Does Stress Increase the Risk for Multiple Sclerosis?

Stress has been linked to a long list of chronic health conditions, including multiple sclerosis (MS). Though evidence is mixed, some research suggests stress could increase the risk of MS and trigger relapses (also called flare-ups).

While it's known that the demands posed by a disease like MS can be anxiety-provoking and overwhelming, the specific effect of stress on MS development remains unclear. This article will explore the possible connection between stress and MS, and why study results may not align. In addition, strategies to help manage stress when living with MS will also be examined.

Person with multiple sclerosis deals with stress

Ridofranz / Getty Images

What Is MS?

MS occurs when a person's immune system attacks the fatty myelin sheath that insulates nerve fibers within the brain and spinal cord.

Symptoms of MS are typically detected in early adulthood, and they vary widely from person to person. Most people with MS experience a relapsing-remitting course, in which they have relapses, when symptoms worsen or new ones develop, followed by periods of recovery.

The precise cause of MS remains unknown; although, experts suspect that both genetics and environmental factors (e.g., vitamin D deficiency or prior viral infections) are involved.

Unfortunately, there is no cure yet for MS. However, disease-modifying treatments (DMTs) can help reduce the number and severity of relapses and slow the natural course of the disease.

Can Stress Cause MS?

Results from studies examining whether stress may make a person vulnerable to developing MS are mixed.

The following are two studies suggesting stress could be a risk factor for MS onset:

  • In one study, investigators questioned nearly 3,000 people with MS to see whether stressful life events influenced MS development. Results revealed that most major life events (e.g., divorce, conflicts, sickness, and accidents) increased MS risk by 15% to 30%.
  • In another study, individuals exposed to any stressful life event in childhood were found to have an 11% increased risk of MS compared to individuals not exposed to childhood stress. On closer look, the death of a parent or sibling in childhood was not associated with MS risk, but parental divorce was.

The following are two studies that did not find stress to be a risk factor for MS onset:

  • In one study, investigators examined over 500 people with MS to determine whether a person's number of total stressful life events was associated with MS risk. Overall, no significant association was found. That said, there was some evidence that certain individual stressful life events, like divorce and homelessness, could be MS risk factors. Marriage, on the other hand, was found to protect against MS.
  • In another study of nearly 150 patients with primary progressive MS (PPMS), stressful life events, including the death of a loved one, jail terms, homelessness, unemployment, divorce, and retirement were not associated with an increased risk of MS. Interestingly, marriage, having a close family member with a serious disease, and being in debt were found to decrease a person's risk of developing PPMS.

Bottom Line

The scientific evidence examining whether stress is a risk factor for the development of MS is inconclusive. Further investigation is needed.

Does Stress Increase the Risk for Relapses?

MS relapses are episodes of symptoms that may persist for days or weeks before they improve or go away. Relapses are confirmed by detecting one or more enhancing lesions (areas of inflammation) on a brain or spinal cord MRI (magnetic resonance imaging) scan.

As with stress and MS onset, the association between stress and MS relapses is unclear. Even among the studies that have found that stress can contribute to relapses, certain stressor properties (e.g., type, severity, duration) were or were not significant.

For instance, there is research suggesting that long-term stressors (those lasting more than 48 hours) increase your risk for relapses while acute stressors do not.

Other research suggests that a higher number of stressors, as opposed to stress severity, increases relapse risk.

One study even found that while major negative stressful events (e.g., assault or partner affair) increased a person's risk for lesions, positive stressful events decreased their risk.

In the end, it's unclear why results from studies examining the link between MS and stress risk are so variable. Different study designs and how stress is defined in each study may help explain the mixed findings. Coping strategies, stress perception, and lifestyle habits (e.g., smoking or having a support system in place) might also play a role.

Bottom Line

The scientific evidence examining whether stress is a risk factor for MS relapses is inconclusive. Further investigation is needed.

How to Manage Stress With Multiple Sclerosis

Since stressful situations (whether related to your MS or not) are unavoidable, learning how to manage them in healthy ways is key to optimizing your quality of life and overall well-being. Following are a few examples of stress-management strategies you might consider trying.

Deep Breathing

Deep breathing is a type of relaxation exercise that takes only a few minutes. It can be performed at virtually any time throughout the day.

The basic steps include;

  1. Sit with your shoulders and head resting against the back of a comfortable chair.
  2. Place your hand on your belly and breathe in through your nose slowly and deeply.
  3. Allow your belly to expand with air, and after inhaling as much air as you can, hold your breath for four to five seconds.
  4. Slowly breathe out the air between your lips, and feel your belly go down.
  5. When all the air is out, sit quietly for a minute before repeating the above steps four or five more times.

Practicing Yoga

The term "yoga" is derived from the Sanskrit word "yuj," which translates to “to join.” Its practice combines exercises, called poses, with specific breathing techniques to symbolically "join" the body, mind, and spirit. Poses can be modified to accommodate a person's level of comfort and physical abilities.

For people with MS, yoga has been found to have many benefits, such as easing pain, fatigue, anxiety, and depression, and improving balance, mobility, and leg/arm strength. It is also effective at reducing stress.

