Many discussions about people with Multiple Sclerosis (MS) include questions and comments about Depression, but Anxiety is often lumped in with Depression and is often not seen as a separate entity in its own right.
Yet Anxiety is something that people with MS often experience, either in the normal course of events or due to specific problems related or unrelated to the disease.
In this review article I want to discuss how Anxiety can effect people with MS. I will also review the categories of Anxiety used by Mental Health professionals in diagnosing and treating Anxiety in all its manifestations.
But let's start with a clear definition: Anxiety is "distress or uneasiness of mind caused by fear of danger or misfortune" and it is "a state of apprehension and psychic tension occurring in some forms of mental disorder" (Random House Webster's Dictionary.)
Physical correlates to Anxiety include muscle tension, trembling, stomach upset or butterflies, nervous tics, and many others. But Anxiety itself is seen as a kind of mental tension, often in anticipation of some negative event.
Anxiety touches us at many levels. A bride is anxious on the evening of her wedding. A citizen, when stopped for speeding may be anxious. One can be anxious before an argument, or before speaking in public.
The anticipation of the arrival of a bill or a test, or an important meeting can cause Anxiety. Like the rest of the world, people with MS have all of these anxieties.
But people with MS also have other causes of Anxiety, some of which are unique to being ill and others are unique to being ill with MS.
People with any illness often have anxieties and worries that haunt them. Some, like fears of pain or debilitation, are shared by people with MS.
Others, like worries of whether the illness will be fatal or if it is contagious, are not shared by people with MS, at least they are not shared once good information is obtained.
MS offers several fairly unique reasons to cause Anxiety. For many it is a recurring disease - it goes into remissions and returns in relapses. For others it is a progressive disease, steadily reducing a persons abilities.
In all versions of the disease, predictability is very low. That means on any day, at any moment, on any morning the disease can raise its ugly head.
A new lesion can develop at random in the Bain and the symptoms that result from it may make themselves known. The fact that this is the case for MS is often cause for significant Anxiety for people with MS. What will tomorrow hold? Will I be able to work or shop or pick up my child?
There are some people who find that their particular version of MS follows a certain pattern, but many people with MS do not have this experience. The anticipation of a random return of the illness is a significant cause of Anxiety.
A second aspect of MS that is a substantial cause for Anxiety is the progressive nature of its course and the accompanying concern about prognosis. This was the first big question that I brought to discussions with others with MS.
What are my chances for getting a "good" version of the disease, versus a version that would put me in a wheel chair in five or even one or two years?
What percentage of people with MS can work for the rest of their lives? What is going to happen to me? These questions can produce a substantial amount of mental tension.
Another time that is ripe for heightened Anxiety in the experience of MS is when a new symptom presents itself. This can cause a great deal of fear or panic.
What does this new symptom mean? How long will it last? Will it get worse? Will it be permanent? Will I be able to keep working? Is this the symptom that signals a drastic worsening of this disease? Being diagnosed with MS raises all of these fears and anticipations of negative events to the fore.
Equally Anxiety provoking is the often lengthy diagnostic process that accompanies the first symptoms. For many a clear diagnosis of MS takes many years. For others the diagnosis is accompanied by many unpleasant, intrusive and potentially painful medical tests.
So there are many reasons to experience Anxiety when one has or suspects one might have MS.
When a situation causes the anticipation of a negative or dangerous event, the body can respond in some very primitive ways. In the primordial world of ancient history Anxiety resulted when the saber tooth tiger jumped out from behind a rock, or when the hunter approached his prey.
This anticipation of danger causes the body to do a number of things that are very helpful in these situations. (See: HypoThalamus)
The body sends Adrenaline to the muscles to optimize their functioning. It shuts down nonessential functions, like digestion, so that all energy can be funneled to essential systems.
It increases heart rate and breathing so that there is a maximum of oxygen available to the muscles to perform. It automatically charges up the fight and flight system in order to increase chances for survival.
It is this system that is implicated in Anxiety. When the system is fully engaged, panic is the result. Partial engagement of the system can cause other kinds of things.
But it is important to remember that Anxiety is not always a bad thing. It saved numerous of our ancestors and it can be a useful signal for us.
I went out in the heat to garden for a few minutes the other day. I was anxious about doing so. I had a work day scheduled the following day and the kind of MS fatigue I have carries over into the next day when I overdo.
