Related Terms

• Aggressive behavior, anxiety, communication skills, conflict resolution, couples therapy, depression, divorce, domestic abuse, domestic violence, intimacy, marriage counseling, marriage counselor, psychotherapy, relationship conflicts.

Background

• Marital distress occurs when a married couple or serious, committed, unmarried couple experiences emotional or physical conflicts or problems that threaten to end the relationship. It is normal for couples to experience difficulties and argue from time to time. However, when these problems cause the couple to become profoundly disappointed and unhappy with their relationship, it is called marital distress.

• There are many problems that can lead to marital distress, including, but not limited to: poor communication, difficulty solving problems (which leads to frequent arguing), lack of physical and/or emotional intimacy, sexual difficulties, infidelity, substance abuse, domestic abuse, major life changes, and negative life events (such as the death of a loved one).

• It has been estimated that about 20% of all married couples in the United States are experiencing marital distress at any given time. Research has shown that couples have the greatest risk of experiencing marital distress early in marriage. However, the risks also increase after major life changes or transitions, such as the birth of children, moving, and retirement. Recent data suggest that about 50% of all first marriages in the United States end in divorce.

• Deciding whether or not to stay together can be a difficult decision for couples. This is often more difficult for couples with children. Prolonged exposure to serious marital conflict has been shown to lead to emotional and behavioral problems in children. Some marriage counseling experts believe that couples who are able to be civil towards one another should stay together to prevent putting children through the trauma of divorce. Most experts agree that divorced parents should continue to play active roles in their children's lives.

• It is unclear exactly how children of divorced parents are affected, and it is often the subject of debate among experts. Some evidence suggests that children of divorced parents are twice as likely to go through a divorce when they are adults. However, other studies suggest that as many as 80% of children with divorced parents grow up to be emotionally healthy adults.

• Couples can undergo marriage counseling, or couples therapy, to help them decide whether or not the relationship can provide what each partner needs for a satisfying relationship. A therapist first helps a couple identify the root of their problems, and then helps the couple solve those problems. For instance, if a couple constantly argues, a therapist may help them improve their communication and problem-solving skills.

• This type of therapy is also available for long-term couples (married or unmarried) who want to improve their relationships. In some cases, couples are able to improve their relationships without counseling.

Causes

• General: Couples may experience problems early on in their marriages, while others may be happy for many years before problems develop. There are many factors that may lead to marital distress. Below are some of the most common causes of marital distress.

• Poor communication: Experts believe that poor communication is the most common cause of marital distress. Communication skills include verbal, non-verbal (facial expressions, gestures, and vocal tones), and listening skills. All of these skills are important in a relationship because they help people know what to say, how to make good choices, and how to behave in different situations.

• People with poor communication skills may be unhappy or upset with how their partners are behaving, but they are unable to express their feelings. In other cases, talking about such issues results in fighting. Sometimes people will avoid discussing bothersome issues in order to prevent arguments. As a result, the person's feelings go unresolved and changes are not made to improve the relationship. Communication problems often cause spouses to feel bad about themselves, their partners, and their relationships.

• When a couple has communication problems, people often feel that their partners are making excessive demands or requesting much more than they can give. Other people may feel that their partners are too withdrawn or do not share or open up enough.

• Having poor communication increases the likelihood that other marital problems, such as lack of intimacy, sexual difficulties, and major life transitions, will cause marital distress.

• Arguing: Frequent arguing is also a common cause of martial distress. Many experts believe that the topic being argued is less important than how the argument is actually handled. If one or both people in a relationship have poor communication skills, they may not be able to properly resolve their arguments and as a result, they might fight often. People who are unable to compromise, negotiate differences, and listen to others are most likely to face marital difficulties. Some experts suggests that it is important that couples view their relationship as a partnership.

• Studies show that money is the number one thing couples argue about, followed by issues relating to their children. Other common conflicts involve problems with in-laws, cultural clashes, and differences in values or priorities. For instance, some couples may have very different religious beliefs that come into conflict when they try to make major life decisions. Couples may also disagree with the parenting philosophies of their partners.

