Stress & Autoimmune Disease: Navigating the Complex Relationship
Stress is a powerful and often underestimated force that can significantly impact our overall health, particularly when it comes to autoimmune diseases. While stress can sometimes act as a motivator, chronic and intense stress can lead to a cascade of negative health effects, particularly by disrupting the immune system’s delicate balance.
This article explores the intricate relationship between stress and autoimmune diseases, examining how negative stressors can trigger and exacerbate these conditions. We delve into the physiological mechanisms of stress, its various manifestations, and its profound impact on specific autoimmune diseases, shedding light on the importance of managing stress for those affected by these chronic conditions.
What is Stress?
Stress can be defined as a threat to homoeostasis, whether the threat is real or psychological (1). But stress is not necessarily negative. An actress who is feeling stress before a production may feel energized to take to the stage.
When a situation exceeds an individual’s ability to cope, however, negative stressors can occur. During a “fight or flight” response, for example, an individual can experience a quickened pulse, faster breathing, and increased blood pressure (2).
“Our brains perceive events in our lives as stressful or not, and when they’re perceived as stressful, that results in the activation of certain areas of the brain, which includes the activation of pathways that release the so-called stress hormones norepinephrine, epinephrine and cortisol,” said Dr. Michelle Dossett, who has studied mind-body health.
“These stress hormones have effects on all the organs and tissues of our bodies and can impact intestinal functions, cardiovascular functions and the immune system.”
Responses to stressors vary, and an individual may generate a greater response depending on a situation’s intensity, controllability, and predictability. Persistent stress stemming from worry over issues including finances, health and relationships can also have long term negative effects (2).
Is Stress a Factor in the Development of Autoimmunity?
Stress may both trigger and exacerbate autoimmune disease. Up to 80% of patients have reported uncommon emotional stress before the onset of disease (3). Researchers describe a sort of feedback loop: Stress not only causes disease, but disease causes significant stress in patients.
In one study, researchers looked at more than 100,000 people with stress-related disorders. Compared to 126,000 of their siblings and another million without stress-related disorders, it found that those individuals were more likely to be diagnosed with an autoimmune disease or develop multiple autoimmune diseases (4).
However, an autoimmune condition may have already been present before the stress-related disorder was diagnosed or there may have been other explanations for the higher rate of autoimmune disease (2).
Which Autoimmune Diseases Have Been Associated with Stress?
Stress has been associated with rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple sclerosis, Graves’ disease and other autoimmune conditions.
Rheumatoid Arthritis and Stress
Rheumatoid Arthritis (RA) is an autoimmune disease that causes pain, swelling, stiffness and tenderness in the joints. It occurs when the immune system destroys the synovial membrane in diarthodial joints. The symptoms of RA can prove stressing, but stress can make tolerating the disease more difficult and worsen the pain.
Stress and Multiple Sclerosis
Multiple Sclerosis (MS) is an autoimmune disease that affects the brain and spinal cord. It damages the myelin sheath, which surrounds and protects nerve cells. MS has been shown to be aggravated by exposure to stress. In a study, around 80% of patients with MS reported an unusual amount of stress before the onset of the disease.
Stress and Inflammatory Bowel Disease
Inflammatory bowel disease (IBDs), including Crohn’s disease (CD) and ulcerative colitis (UC), is an intestinal inflammatory disease. Stress has been found to aggravate the disease and have an impact on the frequency of symptomatic flares.
Stress and Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect many parts of the body, including the skin, joints, heart, lungs, kidneys, circulating blood cells, and brain (5). Stress has been found to increase the incidence of SLE and exacerbate symptoms, including physical pain and sleep disturbances.
Stress and Graves’ Disease
Graves’ disease is an autoimmune disease that can cause hyperthyroidism or an overactive thyroid. Several studies have found that stress hormones have an impact on the pathophysiology of Graves’ disease.
Stress and Type 1 Diabetes
In Type 1 diabetes, the pancreas makes an insufficient amount of insulin. Stress may cause blood sugar levels to rise and become more difficult to control, meaning patients may need to take higher insulin doses.