When I was outside my wife was working on digging a hole for a tree we had ordered. I got a hoe and started helping. I was hot, but it was initially pleasant.
Then I stumbled just slightly and my Anxiety increased. I made a comment to my wife that I probably shouldn't be out in the heat. She told me to go in. I kept working.
But I started thinking "you shouldn't be doing this." "It's to much for you." And my Anxiety grew. Finally when my knees started notably wobbling after about 20 minutes I finally listened to my Anxiety and went into the air conditioning.
Anxiety is often a signal that tells us something is amiss. When we know what the signal means and listen to it, it serves an important function.
If we are anxious about a meeting, we will prepare more for it, or we will increase our attention and concentration and pay attention to nuances that we may have missed were we more relaxed.
If we are anxious about symptoms, we may do some things that help to minimize them or manage them more safely. Developing a plan that we follow to manage our own particular version of MS can be very helpful in managing Anxiety.
But sometimes Anxiety gets out of control. For someone with heightened fears of relapses, they can live life in constant fear of the next returning symptoms. Anxiety can paralyze us.
Staying to long in a state of Anxiety can cause digestive problems that can become very serious. Muscle aches and other discomfort can be exacerbated. It can cause headaches and other symptoms.
Anxiety can make us irritable and can interfere with our ability to relate comfortably to people who are important to us. When Anxiety reaches these proportions, it is time to do something about it.
There are some simple ways to manage Anxiety that most people with MS should be able to do. Getting the most information about the disease and understanding it as best you can is a good start to keeping Anxiety reasonable and within bounds.
Utilizing the social support that is available to you by talking about what is going on with the disease with people close to you should also help.
Supplementing natural support systems with more formal opportunities for emotional support can also be very helpful. People can find an MS support group, a PsychoTherapist, or other more general support groups.
Finding a team of trusted professionals to monitor and provide care for the disease and its symptoms can also go a long way in reducing painful fear and Anxiety.
Anxiety is an important feeling that we should all have. We should pay attention to it when we get it. But it can get out of hand and cause substantial unpleasantness.
When this happens a mental health professional should be consulted. Treatments for Anxiety range from supportive and Cognitive therapy, to systematic desensitization, to flooding and can include a variety of very effective medications.
There are many distinct diagnostic labels that are given to varieties of Anxiety. Here is the list of disorders from the Diagnostic and Statistical Manual of the American Psychiatric Association, fourth edition.
Categories in DSM IV:
Some of these disorders may be experienced separate from MS, but many may be related.
Anxiety due to a medical condition may come from certain strategically occurring MS lesions so that the Anxiety is actually triggered by a physiological event caused by MS. A generalized Anxiety disorder may have MS as part of its causal configuration.
Social phobias or panic disorders can also be exacerbated by a diagnosis of MS and can also relate directly to fears that result from the experience of having MS or its symptoms.
Phobias may also be related - like an irrational fear that prevents maximum independence or keeps a person restricted to certain physical areas. There are times when Anxiety presents in ways that appear to be something else.
For example, there are is a long list of symptoms that may indicate a physical illness that may also be a panic attack: palpitations, pounding heart, accelerated heart rate, sweating, trembling or shaking, sensations of shortness of breath or smothering, feeling of choking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady, lightheaded, or faint.
These and other symptoms can cause a person to fear losing control or going crazy, to fear dying. Indeed, panic attacks and other forms of Anxiety have produced symptoms very like those of MS: numbness or tingling sensations.
When these symptoms present themselves it is important that they be taken to a physician. If no physical cause is found and it is thought to be resulting from Anxiety, treatment by a mental health professional is in order.
Anxiety is often caused by MS and the symptoms of MS. To a certain degree this is unavoidable and even appropriate. MS is a real, dangerous, and often debilitating disease and offers much to fear.
But the fears, worries and anxieties that can come as a result of MS can also do their own damage. Much can be done to manage these anxieties and leaving them untreated or ignored is a mistake that can have both immediate and long term consequences.
Written by J. Lamar Freed, Psy.D., February 19 1997. This article may be printed or posted without permission, but not without attribution.
Dr. Freed is a psychologist in private practice in the northern suburbs of Philadelphia, Pa. He has been diagnosed with MS since 1993.