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MS and Personality

    by: Patricia Daily, L.C.S.W.
    Jeffrey Shore, editor

Preface
Given the various discussion(s) on Cognition and Emotion, there may be some interest in the following article on the effects of MS on one's Personality, Cognitive capabilities, and Emotional responses.

It is an excellent, succinct primer in the areas of Personality, Cognition, and Emotion in people affected by MS. It may be of use not only to the newly diagnosed, their family, friends, and employers, but to the "old timers" in the MS realm as well.

Given my personal experience and that of others, even some in the medical community might benefit from this article.


Introduction
Multiple Sclerosis is a chronic illness that can affect people in many different ways. MS usually changes how a person feels and functions physically. It can also affect an individual's personality.

Changes in Emotions, Behaviors, and Information Processing (Cognitive) abilities are often subtle and barely apparent to others. But for people with MS, these changes can be just as challenging - if not more so - than the physical symptoms of the disease.


MS and Emotions MS and Cognition

Personality is the sum of the behavioral and attitudinal characteristics that give each one of us our individuality.

Our personalities are the result of the complex interaction between our native abilities, our experiences, our values and the mechanisms we have developed to help us make sense of our lives.

Personality is the habitual way we organize and present a coherent picture of who we are to ourselves and to others. The first way that MS can affect Personality is by changing a person's self-concept and sense of Emotional well-being.

MS often presents a very different physical and emotional experience that can be extremely difficult and painfully slow to integrate.

The second way MS can affect Personality is by altering Cognitive abilities and skills. Sometimes the disease impacts the ability to Organize, Integrate and Understand our experiences.


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MS and Emotions
The diagnosis of MS or the impact of any subsequent exacerbation is a psychologically traumatic event that can change a person's sense of security and safety in the world.

Aspects of life that previously seemed reliable and trustworthy suddenly become frightening and undependable. The traumatic impact of MS is intensified because the course of the illness cannot be predicted.

This lack of predictability make it even more difficult to come to terms with and integrate the illness. As one of our patients said to me, "How can I adjust if I don't know what I'm adjusting to?"

Coming to terms with MS necessarily involves dealing with loss. Sometimes it involves the actual loss of physical function. But the loss of security that comes with the loss of predictable health also needs to be acknowledged.

As people struggle to adjust to MS, they often have strong Emotional reactions. Depression, Anxiety, Fear, Frustration and Anger are common responses.

Many people also experience Irritability, Distractability, Poor Concentration and and a loss of interest in activities that were formerly interesting.

Some of these problems can be successfully treated with medication, especially when the underlying cause is Depression.

Learning to live with a chronic illness is one of life's most stressful experiences. As with all new learning, it is often peppered with false starts and errors in judgement.

Many people with MS have difficulty making changes, even when these changes would actually make their lives easier. This "resistance to change" is often labeled "denial," and sometimes it is just that.

More often, however, it arises more from confusion and uncertainty about what changes to make and how to make them. This difficulty is compounded by the tendency we all have to cling to our routine ways of doing things when we are under stress.

Sometimes resistance to change is rooted in the fear that those around us will not tolerate the realities that made these changes necessary.

Sometimes people with MS have difficulty controlling their Emotional responses. A mild stimulus can set off a response that far exceeds what the person feels.

For example, sometimes people find themselves crying when they aren't sad or laughing untrollably at something that is only mildly funny.

Sometimes people feel embarrassed by these problems to the point of avoiding social situations. Both they and their family members may mistakenly believe that this lack of emotional control is the result of depression.

It often is not linked to Depression but to Brain functions which can be successfully treated with medication in many cases.

The degree of Emotional difficulty experienced by people trying to integrate MS is not necessarily determined by the severity of physical impairment.

Relatively mild symptoms that may be virtually invisible to others can be just as hard to integrate - sometimes harder - as more severe, physically disabling symptoms.

Even when the physical trauma created by MS is mild and transitory, people can experience a powerful psychological trauma, with all the feelings of vulnerability, fear of uncertainty and sense of helplessness that can accompany a major trauma.


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MS and Cognition
The other set of personality changes that we see with MS [is] caused by the impact of the disease on the brain. Until recently MS was not thought to cause cognitive problems. But it is now estimated that as many as 60% of people with MS have at least mild Cognitive problems.

Another common Cognitive difficulty is mild to moderate impairment of short-term and working memory. People who usually have good memories may find themselves forgetting appointments or other things they meant to do.

Their attention span and ability to concentrate may be diminished. Sometimes they find it hard to keep track of what they had been doing before they were interrupted.

For example, they may have difficulty getting back on track if the phone rings while they were sorting mail. While these problems can be quite subtle, they can be extremely frustrating and upsetting.

Some people with MS experience more serious Cognitive problems. They have difficulties with planning and problem solving and tend to become overwhelmed and inflexible when a task is too complex.

They may lack the flexibility to generate alternative solutions. They may be unaware of their difficulties and have problems monitoring their own behavior and with comprehending the impact of their behavior on others.

Difficulties with the self-regulation of behavior can create problems in many different ways. Some people with MS may be unable to plan and organize purposeful activity.

Sometimes the problem is in the area of initiating behaviors. This trouble with "getting started" may appear to others as depression or lack of motivation.

Other people who have MS may have the opposite problem of being unable to stop themselves. They may be very talkative and uninhibited, blurting out comments they would have kept to themselves in the past.

Because they are unresponsive to the normal social clues that let them know their behavior is inappropriate, they seem very impulsive and oblivious to the reactions of others. Further, they may have a "short fuse" and experience unpredictable, angry outbursts.

It is important to remember that there often is an overlap between cognitive and emotional problems associated with MS and that many people experience some of each.

A person may have some memory difficulties and develop Depression in reaction to these. On the other hand, one of the symptoms of Depression can be forgetfulness.

An evaluation by a physician or knowledgeable health care professional can help differentiate these problems. Many of these symptoms can be treated once they are identified. Cognitive problems often improve with Cognitive rehabilitation provided by a Speech and Language Pathologist.

Emotional problems often respond to medications or to psychotherapy. Support groups, recreational programs and social activities can help many people with MS cope with the challenges of the disease.


If you or someone you know would like to learn more about the Cognitive and/or Emotional consequences of MS, please call at [303] 788-7667.

"MS and Personality" by Patricia Daily, L.C.S.W.,
Director of Psychological Services
The Rocky Mountain Multiple Sclerosis Center,
Denver, Colorado

RMMS Center's Quarterly Newsletter
INFORM, Volume IX, Number 1, Winter 1994,

    Contact info for RMMS:
      Center for Neurological Diseases
      RMMS Center
      701 East Hampden Avenue, Suite 430
      Englewood, CO 80110-2790
      USA: 303-788-7667

Modifications for format purposes only were made on 5/25/98.


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