Can people-pleasing lead to chronic symptoms and conditions?
I was born a people pleaser and I have also battled chronic symptoms and conditions most of my life.
Highly sensitive and anxiously attached, my little child brain thought that doing what people wanted would be much easier than following my impulses and potentially upsetting someone. As I grew older, I somehow learned that being direct was unfeminine and rude, so I never really asked for what I wanted either. I learned that saying no was oppositional and that it’s normal to do things you don’t want to do just to avoid conflict.
I thought I easily found common ground with so many people because I was well-rounded and curious, but honestly, I often had no distinct point of view of my own or it felt really fuzzy, and I was usually afraid to disagree. I learned to orient outward for social survival. Because my parents had a difficult child, my brother, I was praised for being easy and agreeable. I had somehow learned that jumping through hoops, wearing masks, and self-abandoning were normal ways to get closeness and be liked. Except that didn’t actually work for me, and I often found myself feeling terrible physically and terrible about myself.
People pleasing and nervous system dysregulation
We have little control over what others do or how they respond to us—this is a key reason why people pleasing is an ineffective strategy for consistently meeting our needs for connection. Unfortunately, many of us didn’t grow up in environments where making respectful, nonviolent requests to meet our needs was modeled. Nor were we properly taught how to care for our own emotional well-being; instead, we may have observed our caregivers self-abandoning or neglecting their own needs or using manipulative communication tactics instead of directness.
When we're disconnected from our true selves, we may attract unfulfilling relationships and struggle to assert ourselves when necessary. We often develop circular, maladaptive patterns to control or manipulate others into providing what we want. However, these superficial connections leave us yearning for genuine depth and safety.
A core issue is that many of us haven't learned that setting boundaries or saying no is okay—likely because we were punished or discouraged from doing so in the past. Consequently, we habitually push beyond our limits to maintain appearances, which can overload our nervous systems. This ongoing state of strain intensifies feelings of instability and overwhelm.
As social beings, our survival as infants depended on close, attentive caregiving. When we lack deep, meaningful connections, our primal brains interpret this as a threat, creating a persistent sense of danger. If our default strategy is people pleasing, we keep pushing ourselves harder for connection—yet the results often fail to satisfy, leaving us feeling more drained and depleted.
Over time, this relentless effort can lead to physical and emotional exhaustion, with our bodies beginning to rebel against the stress and imbalance.
I don’t know if you’ve noticed this, but people don’t tend to respect people pleasers.
You know, you’re just so easy-going and cool with everything, but are you really? What happens deep inside your body when you abandon yourself and your own needs and still get stepped on in romantic relationships, in your family dynamics, and at work? For me I struggled with anxiety in the form of stomach aches starting at a young age. Then body aches. Then chronic infections. Then an autoimmune disease. I could keep going. All while harboring shame and low self-esteem because even though I was always bending over backward, I still couldn’t get everyone to fall in love with me. Because that is impossible no matter what you do.
If you’ve been a people pleaser all your life, there are likely parts of you screaming out to come back to yourself. Over the years, self-abandonment and orienting to the needs of others over your own can lead to anxiety, depression, a loss of sense of self, an inability to tune into your own impulses and sensations, immune system dysregulation, IBS, heartburn or ulcers, back pain, sarcoiditis like this woman, and more. Part of it is that our nervous system panics a little when we continually override our own needs. Another part of it can be that we don’t get the results we were hoping for or at least not enough to quench the endless thirst that we can develop for external validation. Over time, this can lead to an extended stay in the fight, flight or freeze state of the nervous system, which doesn’t allow for proper healing, good sleep or digestion. See more on polyvagal theory and nervous system states here.
Dr. John Sarno and Dan Buglio blew my mindbody
Dr. John Sarno was a pioneering physician and professor of rehabilitation medicine, renowned for his work on chronic pain, particularly back pain. He developed the theory that many persistent pain conditions are rooted in psychological factors, specifically emotional and stress-related issues, rather than structural abnormalities. Sarno's approach emphasized the connection between the mind and body, advocating for mind-body awareness and psychological healing as key components of recovery. His methods have helped many individuals overcome longstanding pain by addressing subconscious emotional conflicts and unacknowledged tensions.
After a couple of years of nervous system and inner work, many of my symptoms had taken a hike, but there was still one thing that lingered, making my life difficult. I’ve had chronic low back and hip pain that comes and goes since I was eleven. But as soon as I had finished a successful treatment for Lyme, while most of my long list of symptoms resolved, I got this intense low back and hip nerve pain that was making me miserable. It was almost as if all my other symptoms packed their suitcases and moved into my back and hips. Some days I could barely walk when I woke up in the morning. It was no joke.
I fought for an MRI that showed only normal wear and tear for my age and I felt so defeated—yet another western medical situation where I was treated like a hypochondriac, adding insult to injury. After two years of seeing multiple PTs and watching every YouTube video on exercises for hip and back pain, I was completely stumped. Nothing was working. Could this be mindbody? But no, I had already done so much nervous system work. I was convinced it was structural and we just hadn’t found the problem yet. A peer of mine had mentioned she was doing work informed by Dr. John Sarno’s work.
