PTSD Linked to Greater Risk of Developing Lupus

Post-traumatic Stress Disorder (PTSD) is a condition that develops if a person has experienced a highly traumatic event in the past like an accident or a sexual assault. Most people, if faced with a traumatic event, find it difficult to forget for some time. They are disturbed by bad memories and thoughts, and sometimes find it difficult to sleep and do day-to-day activities. To an extent, such kind of reaction after a traumatic event is normal. But few people find it difficult to overcome the memories of trauma for a much longer time and may continue to suffer from negative psychological impact for months or years.

Any kind of chronic stress including PTSD is very different from the acute reactions. In all stressful conditions, certain hormones are released to tackle the immediate threat, but such hormonal changes do not continue for long due to negative feedback. In chronic stress like PTSD, things are different. The release of stress hormones in such cases is more resistant to negative feedback, which results in altered sleep pattern, hypertension, dietary changes, emotional changes, and other biological changes. PTSD is also known to alter the immune responses. Chronic traumatic stress has more immune-altering effects as compared to acute stressful events (1).

Stress-related diseases emerge, predominantly, out of the fact that they so often activate a physiological system that has evolved for responding to acute physical emergencies, but we turn it on for months on end, worrying about mortgages, relationships, and promotions (Sapolsky, 1998, p. 7) (2).

Lupus is an autoimmune disease, which means that immune responses have everything to do with it. Thus, long-term stress like PTSD is well known and documented to change the course of many existing diseases to worse and is known to serve as the initiator of various autoimmune diseases (3).

PTSD and Lupus

Lupus is a chronic autoimmune disorder characterized by abrupt starting, periods of flares and remissions. Chronic stressful conditions have long been reported to aggravate the symptoms of lupus, trigger flares (4,5). But little has been known about the role of a prolonged stressful condition like PTSD.

In one of the studies published in the journal Arthritis & Rheumatology, 54,763 civil women was studied to find out the association between the PTSD and lupus in 24 years worth of data. This study found the three-fold increase in the risk of developing lupus in those suffering from a chronic stressful condition like PTSD (6). It also had some surprising outcomes. PTSD had a higher link to lupus as compared to other risk factors like smoking and obesity.

Controlling PTSD May Help Fight Lupus

If PTSD can lead to lupus, then logically its control would help to fight and manage lupus effectively. Thus treating stress and PTSD along with usual pharmaceutical treatment of lupus is vital. It is important to assess the level of stress in a person at the time of their lupus diagnosis, so as to craft a better treatment strategy (7).

Overcoming PTSD

It is important to take measures to cut down any kind of daily stress for better health outcomes in lupus. Regular exercise and practice of mindfulness have been shown to be highly helpful in stress management. When discussing how to overcome PTSD, it is important to understand that it is different from the daily stress. Though humans have known PTSD for ages, it was only in 1980 when the American Psychiatric Association added PTSD as separate disease form in its diagnostic manual of mental disorders (8). Thus approach to overcome PTSD is also different from other stressful conditions.

As per American Psychological Association, PTSD can be treated with psychotherapy, medications or a combination of both. Each case of PTSD is different, hence the treatment would also differ from person to person. PTSD is now well recognized as a serious mental disorder, thus it is important to get treatment from the qualified and well experienced professional(9).

Cognitive Behavior Therapy (CBT):

It is a type of psychotherapy that is usually carried out under the supervision of professional, lasting for 12 to 16 weeks. In CBT for PTSD, trauma event that initiated the stress-related disorder is the main focus. Psychologist or psychiatrist helps a person suffering from PTSD to understand, identify the problem and change his or her thinking or behavior pattern. In CBT person is actively involved in the treatment process.

Two strategies are most commonly used in CBT to treat PTSD. The first strategy is called exposure therapy, in which a person is repeatedly and gradually exposed to the feared situation until a person becomes insensitive to the situation. The second strategy is called cognitive restructuring, it is a strategy that helps a person to think more rationally about his or her trauma and change opinion about it.

Pharmacological treatment

Medical drugs belonging to the class selective serotonin reuptake inhibitors (SSRIs) are the mainstay of treatment of PTSD.

Conclusion

There is mounting evidence regarding the role of PTSD in the development of various autoimmune disorders including lupus. Latest studies support the idea that PTSD leads to biological changes that can trigger the onset of lupus, exacerbate flares, and worsen the symptoms of lupus.

Hence, it is important that PTSD should be diagnosed early and treated under the supervision of experienced professional. Thus the treatment of PTSD, emotional distress, chronic stress and other psychological problems may help to decrease the burden of lupus.

References

1. Segerstrom SC, Miller GE. Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychol Bull. 2004 Jul;130(4):601–30.

2. Sapolsky RM. Why zebras don’t get ulcers: An updated guide to stress, stress-related disease, and coping. New York, NY: Freeman; 1998.

3. Hassett AL, Clauw DJ. The role of stress in rheumatic diseases. Arthritis Res Ther. 2010;12(3):123.

4. Pawlak CR, Witte T, Heiken H, Hundt M, Schubert J, Wiese B, et al. Flares in patients with systemic lupus erythematosus are associated with daily psychological stress. Psychother Psychosom. 2003 Jun;72(3):159–65.

5. Peralta-Ramírez MI, Jiménez-Alonso J, Godoy-García JF, Pérez-García M, Group Lupus Virgen de las Nieves. The effects of daily stress and stressful life events on the clinical symptomatology of patients with lupus erythematosus. Psychosom Med. 2004 Oct;66(5):788–94.

6. Roberts AL, Malspeis S, Kubzansky LD, Feldman CH, Chang S-C, Koenen KC, et al. Association of trauma and posttraumatic stress disorder with incident systemic lupus erythematosus (SLE) in a longitudinal cohort of women. Arthritis Rheumatol. :n/a-n/a.

7. University of Granada. Controlling Stress Helps Fight Chronic Diseases Such As Lupus [Internet]. ScienceDaily. 2007 [cited 2017 Oct 8]. Available from: https://www.sciencedaily.com/releases/2007/08/070802090644.htm

8. PTSD History and Overview - PTSD: National Center for PTSD [Internet]. [cited 2017 Oct 8]. Available from: https://www.ptsd.va.gov/professional/ptsd-overview/ptsd-overview.asp

9. American Psychological Association. Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults [Internet]. American Psychological Association; 2017. Available from: https://www.apa.org/ptsd-guideline/ptsd.pdf