Stress is real
February 1st, 2008I’ve been watching a discussion about gut issues and autism online, and have been struck by the clear prejudice against the possibility of gut issues being caused by stress.
Is there any non-stress connection between “gut issues” (which usually mean elimination problems to the people using that phrase) and autism? I have no idea. But I will say that the research I’ve read seems to point towards “no”, and I haven’t seen anything that looks the slightest bit reputable that supports the idea of a connection where the gut issues are something other than stress.
Which brings us to stress…being stressed has extreme effects upon the body. One of these effects is that the gut actually functions differently under stress, mimicking other “gut issues”. Autistic people are quite commonly under tremendous stress, so it would make sense that we would see more stress-related gut issues than the “typical” person (note that I’m not saying NTs don’t get stressed or have gut issues – neither of which is true).
But, it’s breaking a taboo to mention this. You see, stress-related injury and illness isn’t “real”. Or, rather, that’s what a lot of people seem to think. You’ll hear very passionate people complain about being misdiagnosed and having “real” medical problems in the gut that were dismissed as “just” stress by their doctor. So, by mentioning the impact of stress, you are part of the group of people who is determined to deny medical care to people who need it (not people with stress – they apparently don’t need it).
It’s about time that we, in the autistic community, recognize the reality of stress in our community, and the medical effects of being under tremendous stress. We need to fight against society’s prejudice that stress isn’t a medical condition, doesn’t have medical effects, and something with effects that are simply a sign of someone that isn’t trying hard enough to cope. That’s not the case. It’s never “just” stress. Stress is never different from “real” conditions. It is real.
Doctors who suggest stress initially for bowel problems are doing good work most of the time, even in cases when it is later found that the problem is caused by something else. Why do I say this? Because it would be very wrong for a doctor to ignore an obvious cause that has been scientifically linked to the problem, when that cause is present in a patient, especially when it is a very common cause, and especially when treating that cause has the potential to improve many areas of someone’s life. If you went into a doctor complaining of a sore leg, and there was an obvious break in the bone, of course they would deal with the bone before looking at other possibilities of the sore leg – even if those other possibilities are also there. In a similar way, many practitioners look at stress and try dealing (unfortunately often ineffectively) with that problem before working on other problems.
Am I saying autistics don’t have other types of bowel problems? Of course not. We can have any medical problem anyone else can have, and for some unknown reason, we often do have other medical problems, at least if my informal recollection of other autistic people is anything to go by. But we need to recognize the impact of stress, and allow treatment of stress. It has the potential to help many, many people.
Not only does stress cause bowel problems, but it has been linked to many other things – including early death (not just suicide, but many other forms of death). When stressed, you get sick easier. Things hurt more. We need to get to the point where we don’t consider someone “healthy” who is under a lot of stress – chances are, their body shows plenty of signs everyone, even people who think stress isn’t a “real” medical condition, would consider medical.
Disclaimer: I’m not advocating a particular treatment for stress, nor am I saying that every problem should be blamed on stress if someone is under stress when they see a medical professional. But I don’t think it should be discounted either. Stress is real, and it is just as medical as other medical problems.
Yep, stress-related illness is real and potentially serious. (As you pointed out, potentially fatal.)
I’m diabetic, and I know my blood sugar levels rise – regardless of diet – when I’m seriously stressed.
I get headaches, stomach aches, joint aches, fatigue, and more from being stressed. Stress makes it nearly impossible for me to eat and increases my problems with executive dysfunction. It makes it hard to sleep, socialize, or get just about anything done. So, yes, of course I do agree with you. I have first hand experience of the things these people are claiming don’t exist.
Great post, yes stress is very real, and can cause real problems, not only for autistic people but us parents to!
I have a few different thoughts on this.
Firstly: in my experience, doctors putting something down to “stress” is their way of saying they can’t or don’t want to justify trying to treat it. It also effectively says “this is all psychosomatic”, ie “your fault”, and passes the buck to someone other than the doctor to “solve the problem”, even when, regardless of the origin of a symptom, there are simple physical or chemical treatments for it, which may not solve the underlying problem, but which certainly have value in themselves in improving quality of life.
Secondly: i think, when stress and physical problems are linked, it’s cyclical rather than one-way. Amanda (Ballastexistenz)’s recent post “Backwardsness” illustrates the problem with assuming a correlation between X and Y means X causes Y, but rather than Y causing X, it could be that a third factor Z causes both X and Y, or it could be that X and Y have a cyclical relationship to each other: X causes Y, which then causes more X.