• Lack of intimacy: A lack of emotional and/or physical intimacy among couples may also lead to marital distress. According to the American Association for Marriage and Family Therapy (AAMFT), it is natural for strong emotions associated with courtship to decline over time. For instance, romantic gestures (such as buying flowers) or weekend date nights may become less frequent over time. Although this is considered normal for most couples, some people may perceive this decline in courtship behaviors as a loss of loving feelings. These feelings may lead to a reduced interest in sexual activities.

• Intimacy may decline for many other reasons, including emotional stress and sexual difficulties. For instance, working long hours may cause a person to feel tired and stressed when he/she returns home. As a result, his/her partner may not feel as emotionally or physically connected to the person.

• Sexual difficulties: Sexual difficulties, such as erectile dysfunction (ED) or menopause (which leads to a decreased libido), may also lead to marital distress. Sexual activities are important for many relationships because it is one way for couples to be physically intimate and close with one another.

• Infidelity (affair): Infidelity is a potential cause of marital distress. Infidelity may lead to feelings of jealousy and mistrust, as well as a lack of intimacy.

• Major life transitions: Some couples experience marital distress during major life transition or changes, such as the birth of children or moving. Changes that affect a spouse's role in the relationship, such as retirement, employment success or advancements, or unemployment may also put stress on a relationship.

• Negative life events: Negative life events, such as the death of a loved one, diagnosis of a chronic or terminal illness, bankruptcy, or inability to have children, may lead to marital distress.

• Substance abuse: Substance abuse may lead to marital distress. This type of behavior may strain a couple's relationship and lead to increased arguments. This is because drugs and alcohol may interfere with a person's judgment and cause people to behave in ways they normally would not. If the individual is frequently under the influence of alcohol or drugs, it may lead to a decrease in emotional intimacy. In addition, many substances, including alcohol, may lead to a decreased libido (sex drive).

• Domestic violence or abuse: Domestic abuse or violence may lead to marital distress. Domestic abuse occurs when an individual emotionally, verbally, or physically mistreats his/her spouse or intimate partner. However, victims may also include children and/or other family members.

• It is very important that victims suffering abuse contact the appropriate authorities immediately. Domestic abuse is a crime that should not be tolerated. Experts recommend that victims call 911 to report the attack and get immediate medical attention. People who are being abused are advised to leave their relationships. Because it may be difficult to leave an abusive relationship, abuse survivors are encouraged to seek the help of a friend, family member, or support group. Staff at emergency shelters can help victims file for court-ordered protection from the abuser, if necessary. If the abuser seeks treatment, including counseling, he/she may be able to change his/her behavior. However, the victim should avoid contact with the abuser until the abuser has received treatment and has shown that he/she is no longer abusive. Victims are also encouraged to seek counseling.

Signs and Symptoms

• Individuals in distressed marriages or relationships persistently feel unhappy and dissatisfied with their relationships. Couples may fight frequently without coming to resolutions. This may cause individuals to feel worn out. Others may rarely fight, but feel disconnected to their partners. As problems persist, communications generally becomes more difficult. Couples may be less intimate or affectionate and engage in sexual activities less often than they used. Individuals may feel sad, depressed, jealous, worrisome, tense, or angry.

Diagnosis

• There is no definitive method to diagnose marital distress. Instead, individuals who are unhappy in their relationships and wish to seek help are encouraged to visit a licensed therapist, called a marriage and family therapist.

• In some cases, an individual's partner is unwilling to seek help. Although it may be more challenging, individuals can go to marriage or couple counseling on their own. The therapist may provide useful ideas on how to improve the relationship and how to find better ways to approach the person's partner about the idea of entering treatment together.

Complications

• Alcoholism: Studies involving long-term, committed couples have shown that individuals who are having problems in their relationships have an increased risk of alcoholism. In such cases, alcohol may be a way of self medicating or temporarily escaping one's problems.