Stress and Psoriasis
Psoriasis is a chronic inflammatory disease in which the immune system becomes overactive, causing skin cells to multiply too quickly. A classic symptom is scaly patches of skin, usually on the scalp, elbows, or knees, although other parts of the body can also be affected. An estimated 2% of the general population is affected. Stress, which can make itching worse, has been found to be a common trigger for a psoriasis flare.
What are the Different Types of Stress?
Individuals vary in their ability to cope with stressful events (5).
“What I find stressful and what you find stressful may be different,” said Dr. Michelle Dossett, who has studied mind-body health.
“Different things are stressful to different people.”
Some stressors are common to all humans, such as having a spouse die or losing a job.
But there are other physical, psychological and environmental sources of stress as well. Air pollution from sources including vehicle exhaust and forest fires, for example, can have detrimental effects on health and play a major role in various autoimmune diseases. Pollution includes solid, liquid and gas components such as: carbon monoxide, nitrogen dioxide, ozone, and sulfur dioxide (5).
Stress can occur at any age — from early life stages to adulthood.
Is Stress a Trigger for Autoimmune Disease Flares?
Symptoms of autoimmune diseases may ebb and flow (6), but during a flare, they may be sudden and severe.
Stress is a common trigger.
said Dr. Michelle Dossett.
“I can’t tell you how many patients I’ve seen who’ve had a major stressor and started to develop symptoms or had a flare of an ongoing condition,”
A stressful event doesn’t mean someone will experience a flare. But sustained stress increases the risk.
Becoming aware of what triggers symptoms can help alleviate flares or prevent them from becoming worse. Psychological and cognitive behavioral therapy aimed to reduce stress levels has also been shown to be effective in influencing better outcomes for many autoimmune diseases (7).
Dr. Dossett also studies yoga and breathing techniques which help to reset the body to a more normal homeostatic regulation.
“It’s well-documented that the regular practice of meditation impacts the expression of genes involved in the production of inflammatory cytokines,” she said.
“Meditating for 20 minutes a day creates changes that we can see in an MRI scan.”
Data is still slim.
“There haven’t been a lot of randomized, controlled trials of mind-body interventions in people with autoimmune conditions to show it reverses the disease course,” she said.
But some studies have shown mind-body interventions which have improved quality of life and given patients additional options for improving their health.
Sources
- Article Sources
Ilchmann-Diounou, H., & Menard, S. (2020). Psychological Stress, Intestinal Barrier Dysfunctions, and Autoimmune Disorders: An Overview. Frontiers in immunology, 11, 1823. https://doi.org/10.3389/fimmu.2020.01823
Robert H. Shmerling, M. D. (2020, October 27). Autoimmune disease and stress: Is there a link? Harvard Health. Retrieved from https://www.health.harvard.edu/blog/autoimmune-disease-and-stress-is-there-a-link-2018071114230
Seiler, A., Fagundes, C. P., & Christian, L. M. (1970, January 1). The impact of everyday stressors on the immune system and health. SpringerLink. Retrieved from https://link.springer.com/chapter/10.1007/978-3-030-16996-1_6
Song, H., Fang, F., Tomasson, G., Arnberg, F. K., Mataix-Cols, D., Fernández de la Cruz, L., Almqvist, C., Fall, K., & Valdimarsdóttir, U. A. (2018). Association of Stress-Related Disorders With Subsequent Autoimmune Disease. JAMA, 319(23), 2388–2400. https://doi.org/10.1001/jama.2018.7028
Autoimmune diseases | Office on Women’s Health. Retrieved from https://www.womenshealth.gov/a-z-topics/autoimmune-diseases
Sharif, K., Watad, A., Coplan, L., Lichtbroun, B., Krosser, A., Lichtbroun, M., Bragazzi, N. L., Amital, H., Afek, A., & Shoenfeld, Y. (2018). The role of stress in the mosaic of autoimmunity: An overlooked association. Autoimmunity reviews, 17(10), 967–983. https://doi.org/10.1016/j.autrev.2018.04.005
