Multiple sclerosis (MS) is a chronic disease that affects the central nervous system and can cause a wide range of symptoms. Some research has suggested there may be a link between MS and changes in personality or behavior, including increased irritability or aggression.
What is multiple sclerosis?
Multiple sclerosis (MS) is an autoimmune disease where the immune system mistakenly attacks the myelin sheaths that protect nerve fibers in the brain and spinal cord. This damage to the sheaths is called demyelination, and it interferes with the ability of nerves to transmit signals between the brain and body. The underlying cause of MS is still unknown.
Common symptoms of MS include fatigue, numbness or tingling, vision problems, problems with mobility and balance, muscle spasms, bladder dysfunction, cognitive changes, and pain. Symptoms vary greatly from person to person and over the course of the disease as new areas of the central nervous system are affected.
What causes changes in mood or personality with MS?
There are several ways that MS may contribute to changes in mood, personality and behavior:
- Inflammation – Chronic inflammation in the brain that occurs with MS can alter mood and behavior.
- Location of lesions – If areas of the brain related to personality, emotions or behavior are affected, this can directly impact mood or behavior.
- Psychosocial effects – Coping with a chronic illness can be stressful and lead to changes in mood or behavior.
- Medication side effects – Some medications used to treat MS symptoms may have psychological side effects.
- Pseudobulbar affect – Uncontrollable laughing/crying spells which can cause irritability.
- Fatigue/pain – Dealing with constant fatigue or pain may decrease patience and increase irritability.
- Frustration – MS symptoms like cognitive changes or vision loss can lead to frustration and anger.
Is there an increased risk of irritability or aggression with MS?
Some research has suggested there may be an increased risk of irritability, aggressive behavior or inappropriate affect among those with MS compared to the general population or people with other chronic diseases.
For example, a 2015 review found that 20-40% of people with MS may experience issues with irritability, aggression or excessive emotionality. And a 2016 study that evaluated personality changes with MS found significantly higher rates of irritability and aggression compared to healthy controls.
However, the data is mixed – other studies have not found dramatic differences in aggression levels between MS patients and healthy controls. More research is still needed.
What factors contribute to increased irritability/aggression in MS?
There are likely multiple factors that play a role in determining whether someone with MS will experience issues with increased irritability, aggression or anger, including:
- Location of lesions – Lesions in frontal lobe areas related to behavior control seem connected to aggression risk.
- Pseudobulbar affect – Uncontrollable emotional outbursts may manifest as irritability/anger.
- Fatigue and pain – Dealing with constant symptoms can understandably decrease patience.
- Cognitive impairment – Frustration with cognitive changes could increase irritability.
- Medications – Steroid treatments may cause changes in mood or behavior.
- Psychosocial factors – Stress, isolation, depression, hopelessness, loss of identity with MS diagnosis.
- Individual differences – Pre-existing personality traits or vulnerabilities also play a role.
Understanding the underlying cause for a specific patient can help guide appropriate treatment approaches.
What are some examples of irritability or aggression in MS patients?
Some examples of irritability, aggression or emotional lability that may present in MS include:
- Road rage or impatience while driving
- Angry outbursts at family members
- Yelling at coworkers
- Overreacting to minor frustrations
- Saying hurtful things without thinking
- Sudden mood swings
- Inappropriate laughing or crying
- Difficulty controlling frustration
- Slamming things when angry
- Verbally abusive language
However, it’s important to note that not all people with MS will exhibit increased aggression or irritability. Many are able to cope well with the disease’s emotional challenges.
What treatments help manage irritability and aggression with MS?
Treatment options that may help reduce irritability, aggression and emotional lability in MS patients include:
- Medications – Antidepressants, mood stabilizers or anticonvulsants may be prescribed.
- Psychotherapy – Counseling helps develop coping strategies for behavioral symptoms.
- Mindfulness and relaxation practices – Helps individuals better control reactions to stress or frustration.
- Aerobic exercise – Elevates mood and relieves stress.
- Support groups – Helps reduce isolation and provides community.
- Lifestyle changes – Getting adequate rest, maintaining relationships, etc.
- Family education – Helps loved ones understand and react appropriately to behavioral symptoms.
A combination of pharmacological and psychosocial interventions tailored to the individual offers the best chance of successfully minimizing the impact of irritability and aggression on quality of life for those with MS.
What can caregivers do to help manage aggressive behaviors?
For caregivers of those with MS who exhibit increased aggression or irritability, some tips include:
- Remain calm during outbursts to help de-escalate situations.
- Validate the person’s feelings and frustrations.
- Distract and redirect attention to something positive.
- Avoid lecturing or criticizing as it may further aggravate.
- Encourage open communication when emotions are calmer.
- Set reasonable limits on unacceptable behavior.
- Ask what would help next time feelings start to escalate.
- Keep notes on triggers to help prevent future issues.
- Seek support through counseling or support groups.
Being empathetic yet firm, avoiding triggers when possible, and having an action plan for outbursts can help ease the strain aggressive behaviors may place on relationships with caregivers.
Does MS treatment help improve aggressive behavior?
Data on whether MS treatments impact behavioral symptoms like aggression is somewhat limited. However, some findings indicate:
- Steroid treatments may worsen behavior issues in some cases.
- Interferon therapy resulted in emotional improvements in one small study.
- Tysabri was linked to decreased aggression in an observational study.
- Some research connects DMTs that slow brain atrophy with decreased irritability.
More research is still needed, but effectively managing the overall disease process with MS therapies may have benefits for controlling aggression and irritability in some individuals.
What is pseudobulbar affect in MS patients?
Pseudobulbar affect (PBA) involves sudden, uncontrollable episodes of laughing or crying that are exaggerated or disconnected from the person’s internal feelings. It occurs secondary to neurological disease or injury such as MS.
It is estimated that around 10% of people with MS experience PBA. The disinhibition of emotional expressions may manifest as frequent bouts of laughter, crying or both. These outbursts may not match the individual’s mood.
PBA is thought to be related to lesions in pathways that control voluntary emotional expression. Treatment usually involves medication to stabilize mood. Addressing PBA can improve quality of life and decrease any irritability related to these uncontrolled emotional episodes.
What triggers aggressive behavior in MS patients?
Some common triggers that may lead to increased irritability, aggression or emotional outbursts in MS patients include:
- Fatigue and sleep problems
- Pain exacerbations
- Cognitive problems like forgetfulness
- Bladder or bowel issues
- Sensory disturbances (numbness, pins-and-needles)
- Spasticity or mobility impairments
- Depression or anxiety
- Stress
- Feeling loss of independence or self-esteem
- External heat
- Medication side effects
Identifying and managing triggers than precede outbursts, when possible, can be an effective prevention strategy for those with MS who struggle with irritability and aggression.
Conclusion
MS disease processes in the brain, combined with the stresses of managing a chronic illness, can contribute to increased irritation, aggression and emotional lability in some patients. However, the severity varies greatly between individuals. Strategies like medication, psychotherapy, lifestyle changes and trigger management may help. More research is still needed to clarify the scope of aggression risk with MS and best treatment approaches.