• Anxiety: According to studies, marital distress has been associated with anxiety disorders. Anxiety is an unpleasant complex combination of emotions that are often accompanied by physical sensations, such as irregular heartbeat, nausea, chest pain, shortness of breath, tension headache, and nervousness.

• Depression: Individuals who are experiencing marital distress have an increased risk of developing depression. Symptoms of depression may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities usually enjoyed, and feelings of worthlessness or guilt. Depression may result in poor sleep, a change in appetite, severe fatigue, and difficulty concentrating. Severe depression may increase the risk of suicide.

• Behavioral/emotional problems in children: Children may also be affected by their parents' marital distress. Research has shown that children are more likely to develop behavioral and emotional problems if there is continuous conflict among their parents. Some children affected by marital distress may act out in school or at home, have low self-esteem, or feel sad, angry, or withdrawn. Children may also exhibit nonverbal or verbal hostility or aggressive behaviors.

• Decreased work productivity: Marital distress has been associated with decreased work productivity, especially in men. This may be the result of decreased concentration and preoccupation with problems at home.

• Infidelity: Marital distress may cause people to cheat on their partners and have affairs. For instance, if there is a lack of physical and/or emotional intimacy that is straining a couple's relationship, a partner may end up having an affair with someone.

• Violence: Distressed couples have a greater risk of experiencing violence at some point in the relationship. Violent or aggressive behaviors can have serious affects on the relationship, as well as the victim's psychological and physical well-being. Abuse typically occurs in cycles. When the abuser gets angry, tension grows and there is a breakdown in communication. Then the abuser verbally or physically mistreats the victim. Afterwards, abusers are usually apologetic. In some cases, the abuser will deny that the abuse ever took place. Sometimes the abuser may behave pleasantly and kindly towards the victim most of the time. This often makes it difficult for the victim to leave the abuser.

• Experts recommend that victims call 911 to report the attack to police and get immediate medical attention. People who are being abused are advised to leave their relationships. Because it may be difficult to leave an abusive relationship, abuse survivors are encouraged to seek the help of a friend, family member, or support group. Staff at emergency shelters can help victims file for court-ordered protection from the abuser, if necessary.

Treatment

• General: Treatment for marital distress focuses on building or enhancing skills that are necessary for a successful long-term and committed relationship. The goal is to help couples learn how to effectively communicate, solve problems, and how to resolve arguments without hurting the other person.

• Marriage counseling and couples therapy: Marriage counseling, also called couples therapy, is the standard treatment for individuals experiencing marital distress. Therapy may help individuals decide whether or not the relationship can provide what each partner needs for a satisfying relationship. It may also help improve the relationship. Therapy may also be helpful in cases of domestic violence or abuse. However, the safety of the abused victim should be considered first and foremost in all cases. The victim should avoid contact with the abuser until the abuser has received treatment and has shown that he/she is no longer abusive.

• Therapy is provided by a licensed therapist, called a marriage and family therapist. These professionals provide the same mental health services as other therapists, but with a focus on relationships.

• Therapy sessions are tailored to a couple's specific needs. A therapist first helps a couple identify the root of their problems, and then helps them solve those problems. In general, therapists typically use a holistic and family-centered approach in order to help improve a person's overall, long-term wellbeing. Some therapists may focus on teaching and practicing communication and problem-solving skills in order to improve the couple's relationship. Others may be more retrospective and focus on the past in order to determine how problems arose. Some may involve a combination of approaches.

• According to the American Association for Marriage and Family Therapy (AAMFT), about 50% of couples receive treatment on a one-to-one basis. The other half attend sessions with their partners and/or immediate family members.

• At first, therapy may be difficult for couples. Some people find it difficult to share their relationship problems with strangers. For many, therapy gets easier with time.

• Therapy may be short or long term, depending on the type and severity of a couple's problems. Some couples only need a few sessions to help them deal with a sudden crisis, such as the death of a loved one. Others may need to undergo therapy sessions for several months. On average, couples typically meet with a counselor once a week.

