Tuesday, 30 January 2018

A stressed life

Do you suffer from post-traumatic stress disorder? Did you know MS is a potential cause?



J Nerv Ment Dis. 2018 Feb;206(2):149-151. doi: 10.1097/NMD.0000000000000780.

Prevalence of Posttraumatic Stress Disorder in Patients With Multiple Sclerosis.

Carletto S, Borghi M, Scavelli F, Francone D, Perucchini ML, Cavallo M, Pagnini F, Bertolotto A, Oliva F, Ostacoli L.

Abstract


Chronic and life-threatening illnesses, such as multiple sclerosis (MS), have been identified as significant stressors potentially triggering posttraumatic stress disorder (PTSD). The study aims to investigate the prevalence of PTSD according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria in a large sample of patients with MS. A total of 988 patients with MS were screened with the Impact of Event Scale-Revised, and then assessed with the PTSD module of the Structured Clinical Interview for DSM-IV and with the Clinician-Administered PTSD Scale to confirm PTSD diagnosis. Posttraumatic symptoms were reported by 25.5% of the sample. A confirmed diagnosis of PTSD was found in 5.7% of patients, but prevalence could reach 8.5%, including also dropout patients. Further studies are needed to evaluate if adjustment disorder could better encompass the frequently encountered subthreshold posttraumatic stress symptoms and how clinicians can deal with these symptoms with appropriate interventions.

In her book "Bossy Pants", Tina Fey (comedian) coined a new word "Blorft meaning 'Completely overwhelmed but proceeding as if everything is fine and reacting to the stress with the torpor of a possum'. I have been blorft every day for the past seven years", she says.

Blorft sadly in the current climate is firmly situated in our working lives, but the concern is that it may eventually lead to an even scarier entity, that of PTSD (post traumatic stress disorder). Lucky for us PTSD is rare (prevalence is 6.8% in the general population), well publicized and now accepted by the medical profession as a real condition.

The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) classifies PTSD as a clinical condition developed after exposure to a traumatic event. First described initially in relation to war, the definition has diversified to include chronic illnesses as a stressor that can trigger it. In those affected by chronic illnesses it is rarely screened for and therefore a largely an unknown entity.

According to the authors of this paper, a couple of things are already known about PTSD:
  • has a long-lasting impact on relational, social and working functioning
  • may be difficult to identify a single traumatic stressor
  • may persist over time and worsen with disease progression
  • criterion for reexperiencing the threatening event is linked to the reoccurence of the symptoms (e.g. fear of relapsing episodes, fear of disease progression).
For many, the diagnosis of MS alone can be considered a significant traumatic event. Previous studies have reported as much as 55% PwMS said MS was at least traumatic on an internet survey, although the PTSD criteria was not specifically tested (Counsell A, Hadjistavropoulos HD, Kehler MD, Asmundson GJG (2013) Posttraumatic stress disorder symptoms in individuals with multiple sclerosis. Psychol Trauma Theory Res Pract Policy. 5:448–452).

Here, they investigated the prevalence of PTSD in 988 PwMS according to the DSM-IV criteria. They found a significantly lower prevalence than previously reported at 5.2% and therefore in line with the general population; although 25% presented with an IES-R (Impact of Event Scale - Revised) above threshold, suggesting the possibility of PTSD. The latter probably, have sub-threshold PTSD, but like PTSD may have the same implications in terms of impact of mental and physical functioning (Grubaugh AL, Magruder KM, Waldrop AE, Elhai JD, Knapp RG, Frueh BC (2005) Subthreshold PTSD in primary care: Prevalence, psychiatric disorders, healthcare use, and functional status. J NervMent Dis. 193:658–664).

The current DSM-V criteria now states that medical disease per se cannot be considered as a stressor event that qualifies for PTSD, and now classifies this as an adjustment disorder for those who do not display the full house of PTSD symptoms. Adjustment disorder is not surprisingly more prevalent than PTSD, but may respond to the same treatment strategies that are used in PTSD. The two are likely to be on the same continuum.

7 comments:

  1. Living with MS has definitely caused me a lot of anxiety, but it has also generated the opposite of PTSD, what psychologists call post-traumatic growth: https://en.wikipedia.org/wiki/Posttraumatic_growth

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    Replies
    1. Well said Sebastien

      Tony Fonda

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    2. Thank you Sebastien for introducing me to the concept of post-traumatic growth. It explains a lot about why my response to trauma is different to many family members and friends.

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  2. "Well said Sebastien"

    Easily said..if you don't have PPMS

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  3. Could it not be the other way around?
    MS is a symptom of an unresolved major stress? After all, myelin is a factor of memory - it is produced when nerve impulses travel more and more frequently along a certain path to allow easier and faster transmission of electrical impulse. Is MS as a destroyer of myelin acting as a protection against traumatic memory?

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  4. lol. i don't have ms. i do have ptsd... from dealing with neuros :)

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  5. When I first heard about PTSD some years ago and many years after I was told the numbness in my face could be MS, I realised that I had suffered from PTSD at the time and for a few years afterwards. Flashbacks, nausea, intense anxiety - but then the whole experience wasn't handled well

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