Seeking Out Social Support

Seeking out or devising a solid social support network is also important for helping manage stress. Your network may consist of a couple or several people and include friends, family members, neighbors, community members, or work colleagues.

Besides emotional support and comfort, your network should also include at least one person who can provide as-needed physical support, like running errands or assisting with pets or childcare.

Lastly, you might consider joining a virtual or in-person MS support group. Members of support groups may share useful coping strategies for managing the day-to-day struggles of living with MS. They can also help you feel less alone.

Additional Ways to Manage Stress in MS

Besides the above strategies, other ways to manage stress in MS include:

  • Distracting yourself through humor or taking on a new hobby
  • Writing your thoughts and worries down in a journal
  • Engaging in a relaxation exercise or practice (e.g., meditation or self-hypnosis)
  • Practicing healthy lifestyle habits (e.g., ensuring enough sleep and eating nutritiously)
  • Joining a club or spiritual or religion-based community
  • Scheduling a daily nap time to allow your mind and body to rest
  • Prioritizing your time and energy, which might mean saying no to certain commitments

Summary

Living with MS is stressful, as the disease poses numerous physical, emotional, and logistical challenges. While stress has long been connected to MS, experts still aren't sure exactly how. Research is conflicting as to whether stress makes you more susceptible to developing MS or having a relapse (if already diagnosed).

Managing your stress well is important for optimizing your quality of life and how you feel on a daily basis. There are numerous healthy stress-management strategies to consider trying, such as practicing deep breathing techniques or yoga and participating in an MS support group.

A Word From Verywell

The link between MS and stress remains unclear but is likely complex. While it's sensible to spend some time considering how stress may be impacting your MS, try to direct most of your energy on learning how to healthily manage your stress.

Along the way, remember to practice self-compassion, and don't hesitate to seek out professional guidance to help you tackle certain stressors (e.g., therapist, financial planner, career coach).

Frequently Asked Questions

  • Can emotional trauma cause MS?

    The research is still inconclusive on whether stressful life events, including emotional trauma, make a person more likely to develop MS.

  • How do I know when stress is taking its toll?

    People exhibit their stress in different ways. With high levels of stress, you may experience physical symptoms like tight muscles or frequent headaches, or you may become more irritable, distracted, or have difficulty making everyday decisions.

    Talking about your stress with loved ones and engaging in various relaxation strategies (e.g., deep breathing, meditation) can help ease your symptoms.

 

  

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Briones-Buixassa L, Milà R, Aragonès JM, Bufill E, et al. Stress and multiple sclerosis: A systematic review considering potential moderating and mediating factors and methods of assessing stress. Health Psychol Open. 2015;2(2):2055102915612271. doi:10.1177/2055102915612271

  2. McGinley MP, Goldschmidt CH, Rae-Grant AD. Diagnosis and treatment of multiple sclerosis: A reviewJAMA. 2021;325(8):765-779. doi:10.1001/jama.2020.26858

  3. Jiang X, Olsson T, Hillert J, Kockum I, Alfredsson L. Stressful life events are associated with the risk of multiple sclerosis. Eur J Neurology 2020;27(12):2539-2548. doi:10.1111/ene.14458

  4. Nielsen NM, Pedersen BV, Stenager E, Koch-Henriksen N, Frisch M. Stressful life-events in childhood and risk of multiple sclerosis: a Danish nationwide cohort study. Mult Scler 2014;20(12):1609-15. doi:10.1177/1352458514528761

  5. Abdollahpour I, Nedjat S, Mansournia MA, Eckert S, Weinstock-Guttman B. Stress-full life events and multiple sclerosis: A population-based incident case-control study. Mult Scler Relat Disord. 2018;26:168-172. doi:10.1016/j.msard.2018.09.026

  6. Alsharie AM, Rafiee F, Rezaeimanesh N, Moghadasi AN, Sahraian MA, Eskandarieh S. Stressful life events and the risk of primary progressive multiple sclerosis: a population-based case-control study. Mult Scler Relat Disord 2021;51:102937. doi:10.1016/j.msard.2021.102937

  7. Oveisgharan S, Hosseini SS, Arbabi M, Nafissi S. Stress differently predicts multiple sclerosis relapses. Neurology Asia. 2014;19(1):53-8

  8. BurnsMN, Nawacki E, Kwasny MJ, Pelletier D, Mohr DC. Do positive or negative stressful events predict the development of new brain lesions in people with multiple sclerosis? Psychol Med. 2014;44(2):349-359. doi:10.1017/S0033291713000755

  9. Kotas R, Nowakowska-Kotas M, Budrewicz S, Pokryszko-Dragan A. The level of stress and coping strategies in patients with multiple sclerosis and their relationships with the disease course. J Clin Med. 2021;10(17):3916. doi:10.3390/jcm10173916

  10. Thakur P, Mohammad A, Rastogi YR, Saini RV, Sainib AK. Yoga as an intervention to manage multiple sclerosis symptoms. J Ayurveda Integr Med. 2020;11(2):114–117. doi:10.1016/j.jaim.2019.04.005

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.