Stress, mental health and autoimmunity

Stress is an umbrella term that has been quite used in a scientific context but not only. We all know what stress concerns, mainly in its negative sense. But do we really understand how it is fundamental in the processes of becoming ill or healthy?

Vaudeville Act 4: Bumbery Blads & Cie, (1907) by Moriz Jung

Scientifically speaking, stress is a non-specific response of the body to any demand to change, which means an effort to adapt to any kind of stimuli, positive or negative. Therefore, stress is a basic adaptative mechanism very important to keep individuals healthy.

However, stress syndrome or a dysfunctional response of body and mind to changing demands can cause real damage in diverse ways. This can be manifested in variable intensity and frequency. Different stress categories include psychological trauma, which refers to a single but very intense response to traumatic events; chronic stress, which can be less intense but much more frequent and cumulative; stress disorders, which are serious manifestations of mental illnesses after psychological trauma and/or chronic exposure to stress triggers; and finally positive stress, which is the response for positive stimuli that can be quite intense and sometimes creates imbalances.

For instance, a person submitted to systematic violent communication can develop chronic stress, having the constant experience of being alert and rare relaxing moments even while sleeping. On the other side, when the body needs to respond to exciting stimuli as radical sports, the mindset is full of positive thoughts associated with positive emotions like joy, hope, confidence, but still, the body needs to adapt rapidly to new circumstances and deal with risks implied – this is positive stress.  

As a medical category, autoimmune diseases also comprise very different conditions with a common mechanism:  the dysfunction of immune cells and the damage of healthy tissues by antigens that were supposed to protect them, mostly through inflammation. The most common symptoms are arthralgia, arthritis, skin rashes, extreme fatigue, gastrointestinal problems and neuropathic pain – but other more individualized symptoms can be presented like food intolerances, eye dryness and in advanced cases heart and kidney inflammations.

There are more than 70 medical conditions in the big umbrella of autoimmune diseases – the most familiar to the general public being Systemic Lupus Erythematous (SLE), Rheumatoid Arthritis (RA). They vary greatly in symptoms and prognosis. And even blood test results can be quite different among patients with the same diagnoses. But, usually, autoimmunity is an excessive response to stress at a cellular level, in which certain hormones or immune cells produce more inflammation than needed. Genetic predisposition plays an important role, but various researches have shown the association between stress and those conditions.

Many studies have found that about 80% of patients with an autoimmune diagnosis, men and women, reported uncommon emotional stress before disease onset. Besides, cumulative stress exposure during childhood, including domestic maltreatment, increases significantly the risk of developing a rheumatologic condition as RA in adult life. In general, women are more resilient to infections but more vulnerable to the damaging effects of stress, biologically speaking. Females compose more than 80% of autoimmune patients, and for some diseases as SLE, Sjögren’s Syndrome (SS) and Hashimoto Thyroiditis (HT) they comprise more than 90%. One of the hypotheses to this phenomenon regards the females’ tendency to have more reactive immune systems because of sexual hormones, menstruation, pregnancy and menopause.

The great problem is: being stress and autoimmunity umbrella terms, many health professionals and patients find it difficult to understand and validate the associations experienced by the latter. Also, being women the majority of autoimmune patients, in a still sexist environment, many collect bad experiences with health professionals including physicians and mental health therapists before having proper diagnoses and treatments. Once, I heard from a physician who could not explain the chronic swellings of a patient that her symptom “was solely caused by stress”; then he warned her “be careful, stress can kill you!” Sure, I would say “stress can kill you, and also keeps you alive”.

Counselling someone to not be too stressed to avoid the physical discomfort they are experiencing is not effective and sometimes it can even worsen the symptoms since the patient can feel invalidated and alone in their experience – and this can be even more difficult for people systematically struggling with social inequalities. Insisting on discovering a determinant relationship between psychological trauma and organic symptoms can be interesting but not if expecting that doing so would magically cure the patient. I keep wondering how many women must have been wrongly diagnosed as “hysterics” by the first psychoanalysis practitioners when they could have been suffering from complex and biologically grounded diseases as autoimmune ones. It can be truly a stressful cycle when you’re in pain and with rigid joints, and someone insists you “only” have a psychological problem that can be treated on the divan.

Still, I’m sure that psychotherapy can enhance autoimmune patients’ mental and immunity health if coordinated with physiotherapy, lifestyle changes and medication when needed. I do believe that the most important part that a mental health therapist can play in those cases is to help patients to recognize and validate their own bodily experiences and develop their personal resources to better respond to stress and pain. Learning about the mode of one’s body functioning makes them feel empowered. In this way, patients can better communicate with family, friends and health professionals about their symptoms and treatment choices.

I usually suggest the use of a simple pain and emotional scale card with which the patient can become habituated to mensurate their pain and identify emotions and mood changes triggered by it. Those scales can be assessed during therapy sessions and contribute to the whole therapeutic process. The level of pain can be added to Diary Cards used in DBT and other cognitive-based therapies. Mindfulness exercises can also be learned during sessions and be applied by the patient on a daily basis in order to maintain a grounded embodiment experience, avoiding intense psychological disorganization brought by disruptive experiences as acute pain. Those strategies and having a safe and validating space in therapy can surely prevent stress to become too intense and trigger flares.

Ljudmila Stojanovich and Dragomir Marisavljevich. Stress as a trigger of autoimmune disease. Autoimmunity Reviews 7 (2008) 209–213
Georgia E. Hodesa et al. Individual differences in the peripheral immune system
promote resilience versus susceptibility to social stress. PNAS, November 11, 2014, vol. 111 no. 45 

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