“Be a bitch or get an autoimmune.”
The caption circulates on social media with the force of gospel truth. It implies a binary choice: self-sacrifice leads to sickness, assertiveness leads to health. Industrial engineer Ronak Pakzad wrote it on X, declaring people-pleasing the number one cause of autoimmune issues in women. Stand-up comic Pearl Rose backed it up, claiming her eczema vanished the moment she started being mean.
Is it true?
Well.
It’s complicated. And slightly terrifying if you take it literally.
The “Body Keeps Score” Theory
The trend didn’t come out of thin air. It taps into a specific, gnawing anger. Women are taught to be nice. Quiet. Accommodating. Girls play with dolls. Boys wrestle. By adulthood, that wiring hasn’t just softened into politeness. It’s hardened into a habit of silencing our own needs to keep others comfortable.
Rachel Gabelman, a clinical psychologist in Columbus, calls it out plainly. Society teaches women to seek approval. To avoid rocking the boat. To swallow our desires so no one gets offended.
This constant suppression? It’s stress.
“The body keeps score,” says Dr. Brinen. Every time you say “yes” when you mean “no,” your nervous system registers a hit. Chronic stress adds up. It piles onto the spine. It inflames the system. The logic on social media suggests that if you stop doing that—if you start acting “mean” by traditional standards—the inflammation drops. The disease goes away.
People are citing studies like the 2021 survey of 290 women who measured “self-silencing.” Higher rates of silence correlated with worse health markers. The correlation looks like causation from a distance.
But looking closely? The view changes.
Science Doesn’t Do Binaries
Doctors are rolling their eyes. Or at least shaking their heads.
Stanley A. Schwartz, an immunology chief in Buffalo, points out that stress affects the immune system. We knew that. But saying people-pleasing causes autoimmune disease? That’s a massive leap. It ignores genetics. Environmental toxins. Random cellular errors. Unknown factors.
Autoimmune disorders aren’t punishments for bad attitude. They’re biological lottery tickets, and we haven’t figured out who wins them yet.
Dr. Gabelman warns that this trend does something dangerous. It blames women. If your disease comes from being “too nice,” then you’re responsible for fixing it by being “less nice.” You’re responsible for your suffering.
Absolutely not.
Brinen adds another layer. Calling assertiveness “being a bitch” reinforces old stereotypes. Why use a slur to advocate for mental health? It perpetuates the idea that women can’t be strong without being bad. It’s scare tactics. We don’t need to threaten women with rheumatoid arthritis to tell them to set boundaries.
What Gets Missed (And What Doesn’t)
The internet hates nuance. Nuance is hard to retweet. But the trend isn’t wrong about everything.
Excessive self-sacrifice ruins you.
If you give everyone else your time, energy, and peace while ignoring your own baseline needs, resentment builds. Resentment is heavy. It wears on mental health. Mental health bleeds into physical health. Brinen says that link is real.
Reflect. Are you angry after you help? Do you feel hollow after you accommodate? Then change it. Be assertive. Say “no.” Define your limits.
That isn’t “being a bitch.”
That’s basic self-preservation.
The bottom line? You can’t control genetics. You can’t predict who develops lupus or Crohn’s. You might be perfect, kind, and still get sick. You might be a tyrant and stay healthy. The link between stress and disease exists, but it isn’t a simple on/off switch controlled by your attitude toward others.
Still. Boundaries feel good. And sometimes, the most rebellious thing a woman can do is protect her own energy.
