomic nervous system. 

Stress hormones reduce lymphocytes (our natural killer cells that go after invaders in our body), and inhibit antibody production. High cortisol produces pro-inflammatory cytokines. Immunoprotective cells are suppressed by inflammation, decreasing the ability to fight off viruses or infection.

Inflammation is intended by the body as a short-term solution to help initiate healing – such as when we injure a joint, and swelling occurs. Or, when invasive pathogens need to be eliminated quickly, and blood vessels respond by leaking fluid (creating inflammation), which helps contain the threat from spreading. But, when the body is confused by an ongoing threat signaled from unmitigated high cortisol, and unabated inflammation – the immune system attacks healthy tissue and organs. An autoimmune disease develops when the immune system is no longer able to distinguish healthy tissue from pathogenic threat. The body begins to attack itself. Autoimmune disease is significantly correlated with occurring after chronic stress. Anecdotally, many of my neurotypical clients suffer from a variety of autoimmune disorders, such as Hashimoto’s thyroiditis, rheumatoid arthritis, lupus, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and Sjögren syndrome. 

High cortisol increases blood sugar, which over time creates insulin resistance and glucose intolerance. Appetite increases to support energy reserves for fight or flight. Weight gain from cortisol-induced metabolic dysfunction creates centralized, inflammatory fat. As weight accumulates in the abdomen, visceral fat wraps around organs – releasing inflammatory properties, and quickening the development of disease. High blood sugar leads to excess glucose that is unused by the body, and this extra glucose contributes to risk of developing diabetes, along with high triglycerides that impact cardiovascular health. Indirectly, lifestyle habits that result from obesity also impact the propensity for heart disease. 

When adrenaline is high, heart rate increases, and blood pressure is raised – an adaptation intended to be helpful for surviving threats. Arteries narrow when blood pressure is elevated, increasing the risk of hypertension developing. Hypertension causes the heart to pump blood more forcefully, stressing arteries. Visceral fat developed from metabolic dysfunction may surround the heart, and its release of inflammatory substances quicken the buildup of plaque, leading to coronary heart disease, or stroke. Elevated cortisol levels also cause the heart to pump excess resources into muscles for survival response, which reduces blood flow to the heart, and increases risk for heart attack. 

Continuous threat perception changes the brain’s emotional processing, due to sending out perpetual alarm signals to the amygdala, and over-activating the hypothalamus. Depression and anxiety frequently develop, and a high percentage of my neurotypical clients are on a number of psychotropic medications. Many of them note that they did not require pharmaceutical intervention for any mental health concerns prior to the ongoing relationship trauma occurring in their marriage. 

When the amygdala and hypothalamus are continuously managing an onslaught of threats, the HPA axis is perpetually disrupted, which thwarts the nervous system from functioning as intended. The sympathetic system (danger management) operates in over-drive, suppressing the restoration that would otherwise occur from the parasympathetic system (responsible for rest, relaxation, digestion, and repair after stressful occurrences). This prevents the autonomic nervous system from operating “automatic” body processes, such as heart rate. Dysautonomia creates a multitude of uncomfortable symptoms, which are extremely common in my neurotypical clients. Rapid heart rate with palpitations, unstable blood pressure, orthostatic intolerance, dizziness and fainting, shortness of breath, nausea, insomnia from circadian rhythm disruption, crushing fatigue, and brain fog. Of all the chronic illnesses that my neurotypical clients tend to suffer from, cardiac dysautonomia is extremely prevalent. 

Clearly, the impact of Ongoing Traumatic Relationship Syndrome as a stress disorder is potentially very destructive to health and well-being. Aside from excessive stress hormones causing enough inflammation to malfunction multiple body systems, other degenerative illnesses are intrinsically linked. Chronic inflammatory diseases include many mentioned above – diabetes, heart disease, stroke, obesity, and various autoimmune diseases – but also dementia, and cancer. I’ve walked alongside several neurotypical clients who, after decades of a high-conflict neurodiverse marriage, find themselves facing a cancer diagnosis, or Alzheimer’s Disease. Is this because of their chronic stress from a neurodiverse marriage? One can’t know for sure, but chronic stress and the subsequent inflammation is absolutely linked, implicated, and clinically identified as influencing the development of cancer, and Alzheimer’s disease. What often seems to torment my most ill clients is the inescapable rumination of wondering – was their self-sacrifice worth it? Did the endless striving ever improve their quality of life, or did it ultimately just destroy their own health?

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