Multiple studies show that stress and trauma increase the risk of developing lupus as well as causing lupus flares.
ANSWER: “There have now been several studies showing that significant stress, such as post-traumatic stress disorder, natural disasters, sexual abuse, physical abuse, exposure to racism, etc have been associated with higher rates of developing SLE. Studies have also associated stress with flares of lupus, and I know many patients who state that they flare during times of stress. One of the first studies to associate stress with the immune system was by Dr. Janice Kiecolt-Glaser, PhD in the 1980s when she measured natural killer cells in Ohio State University Medical students. She showed there were significant abnormalities in students who were stressed. Then during examination week (a time of high stress for everyone), these abnormalities also occurred in students who were fine before “test week.” This is why I recommend that SLE patients learn to decrease stress as a way to potentially decrease flares. For example, consider practicing mindfulness every day. Just 5 minutes of breathing exercises daily may help make a difference.” Learn more about managing lupus and stress management.
Stress and Lupus: Childhood abuse and trauma are associated with increased risk of developing lupus
As the questioner points out, a group of Harvard researchers published this study in 2019. It showed that women with lupus were more likely to have suffered from significant abuse and trauma as children.
- They evaluated over 67,000 women who joined the Nurses’ Health Study in 1989.
- 94 of them developed systemic lupus erythematosus by 2015.
- Note that this is probably an underestimation. These were only the women who were proven to meet the 1997 American College of Rheumatology classification criteria.
- Women who had more physical and emotional abuse as children were 3 times more likely to develop lupus.
- This particular study did not find sexual abuse as a cause of triggering lupus. However, this study may not have had enough cases of sexual abuse to pick this up.
- Depression and posttraumatic stress disorder (PTSD) were both singled out as major contributors to developing lupus.
In addition, another study showed that children exposed to 2 or more traumatic events were twice as likely to have been hospitalized with rheumatic disease. This also suggested that childhood stress increases the risk of developing systemic autoimmune diseases. Again, suggesting a link between stress and lupus.
Posttraumatic Stress Disorder (PTSD) and sexual abuse are other examples of the stress and lupus connection
Several studies have shown that people who have had PTSD are more likely to develop lupus.
For example, one study evaluated veterans.
- 203,766 Afghanistan war veterans with PTSD were compared to 129,704 without PTSD.
- Those with PTSD were twice as likely to develop an autoimmune disease (like lupus) compared to those without PTSD.
- Both men and women who had suffered military-associated sexual abuse were especially at risk.
The Harvard group showed in a previous 2017 study that women who had suffered trauma or “probable PTSD” were three times more likely to develop lupus.
Racism is linked to stress and lupus
Hearing about and observing acts of racism and discrimination are causes of significant stress. Just think about it. When you witness acts of discrimination against someone similar to you (race, gender, religion, sexual orientation, age, etc.), you realize that this could happen to you. We call this type of racism “vicarious” or “indirect” racism.
Auburn University (Alabama) conducted the Black Women’s Experiences Living with Lupus (BeWELL) Study. Doctors from the University of California, The University of North Texas Health Sciences Center, and Emory University (Georgia) participated in this.
- 431 women with systemic lupus erythematosus of African ancestery were evaluated from 2015 to 2017.
- They asked them about their experiences and reactions to news about racism, witnessing racism among friends and family, witnessing racism in public, and seeing racism in movies and on TV.
- Women with lupus exposed to vicarious racism were twice as likely to have higher lupus disease activity than those who did not.
This is just another example showing the results of racism. There is no room for racism, bias, and prejudice. We must all work at ridding this virus from society.
Stress Can Incease Lupus Flares
Studies have also shown a link between lupus flares and stress. I would not be surprised if most lupus patients reading this have noted lupus flares occurring during periods of increased stress.
A European study showed that women with lupus who had daily hassles with social relationships had more lupus flares and required increased doses of steroids compared to others. Other studies have shown similar results, which shows the importance of lupus and stress management.
Learning to Decrease Stress Can Help Lupus
Some studies suggest that people with lupus who learn to lessen stress do better and have a better quality of life. This is important because most lupus patients have decreased quality of life due to their disease and all the problems that come with it.
The good thing is that everyone can learn to deal with lupus and stress management. A few recommendations include:
- Practice mindfulness daily. Just 5 minutes of daily breathing exercises is a good way to start.
- Exercise daily. Everyone can exercise. If you are unsure of how to exercise safely and properly with your particular health condition, ask your doctor for a physical therapy referral. They can formally assess you and design a regimen specifically for you.
- Learn to say “no.” Many of my patients work and have families. They are used to doing “everything.” Learn to do just the essentials. Ask for help. Take off some “me-time.”
- Download my stress reduction handout to learn how to handle lupus and stress management.
I don’t know if stress caused my lupus, although it wouldn’t surprise me, given that at one point, I was working full-time, raising a family, was in law school, and commuted two hours a day. The stress certainly didn’t help the situation.
Definitely noticed increased flare activity related to periods of increased stress, and, once I retired, lupus symptoms decreased significantly.
Thank you for your comment, Virginia. Your experience is not uncommon. I am glad you are now under less stress so that you can take better care of yourself and hopefully live a better life… Donald Thomas, MD
I grew up in a house where physical and mental abuse occurred on a daily basis until my early teens when my parents divorced. I joined the Police Force when I was 19 and was exsposed to tradgedies that caused PTSD. I started to have SLE sympoms in my late teens but was only diagnosed at the age of 47. Still working. Have regular flare-ups. Thankfully I have a supportive family.
Lourika: thanks for your comments. I’ve seen too many cases like yours. Sharing your story can help others realize that they are not alone in their experiences, and hopefully, the cycle of abuse will hopefully stop in many families. Some of my lupus patients had horrible pasts, and now I see them being the wonderful parent that they never had. I wish you all the best in the future. Donald Thomas, MD
I grew up in a house with physical and mental abuse as well. My father was an abuser and I ended up marrying a man exactly like my father. After 14 years of being married it ended up in divorce. Thinking back I definitely believe my diagnosis of lupus steamed from my childhood situation and the divorce. I could remember days when I would be so stressed before I was diagnosed my joints would hurt throughout my body. I’m doing really well now, haven’t had a any serious issues, have an excellent rheumatologist (Dr. Sheyn).