For example, i have IBS-type (albeit not formally diagnosed) bowel problems. These do get worse when i am under stress, but they also make me stressed; when i am either in constant physical discomfort because of constipation, or having explosive diarrhea every hour, that in itself definitely increases my stress levels massively, especially with the autistic hypersensitivity to pain and other stimuli.
Thirdly: i think that bowel problems may be genetically associated with autism (along with other physical things such as hypermobile joints and unusually fast metabolism). This doesn’t mean one causes the other, but simply that the genes for them are located close together and therefore inherited together. All the things mentioned run in my family, including among the members with no autistic traits.
Fourthly (kind of related to the first point): I have tried (and usually failed) to make the point many times that, for me, a high level of stress is practically unavoidable; i.e., for me almost everything is more stressful than for a neurotypical person, so advice to “avoid stressful situations” really isn’t helpful to me – I have to undergo high levels of stress to do anything at all, and would rather experience stress but have a life than try to avoid stress and end up literally never leaving my house, trying to communicate with anyone, or do just about anything.
So, you know, i think stressed people (whether autistic or not) have the right to have their symptoms treated, if symptomatic relief is available for them, rather than have it written off by doctors as “just stress, and therefore your problem, not mine”, especially if (as IMO is the case for many if not most autistic people) that stress is pretty much untreatable (unless you believe that there is either a cure for autism, or a revolution just around the corner that will turn the world into a totally autistic-friendly Utopia… and, IMO, even in a Utopia certain types of neurology would just “naturally” have higher levels of stress)…
That is because you are talking medical Bollox Joel, just like the curebies
Wait a minute, how is it curebie to say that autistic people suffer more stress than NTs? How is it curebie to say that stress causes and/or exacerbates physical problems? These are both obvious, well-known facts. In fact, I have learned that much of life with autism is in fact stress management, in the form of controlling overload.
Larry was referring not that I was a curebie, but rather I was using the same methods as a curebie – I didn’t provide academic-quality references to what I said.
Being that this is hardly a peer reviewed scientific journal, and anyone would be rather unacademic to expect it to have the same standards, I really don’t care that I don’t use the same means of backing up my statements.
The academics can check it out. If Larry wants to provide something a bit more academic than claiming it is “Bollox”, maybe by explaining why, with references, I’d listen. I’m sure others would too. So, Larry: provide the references that show I’m wrong here.
The difference between my methods and, for instance, the mercury mom’s methods is simple: my claim is easy to study, easy to disprove if you want (it’s testable), and builds on pretty easy to validate and observable data points. Certainly I didn’t conduct a study, and if someone has conducted one that shows my “common sense” isn’t too common, go right ahead.
I think folk wisdom is sufficient here, Larry. Think of references to “Pants-Shitting Hysteria” and “I was so scared I pissed myself.”
I remember reading an account of rations issued by the British Army in WWI which stated that the large cheese content of said rations was useful against the tendency toward loose bowels caused by constant stress and mortal fear.
The word “guts” is not a synonym for courage by accident.
Often, people will describe their feelings after having a very bad, ugly surprise with words like “I felt as if I had been punched in the stomach.”
That’s just my gut feeling on the subject, of course.
P.s. Oh, of course we all know that “Oldthinkers unbellyfeel Ingsoc!”.
I am an Oldthinker.
Maybe we should consider motion sickness, AKA seasickness. I think a connection among the brain, the gut, and the vestibular thingies in the inner ear has been shown to exist, there.
Some people don’t get seasick, others immediately blow lunch if the deck is moving just a little bit under their feet.
M’self, I mind the time I went to the top of Stone Mountain, in GA, while already feeling slightly gastrically queasy. I ventured over toward the slippery slope, with the chain-link fence to discourage brave fools, and immediately threw up in my mouth, a little bit. HCl in the mouth will definitely get one’s attention
Maybe Larry is just a *dyspeptic* kind of guy… K know that when I am under great stress, I feel it in my gut, manifesting as irritable bowel. Isn’t it well established that autistics have a higher level of anxiety than the general population? I have read that it’s like the gut (meaning digestive tract) has a “brain” of its own. And it seems the longer I have known about autism, the less real the whole concept of autism seems.
Speaking of the vestibular thing, I believe that some auties report not getting dizzy after spinning around at great rates, such spinning making the average person a bit nauseous. I always liked the whirly rotating thingys in playgrounds, m’self. I think the Safety Nazis have forbidden them, these days.
Personally I look for comments by laurentius-rex. I know they will, for the most part, be negative, and in proving me right they provide me some entertainment.
http://tinyurl.com/3cpbk4
You are trying to reason backwards for a mechanism for a connection that simply does not exist.
whoops wrong URL
http://tinyurl.com/39ardd
This was the one I meant to send
M’self, I’d like to have good talk with Larry, over a pint or two. It’s a shame that’s unlikely to happen, we living so far apart from each other.
