Riding the Storm
How MS Affects Your Emotional Control
This article is a compilation of several previous ones including, "Maintaining a Sense of Well Being", "Misguided Radar Can Swamp Thinking in MS", and "Multiple Sclerosis and Mood Swings" by Ann Crickmer. Copies of the original articles, and a complete list of references can be obtained by calling the MSA at 206-633-2606. Compiled by Laurie Long
Have you ever found yourself reacting to a situation with an emotional response that was completely out of proportion to the event? Crying over a TV commercial, for instance, or being enveloped in a blinding rage because someone cut you off on the highway? Have you been embarrassed or frustrated by your increasing lack of emotional control? If that is the case, this emotional roller coaster could be a direct result of your MS.
An inability to control the outward expression of emotion is common in MS. The left frontal lobe of the brain is the "neural thermostat". It keeps raw emotion in check. If MS lesions have damaged the frontal lobe's functions, then its ability to regulate mood is compromised. This inability to regulate mood is experienced as intense physical sensations over which there is no control. Many describe it as emotional flooding or storms. Most people coping with MS find that their feelings are closer to the surface than they were before MS became part of their life. Some experience a quick temper and others cry very easily. Their ability to control the expression of strong emotions become less due to the physical changes in their brain.
A Toronto study (Joffe, 1987) found that 72% of outpatients in an MS Clinic had difficulty regulating their emotions. For some, this symptom appeared years before other more visible motor symptoms started. In fact, one of the initial symptoms of MS may be changes in mood and emotional expression (S. Minden, 1990). This is different than the feelings you have in response to the trauma of a diagnosis of a chronic illness. Since people cope most effectively with a chronic illness when they understand the range and severity of their symptoms, it is important to talk openly about emotional symptoms.
Depression
Studies have shown that anywhere from 40 - 60% of people with MS suffer from depression. This depression is may be caused by their circumstances, or can be a physically based symptom of MS, or a combination of both. In fact, studies have suggested that clinical depression, the severest form of depression, is more frequent among people with MS than it is in the general population and even more common than among persons with other chronic, disabling conditions. Depression does not indicate weak character and it should not be considered something shameful that needs to be hidden. Depression is not something that a person can control or prevent by willpower or determination. Discussing it with your doctor and seeking counseling are the first two steps in combating depression.
Depression is a widely under treated symptom of MS. Individuals experiencing this symptom may become withdrawn from their family or friends and give up interests that previously had meaning for them. They may become shy or inhibited. They are unable to maintain a positive mood - the negative emotional state lasts long beyond the event which initiated it. They can't bounce back from a stressful life event like they could before the MS. They can become stuck in a stressful, unregulated, disorganized state of raw emotion. Feelings of shame, humiliation and loss can overwhelm the person.
Fortunately, depression often responds well to treatment. Tricyclics (Elavil, Tofranil, Pamelor), selective serotonin reuptake inhibitors (SSRIs) (Prozac, Zoloft, Paxil, Celexa), and some of the more recent antidepressants ((Effexor, Serzone, Wellbutrin) are all available with your doctor's prescription. If you feel that you might be suffering from depression, consult with your doctor to see if one of these medications may help.
MS and Mood Swings
The Toronto study noted earlier showed that people with MS suffer from Bipolar disorder 15 times as much as the general public. People who suffer from this disorder experience mood swings which include an expansive, elevated mood, feeling on top of the world, alternating with depressive feelings. They may act egotistically, as well as have boundless energy and even agitation. Even after a mild frustration, hyper-irritability can result in an uncontrollable response, including rage. Relationships with family members and friends may become difficult and may include rude, argumentative or even abusive behavior. They may be action oriented and impulsive. They can be thin-skinned in response to the mildest criticism. This is a very frightening experience which has been described by one sufferer as "the invasion of the body snatchers". Once again, if you or someone you care for has these MS symptoms, you should see your doctor and discuss a medication trial to help stabilize mood and increase a sense of well-being. Medications that can be used for this disorder include Depakote, Lithium and Clozapine.
Anger
The hardest mood to control is anger, and emotional flooding is defined as a "susceptibility" to frequent emotional distress: of being swamped by dreadful, out-of-control feelings and thoughts. One cannot "hear" without distortion or respond with a clear head. It is hard to organize thinking. Many people with MS have a low threshold for flooding and family members ask what they can do to help. In his book "Emotional Intelligence: Why it Can Matter More than IQ", Daniel Goleman (Bantam, 1995), gives several suggestions to alleviate and control anger.
To defuse anger, we should strive to undermine the convictions that are fueling the anger in the first place. We know that the sense of being endangered is a universal trigger for anger. Also, symbolic threats to self-esteem or dignity, being treated unjustly or rudely, being insulted or demeaned, or frustrated in pursuing an important goal are anger triggers. One of the most potent ways to put anger to rest is to reframe the situation more positively in order to correct the misperception that, for example, one is being insulted. When the body is primed by anger, adrenocortical arousal causes a hair-trigger condition to occur, with anger then building on anger.
Challenging the thoughts that trigger the surge of anger is more effective the earlier the intervention. Anger can be completely short circuited if the mediation comes before the anger is acted upon. Physiological "cool down" is possible by waiting out the adrenal surge, in a setting where there are not likely to be further triggers for rage.
- At the first sign of an argument:
- get away by yourself for the time being
- seek distractions (TV, movies, reading) to "brake" the anger and stop it from escalating
- take active exercise or a long walk to promote the deep breathing and muscle relaxation which changes the body's physiology from a state of high arousal to low arousal
- write down angry thoughts as they arise and challenge them later
- after cool down - discuss the dispute with the other person
We have learned that giving vent to anger simply prolongs the mood. Family members or friends can help by maintaining calm body language. Anger is infectious: resist taking it personally. You can help to soothe the distressed feelings by showing attunement with them. Accurately mirroring the feeling of being insulted or frustrated contributes not just to feeling understood, but actively and meaningfully demonstrates emotional attunement. Let the person know you can see things from their perspective, that their point of view has validity. It helps to recover more quickly from the emotional flooding.
Remember:
1. Time Out
2. Check your pulse rate
3. Distraction or exercise
4. After a 20-minute minimum discuss the conflict
Conclusion
The loss of emotional control in MS is often the most embarrassing, and most damaging to relationships, of all MS symptoms. Even though it may be difficult, it is important to talk to your close friends, family and physician about these symptoms and work together to alleviate the emotional storms and create a safe harbor for your physical, emotional and spiritual well-being.
This article is a compilation of several previous ones including, "Maintaining a Sense of Well Being", "Misguided Radar Can Swamp Thinking in MS", and "Multiple Sclerosis and Mood Swings" by Ann Crickmer. Copies of the original articles, and a complete list of references can be obtained by calling the MSA at 206-633-2606.
~ Bipolar Information Websites ~
NationalAlliance for the Mentally Ill |
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Depression and Bipolar SupportAlliance |
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NationalAlliance for Research on Schizophrenia and Depression |
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The Child and Adolescent Bipolar Foundation |
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Bipolar Significant Others |
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NIMH Clinical Trial Database |
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Systematic Treatment Enhancement Program for Bipolar Disorder |
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Sequenced Treatment Alternatives to Relieve Depression |
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PubMed (National Library of Medicine) |
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National Institutes of Health |
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Stanley Foundation Bipolar Network |
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