March 9, 2001 -- You'll find them basking, backpacking, boating -- from sunny Cancun to the Blue Ridge Mountains to the local fishing hole -- trying to escape everyday work stress. But for this slim minority of the nation's workforce, vacations and even run-of-the-mill weekends are fraught with headaches and migraines, colds, nausea, and flu-like fevers -- even though these same people are rarely sick during workdays.
That's what happens, according to a new study, when they lug their stresses -- along with their luggage -- on vacation.
It's a phenomenon called leisure sickness, and attitudes toward work, leisure, and relaxation seem to be at the heart of the matter, says Ad Vingerhoets, a psychologist at Tilburg University in the Netherlands. He presented findings from his study of this disorder at this week's American Psychosomatic Society annual meeting in Monterey, Calif.
People suffering from leisure sickness, Vingerhoets tells WebMD, typically have a burdensome workload -- and they simply cannot relax, triggering a host of symptoms. At times, they are so engrossed in their work that they subconsciously delay an illness, he says.
"When you are very busy, you may not even be aware you are sick," he says. "You may not pay attention to signals from your body. It's not until you are away from work that you feel tired, feel pain."
For his study, Vingerhoets recruited (through notices placed in local magazines) people suffering from these symptoms. Of the people who responded, he found 45 men and 69 women, average age 44, who had symptoms of leisure sickness. He matched them up with 56 people who did not suffer from the problem. Each completed a questionnaire asking about personality traits, about their feelings during leisure time, and about their appreciation of work and weekend activities.
Among the items on the questionnaire: "When I go on vacation, I really have to prepare myself. I cannot forget my work. When I have time off, I feel guilty because I am not working. I think I really need a vacation. I never have a moment's peace. I can't cope with my work and obligations anymore."
Headache and migraine were the most common symptoms for weekend sufferers, followed by fatigue and muscle pain. During vacations, they often had cold and flu-like symptoms. The pattern generally started around age 26, and most people had a long history of symptoms -- more than 10 years. They generally could trace the onset to something stressful: a new job, the birth of a child, relationship problems, a change of job, or a marriage.
The healthy people reported no such symptoms.
It's not that those with leisure sickness led any different lifestyle, Vingerhoets says. "Their smoking, drinking, sleeping, and coffee-drinking habits were all about the same," he says.
And it's not that they are more involved in their jobs, he says. "But they are more preoccupied with work in general and have more trouble relaxing. They have trouble dealing with free time, often because they feel guilty," he says.
In fact, the leisure sickness group actually showed a stronger appreciation for vacations and weekends than did the others, he says -- they just weren't able to enjoy their time off.
"Their weekend symptoms they attributed to their own personality traits or work styles, as well as to conditions at work," he says. "Their vacation symptoms were due to the vacation itself -- the stress of preparing for travel made them ill, and they thought more about their jobs than the other group."
Such people typically are perfectionists who are not very assertive, but have a higher sense of responsibility than others, Vingerhoets says.
Is there hope for the leisurely sick? Vingerhoets takes cues from the 20 who reported spontaneous recovery from the condition.
"Most frequently, they reported getting another job, changing their attitude toward their work and work in general, and paying more attention to signals from the body," he says.
Weekend exercise helps, and so does counseling, he tells WebMD.
"It may help to take another view of your life, of your work situation, and see things in a different perspective, give more weight to other things that are important in life," he says.
Vingerhoets is right on target, says Nadine Kaslow, PhD, professor and chief psychologist at Emory University School of Medicine in Atlanta.
"There's this workaholism, this perfectionistic feeling that nothing you do is ever good enough," she says. "You can't take the weekends off or go on vacation because the work is never done -- which it isn't if you're a perfectionist -- or you don't feel like you deserve to relax."
It's probable that the pattern for these people started much earlier, when they were children, Kaslow tells WebMD.
"My guess is that, for a lot of these people, while they were growing up there was this negative connotation with relaxing," she says. "Either it was the work ethic or their families weren't very fun to be around. This is the kid who can't stand to be with his family because it makes him have a headache or stomachache. They don't know how to have fun or relax, and what was supposed to be fun or relaxing as a kid was stress-producing.
"Of course, there's hope for these people," she continues. "Just as we know that migraines get better when tension is reduced, this is a true disorder that can be treated."
Sending people on more vacations or encouraging mental health days won't work, she tells WebMD.
"My guess is that these leisure sick people don't find time off rewarding. Having downtime brings up issues," she says. "If you're sitting at work busy all day, you don't have time to think about stuff. But during downtime, marital conflicts come up, tensions about money, or childrearing or whatever is bothering you. You can put them on the backburner at work, but you can't when you're not working."
Her advice: Deal with the underlying issues or struggles that are causing the symptoms.
"This is a signal there's need for a life change of some sort," she tells WebMD. "They need to think about the rewards of vacation time, about the type of vacation that would be rewarding for them, about what's relaxing for them."
Whether it's spending a whole day in bed or taking a cooking class in Paris, the leisurely sick need to take some control over their lives, Kaslow says -- "to discover what's relaxing for them, which may not be relaxing for other people."
Medically reviewed October 2001 by Gary D. Vogin, MD.