Say, Larry, any news about the head gasket?
Larry, do you have a description of their methodology for determining the frequency of GI issues among autistics? I’ve found that going by summaries is not a good idea in academic literature, and I live an hour away from where I have access to the actual articles (which is why I haven’t managed to get those other articles you asked about yet). Was it a literature review, or was there actual research?
Well you will need an Athens password to get anymore info out of that site online.
If I was to post a link I accessed using Athens, you wouldn’t be able to get into it, therefore the abstract has to suffice, the usual procedure being that if an abstract whets your appetite you go look up the original somewhere, where you do have access.
For what it is worth I believe you are playing into the hands of others who have defined autism as a biological issue and exagerated and invented evidence to suit that.
Let us define autism, and leave guts, limbs, and the colour of our hair out of it.
Larry, it’s *because* I don’t have access at home (I do have access at the university, but not remote access) that I was asking for a summary of the methods they used.
Or as Arthur Hugh Clough put it : -
IS IT true, ye gods, who treat us
As the gambling fool is treated;
O ye, who ever cheat us,
And let us feel we’re cheated!
Is it true that poetical power,
The gift of heaven, the dower
Of Apollo and the Nine,
The inborn sense, ‘the vision and the faculty divine,’
All we glorify and bless
In our rapturous exaltation,
All invention, and creation,
Exuberance of fancy, and sublime imagination,
All a poet’s fame is built on,
The fame of Shakespeare, Milton,
Of Wordsworth, Byron, Shelley,
Is in reason’s grave precision,
Nothing more, nothing less,
*Than a peculiar conformation,
Constitution, and condition
Of the brain and of the belly?*
Is it true, ye gods who cheat us?
And that ’s the way ye treat us?
Oh say it, all who think it,
Look straight, and never blink it!
If it is so, let it be so,
And we will all agree so;
But the plot has counterplot,
It may be, and yet be not.
‘Wen Gott betrügt, ist wohl betrogen.’
Clough, A H, Poems and Prose Remains, Vol II 1869
Bugger, can’t access the full text myself from here
So here is another study that says the same
BMJ 2002;325:419-421 ( 24 August )
Primary care
Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database
Corri Black, research associate, James A Kaye, senior epidemiologist, Hershel Jick, associate professor of medicine.
Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, MA 02421, USA
Correspondence to: C Black cxb2@ph.abdn.ac.uk
Objectives: To assess whether children with autism are more likely to have a history of gastrointestinal disorders than children without autism.
Design: Nested case-control study.
Setting: UK General Practice Research Database.
Subjects: Children born after 1 January 1988 and registered with the General Practice Research Database within 6 months of birth.
Outcome measures: Chronic inflammation of the gastrointestinal tract, coeliac disease, food intolerance, and recurrent gastrointestinal symptoms recorded by the general practitioner.
Results: 9 of 96 (9%) children with a diagnosis of autism (cases) and 41 of 449 (9%) children without autism (matched controls) had a history of gastrointestinal disorders before the index date (the date of first recorded diagnosis of autism in the cases and the same date for controls). The estimated odds ratio for a history of gastrointestinal disorders among children with autism compared with children without autism was 1.0 (95% confidence interval 0.5 to 2.2).
Conclusions: No evidence was found that children with autism were more likely than children without autism to have had defined gastrointestinal disorders at any time before their diagnosis of autism.
And there’s more
Autistic enterocolitis; is it a histopathological entity?
T T MacDonald & P Domizio
Institute of Cell and Molecular Science and Health Sciences Education, Bart’s and the London Queen Mary School of
Medicine and Dentistry, London, UK
MacDonald T T & Domizio P
(2007) Histopathology 50, 371–379
Autistic enterocolitis; is it a histopathological entity?
Aims: To review the literature on the histopathological
diagnosis of the condition termed ‘autistic enterocolitis’.
Methods and results: We have reviewed all published
works where mucosal biopsy specimens from autistic
children have been examined histopathologically.
Abstracts were excluded. Our review of the published
works, nearly all from a single centre, identifies major
inconsistencies between studies, lack of appropriate
controls and misinterpretation of normal findings as
pathology. Ileal lymphoid hyperplasia may be more
prevalent in children with regressive autism but is also
seen in children with food allergies and severe constipation,
the latter being an extremely common finding
in autistic children.
Conclusion: The histopathological diagnosis of autistic
enterocolitis should be treated with caution until a
proper study with appropriate methodology and controls
is undertaken.
