The Danger of Denial

People who won't admit to stress are much more likely to have a heart attack.

By Annie Murphy Paul, published on January 01, 1998 - last reviewed on August 24, 2007

Anger, anxiety, and depression can hasten the progress of heart disease, as scientists have known for some time. The problem, according to one study, is that people with heart problems often deny that they're feeling bad—with serious consequences for their health.

Mark Ketterer, Ph.D., of Henry Ford Health Systems in Michigan, asked 144 men who had undergone heart surgery to report how often they experienced negative emotions; the impressions of each man's wife or close friend were also collected. The results, published in the Journal of Psychosomatic Research, suggested that 40 percent of the men were underreporting the distress they felt. Such denial, the researchers found, was the most powerful predictor of heart attacks, surgery, and death—stronger even than familiar risk factors like smoking, alcohol use, and obesity.

Though men who use denial as a coping strategy may not even admit to themselves that they're troubled, signs of distress are often obvious to wives and friends—and their perceptions match up well with those of expert interviewers. "Clearly, the results argue that you can't rely only on the patient," says Ketterer, who would like to see all treatment for heart disease include input from significant others. Once people at high risk for denial are identified, they can be helped with stress management therapy. Although some of Ketter's patients continue to deny that they need help, about three-quarters comply. "They may never 'fess up' to the snit fits they throw at home," he says, "but they do listen attentively, read the material we give them, and make some adjustments."