(an audio version of this blog for those who find reading less accessible or preferable)
Introduction
It comes as no surprise to anyone living with long-term mental health issues that managing poor mental health takes a toll on the body. The link between poor mental health and the body is the subject of many great books and articles. (The Body Keeps the Score by Bessel Van Der Kolk being one of the most famous, links below.)
Survivors of traumatic events can experience flashbacks in sensory terms. Some feel sensations on the skin or pain in the body. It could be said this is far more common than the recurrence of bad or painful memories that are often associated with the term, 'flashbacks.'
Suppose a person has been living in a state of hypervigilance due to trauma for many years. In that case, it stands to reason that constant muscle tension, particularly in the back or neck, will lead to muscular or skeletal chronic pain. We are also starting to see evidence that points to the long-term effects of living with stress hormones, such as adrenalin, norepinephrine and cortisol, exacerbating cancer cells' growth or their spread to different parts of the body. (Counter to popular belief, less evidence exists that indicates chronic stress directly causes cancers).
What is an autoimmune disease?
An autoimmune disease is when the body's natural defences cannot tell the difference between harmless cells that are meant to be in your body and foreign cells. This means your immune system starts attacking these harmless, native cells. The results and severity of the symptoms vary depending on many things: a person's genetics, health or environment. Common examples of autoimmune diseases are; Rheumatoid Arthritis, Psoriatic Arthritis, Lupus and Graves' disease.
It can be difficult to personally know, let alone receive a diagnosis, for an autoimmune disease. This is partly because the symptoms can be vague or attributed to another illness (or in many cases, sufferers just tolerate the symptoms).
Common symptoms are:
Fatigue
Aches and pains/joints swelling
Chest pains
Difficulty sleeping
Shortness of breath
Anxiety
Rashes or irritated skin
Digestive issues
Plus, over 80 types of autoimmune disease can affect different parts of the body. This makes it difficult to know how to look out for all of them.
How is this linked to PTSD?
Many patients who seek me out for Trauma Therapy discover they have an autoimmune disease. They work hard to process PTSD and a traumatic history. They get to a safer place where they can start to think about everyday health, then suddenly face another diagnosis of Lupus or Rheumatoid Arthritis (or any other autoimmune disease). There is an unfairness to this, made more unfair by the realisation that this autoimmune diagnosis could be caused by past trauma.
"…results were not appreciably different according to combat experience and history of physical or sexual trauma.”
Evidence
A study called ‘Posttraumatic stress disorder and risk of selected autoimmune diseases among US military personnel’ published in Jan 2020 used data from the Millennium Cohort Study to examine whether US soldiers medically diagnosed with PTSD also had higher rates of autoimmune disease. They followed 120,572 participants for roughly just over five years. It concluded that those who had PTSD were at 58% higher risk of an autoimmune disease than those with no history of PTSD. They even considered environmental and health factors like smoking, alcohol use, and BMI, which had little impact on the results. They also concluded that the "results were not appreciably different according to combat experience and history of physical or sexual trauma."
This emphasises that it is not just people who have survived Type One Trauma (i.e. single traumatic instances, such as serious accidents, injury, or conflict) who are potentially vulnerable to trauma-related autoimmune disease, but also survivors of Type Two Trauma (i.e. longer sustained, historical or childhood trauma).
So now I have PTSD and an autoimmune disease...🙄
Getting a physical health condition diagnosis potentially because of a complicated history with trauma can be the last thing we need. (One of my patients described it as "a double whammy" followed by a heavy eye roll). It can feel like an added disadvantage in life caused by a history of trauma or complex PTSD. However, both PTSD and autoimmune diseases are manageable and do not have to define you. Take time to create a care plan, including everything from things that help you relax, nutrition, and food, to keeping active and hobbies.
The best place to start when creating a care plan to manage an autoimmune disease is your doctor or GP. They will be able to prescribe medication, refer you to further medical interventions, and advise lifestyle changes.
We are learning more and more that the body does not differentiate between physical and mental health in the same way we do. I believe that eating tasty, wholesome food when we can and staying active can support our mental health as much as therapy can support our physical health. Involve your GP and therapist in your care plan and pay attention to what helps. Remember, you are more dynamic, nuanced, unique and (frankly) interesting than any diagnosis!
Please remember, a diagnosis of an autoimmune disease does not mean you also have PTSD or a lived experience of trauma. Conversely, having PTSD doesn't mean you have or will develop an autoimmune disease. This blog cannot offer a diagnosis. It is a reflective blog. I hope you will find it informative, supportive and interesting. If you have any concerns about your health, please see a doctor.
Signposting
There are too many different autoimmune diseases to add links to further info on all of them. However, here is the NHS A to Z website where you can search for information on specific conditions https://www.nhs.uk/conditions/
If you are not registered at a GP and not sure how to find one, you can search for one using your postcode here https://www.nhs.uk/service-search/find-a-GP
(FYI. If you do not have a fixed address or postcode, you are still legally entitled to be registered at a GP. GP surgeries are obliged to provide alternative ways for you to register. If you are denied this right, you are within your right to complain to the GP Practice manager).
A more obscure resource is comedian Katherine Ryan's podcast, 'Telling Everybody Everything'. She is open about her Lupus, and her podcast is a perfect antidote to stressful days and a good companion for walks in the park. (Adult content.)
The Body Keeps the Score by Bessel Van Der Kolk. Non-Amazon sites to buy this book:
The Book Shop / Hive / Wordery
Lars I.P. Partecke.S.S. et al. Chronic stress increases experimental pancreatic cancer growth, reduces survival and can be antagonised by beta-adrenergic receptor blockade Pancreatology (2016)
Bookwalter, D.B., Roenfeldt, K.A., LeardMann, C.A. et al. Posttraumatic stress disorder and risk of selected autoimmune diseases among US military personnel. BMC Psychiatry 20, 23 (2020). https://doi.org/10.1186/s12888-020-2432-9