Symmetry is a relevant concept in sociological theories of exchange. It is rooted in the evolutionary old norm of social reciprocity and is particularly important in social contracts. Symmetry breaking through violation of the norm of reciprocity generates strain in micro-social systems and, above all, in victims of non-symmetric exchange. In this contribution, adverse healthconsequences of symmetry breaking in contractual social exchange are analysed, with a main focus on the employment contract. Scientific evidence is derived from prospective epidemiological studies testing the model of effort-reward imbalance at work. Overall, a twofold elevated risk of incident disease is observed in employed men and women who are exposed to non-symmetric exchange. Health risks include coronary heart disease, depression and alcohol dependence, among others. Preliminary results suggest similar effects on health produced by symmetry breaking in other types of social relationships (e.g. partnership, parental roles). These findings underline the importance of symmetry in contractual social exchange for health and well-being.