On a vacation, I read Sarno’s book, Healing Back Pain, and started doing some of the things he talks about. Mostly just telling my brain that I wanted to feel the emotions I was suppressing instead of the pain in my back. I felt kind of silly and didn’t have high hopes for the practice, but what did I have to lose? I noticed a difference in my pain level really quickly, but I was on vacation so I didn’t take it very seriously. Then I listened to Dan Buglio’s book Pain Free You on the plane ride home and he had me convinced that my back pain was indeed a mindbody manifestation of some kind of repressed impulse or emotion.
I would highly recommend Dan’s book and YouTube channel, as it’s a more modern approach that acknowledges many different symptoms and conditions can be emotional in origin.
I realized that I was suppressing a lot of anger related to self-abandonment and people pleasing, while rarely getting the support or recognition I craved from others, but this was buried pretty deeply in my psyche, so it took some time to figure it out.
I started with a couple of simple (but not always easy) things
Allowing anger to come up and be processed in healthy ways, like twisting a towel, silent screaming, sprinting or journaling. And wow. The anger really came up for a while! I was amazed that just telling my brain to let’er rip brought so much out. It wasn’t comfortable and I kind of understand why my subconscious preferred the pain over the emotional experience. As women we are told anger is inappropriate. I think a lot of us contort so we won’t ever be called, “crazy.” I also learned as a child that anger was scary and dangerous. There was quite a backlog I had to allow to move through me and some days I really didn’t feel like dealing with it. It was interesting to observe that on those days when I needed to suppress the anger again, other symptoms would manifest.
Saying “no” more and really using my physical reactions to things as a guide. This is still a practice that is difficult for me. I always identified as a yes person. But I had to stop listening to the part of me that was scared of being abandoned for saying no and start listening to the part of me that wants to be healthy and live my purpose.
I started following my impulses more and doing what was most supportive for me, rather than making others as comfortable as possible. This can bring up some fierce shame and fear if it’s not something you’re used to. It can also get some reactions from people who aren’t used to it. And people who are still deep in their own lack of boundaries and people pleasing may be triggered by you putting yourself first. The audacity!
I started calling the bluff of my abandonment fears. My clients didn’t fire me. My partner is still with me. My true friends still love me.
Here’s what happened
My back and hip pain reduced by 85% or more. This was shocking to me. It still is. As a creative, I work on photoshoots where I stand on concrete all day. I used to have to wear a back brace and then ice after work and still, I could barely walk the day after a shoot. I was at PT and the chiropractor every week, religiously. Now I don’t wear a brace, I go to the chiro once a month for a tune up and I’m pretty much the same the day after a shoot. This will always blow my freaking mind because I was legitimately in 8/10 pain so often and I really thought I had something very structurally wrong with my back or hips.
I have a ton more energy for the things that are important to me. I guarantee you I would not have made this website or be writing this blog post if I hadn’t read Dr. Sarno and Dan’s books.
People seem to respect me a lot more and I feel more respect for myself. It was also cool to see intimacy deepen with the people I love when I started being more honest about my needs. I even found that I set an example for good boundaries and it gave others permission to be more authentic which led to a sense of relief for both of us.
Why do we people please in the first place?
Fear of Rejection or Abandonment – Believing that pleasing others is the only way to stay accepted and loved.
Low Self-Esteem – Feeling that our worth depends on external validation and approval, or that we don’t really deserve to say no put thier own needs first.
Desire for Safety and Security – Mimicking caregiver behaviors learned in childhood to ensure emotional safety.
Need for Control – Using people-pleasing as a way to control outcomes and situations by avoiding conflict.
Impaired Boundaries – Lacking healthy boundary-setting skills, leading to over-accommodation.
Avoidance of Conflict – Choosing to please to prevent disagreements or confrontations.
Seeking Validation and Approval – Looking externally for affirmation that they are “good enough.”
Trauma or Unmet Needs in Childhood – Surviving early relational wounds by adapting to ensure caregivers’ approval.
Fear of Losing Love or Connection – Acting in ways that garner affection and keep relationships stable.
Impostor Syndrome – Feeling that we must constantly earn their place or prove our worth through pleasing others.
Do any of these sound familiar to you?
Are you in the habit of people pleasing? Here are some ways you can start the recovery process
Pinpoint the need: When you catch yourself people pleasing, try to pause and understand what need you are trying to fulfill or what danger you’re trying to avoid.
Experiment with how “no” feels: try saying no to someone you know won’t abandon you. Without over-explaining. See how it lands. It might surprise people at first if they aren’t used to it. It also may trigger someone who doesn’t have their own solid sense of boundaries and self-compassion. Allow feelings of anxiety to come up while holding yourself in regulation through breathing or other self-care that feels good. Lock in that safety. Also notice any other good that comes from saying no, like a new level of respect from someone or more energy for something that you care about and want to accomplish.
Before you say yes or no, tap into what your body is telling you: Try to take a beat before responding to check in with your body. This will help you start orienting more toward your internal compass and less toward the needs of others.
Deep neural networks don’t just change overnight, but plasticity is on your side
Healing from people-pleasing and chronic self-abandonment is a deeply personal journey, but it leads to greater freedom, authenticity, inner safety and vitality. By tuning into your body’s signals, allowing yourself to feel and process difficult emotions like anger, and practicing healthy boundaries, you can begin to reclaim your sense of self. Remember, change doesn’t happen overnight—be compassionate with yourself as you navigate this path. Every small step toward honoring your needs is a powerful act of self-love and self-respect, and when the body feels that, it may no longer rely on the creation of pain and symptoms to get your attention.