• Studies have shown that 65-76% of couples who seek professional therapy experience significant improvements in their relationships after treatment. Research has also shown that if marriage counseling or couples therapy improves the relationship, associated psychological problems (such as depression) also improve. In order for therapy to be effective, both partners need to be willing to make changes and sacrifices and be committed to improving their relationship.

• Couples do not necessarily have to have problems with their relationships in order to seek therapy. Many couples undergo marriage counseling or couples therapy to enhance or strengthen their relationship and gain a better understanding of each other. This may help prevent marital distress in the future. For instance, building strong communication skills may help prevent marital distress from occurring in response to stressful life events, such as the loss of a loved one.

Integrative Therapies

• Good scientific evidence:

• Psychotherapy: Unlike marriage counseling or couple's therapy, psychotherapy sessions are led by a qualified mental health professional. This type of therapy primarily focuses on a person's mental and psychological health, whereas couple's therapy focuses on relationship issues. During psychotherapy, the patient explores thoughts, feelings, and behaviors to help with problem solving. Behavioral marital therapy and insight-oriented marital therapy may decrease marital distress. Marital therapy in conjunction with anti-depressants may also be helpful for depressed people.

• Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed to treat psychological problems. In some cases, symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illnesses or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expressions.

• Unclear or conflicting scientific evidence:

• Prayer, distant healing: Prayer can be defined as a "reverent petition," the act of asking for something while aiming to connect with God or another object of worship. It is unclear if prayer can lead to conflict resolution among couples. Prayer appears to be a significant "softening" event for religious couples, facilitating reconciliation and problem-solving based on one study.

• Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches and require an open dialog between patients and caregivers.

• Traditional or theoretical uses lacking sufficient evidence:

• Art therapy: Art therapy involves many forms of art to treat anxiety, depression, and other mental and emotional problems. Art therapy became a mental health profession in the 1930s. Today, it is practiced in hospitals, clinics, public and community agencies, wellness centers, educational institutions, businesses, and private practices. Art therapy has been suggested as a possible form of marital therapy. However, since studies have not been performed in this area, it remains unknown if this therapy could effectively treat or prevent marital distress in couples.

• Because art therapy may stir up distressing thoughts or feelings, it should be performed under the guidance of a qualified art therapist or mental health professional. Related materials, such as turpentine or mineral spirits, should be used in areas with good ventilation because they release potentially toxic fumes.

• Guided imagery: Guided imagery may involve a number of techniques, including metaphor, storytelling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion. Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Guided imagery has been suggested as a potential treatment for relationship conflicts. However, studies are currently lacking in this area.

• Guided imagery is usually intended to supplement medical care, not to replace it. Guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset because imagery may trigger these symptoms. If feeling unusually anxious while practicing guided imagery, speak with a qualified healthcare provider before practicing guided imagery. Patients with a a history of trauma or abuse should also consult with their healthcare provider(s).

• Psychotherapy: As noted above, psychotherapy has been used to treat couples experiencing marital distress. It has also been used traditionally to treat a variety of relationship problems that may lead to marital distress. Until research is performed in this area, it remains unknown if psychotherapy can successfully treat relationship problems other than marital distress.

• Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illnesses or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expressions.

Prevention

• Couples do not necessarily have to have problems with their relationships in order to seek therapy. Many couples undergo marriage counseling or couples therapy to enhance or strengthen their relationship and gain a better understanding of each other. This may help prevent marital distress in the future. For instance, building strong communication skills may help prevent marital distress from occurring in response to stressful life events, such as the loss of a loved one.

• Individuals who plan to get married can participate in pre-marital preparation and marital enrichment programs, such as the Prevention and Relationship Enhancement Program (PREP) and the Relationship Enhancement Program. These programs may help couples identify and learn how to handle their differences and weaknesses before they become future problems. For example, PREP teaches couples how to improve their communication and problem-solving skills to help prepare them for handling conflicts. Programs may also be offered through various cultural or religious institutions.

• Couples are encouraged to seek professional help as soon as signs of marital distress occur. This increases the likelihood of improving the relationship.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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