Of course there is still the quotation I have never been able to run to earth with a proper citation yet, which I suspect is either Dostoyevsky or Durkheim, to the effect that no-one commits suicide after a good nights sleep and a decent voiding of the bowels, but that is apocryphal n’est ce pas?
Larry, see: http://yourtotalhealth.ivillage.com/can-stress-cause-diarrhea.html
I know it’s not academic, but perhaps you can find academic literature linking diarrhea with stress.
My question to you: Is this going to show up on a biopsy? My guess is no.
Basically, from what I see, the last two studies you mention test many non-stress causes of elimination issues, but don’t test “biologically normal gut influenced by high levels of stress.”
Correct me if I’m wrong, but I would think that would mean my theory still has plausibility. I’ll add that I’m not claiming elimination issues are diagnostic for autism, or a direct symptom of autism, and definitely not a causal element. But I still believe that there very likely *is* a correlation, and stress is the reason for it – and telling people that this isn’t something we need to watch for in autistic people is unhelpful at best.
In addition, at least the last study just says “the studies showing non-stress GI problems are garbage.” I don’t doubt that one bit.
I don’t have the references to hand, but it was at one time commonly believed that stomach ulcers were down to stress until bacterial causes were discovered.
Anyway the point I am making is that if gut issues are not greater in autistic than in non autistic subjects, then why is that so if your stress theory holds that autistics are under greater stress?
The ideas that stress is responsible for x y and z physical conditions is potentially a dangerous one, it is the reason why the GP’s failed to diagnose my mums RA initially, because she was under marital stress.
I might well have had my carpal tunnel and ulnar nerve symptoms overlooked if tests had not shown this was a real measurable state.
We are the victims of mentalist explanations.
Stress does have some physical effects, but due to the endocrine system, marginally the stomach will produce more acid, one will express a desire to void ones bowells in order to prepare one for the fight to come, but I do not see this being a mechanism in the reports of bowel disorders in autistic children. It is a product of selective focus on a co-incidental factor that is all. It has all the status of a meme transmitted because it finds a favourable environment amongst a certain hard core of curebies.
Larry, you are confusing “misdiagnosis” with “diagnosis of stress”. Not all diagnosis of stress is misdiagnosis, and it’s about time we move past “stress isn’t real, like these other conditions.”
I’m sorry your mom’s RA was misdiagnosed. But if she was diagnosed, instead of having RA as having cancer, that would be just as bad.
As for the studies, they are saying, from what I can tell, “The gut looks fine to us, there is no physical gut problems in autistic children, at least not at a greater rate than non-autistic children.” I’d agree with those findings 100%, and don’t argue that at all. None of the ones you provided seem to look at a common cause of elimination issue (stress) or the relationship between stress and autism.
You might want to be careful about your own mentalist thinking though – you don’t know what motivates me or why I hold my beliefs. I assure you it is not because some think leaky guts cause autism.
It’s worth defining what is meant by high levels of stress. The person who diagnosed me thinks that high anxiety is an inherent part of autism and that is why autistics have high levels of stress, along with physiolgical manifestations of that. It could also be that what stresses autistics is not the same as what stresses non-autistics and so it may appear that autistics are more easily stressed, when that is only the case in certain environments and not an inherent part of autism. Or it may be that autistics are stressed by the normal things but have to put up with more.
I mean sometimes stress refers to external events that cause a particular response, and sometimes it refers to the way in which events are perceived as dangerous or unpleasant, sometimes its the physiological response itself. And then there’s stuff like hypothermia which can stress the body but doesn’t crucially involve a cognitive process.
My favorite definition of stress is the interaction of an event and that person’s appraisal of an event, so that the person sees the event as being potentially damaging or sees him or herself as incapable of managing the event so that it will not be damaging.
Stress is an engineering metaphor and entered the language that way for socio-historical reasons at a certain stage of the enlightenment, itself predicated on the industrial revolution and the growth of capitalism.
It was philosophers such as Hume who introduced such “modernist” notions to the world.
Stress is the antagonism of forces upon some object such that it’s properties are altered to point where it may eventually fail as a component within a system, causing the bridge to fall or the arch to crumble or whatever
“Stress” in a physiological sense is what the body does when it is in “fight or flight” mode. A “stressed state” is invoked to better survive what ever it was that caused that stress. Sometimes that state is invoked inappropriately (that would be usually in modern life compared to living in the “wild”).
Usually “fight or flight” responses require more muscle activity, to fight or to run away. “Stress” diverts more resources to being able to fight or run away, which means there are less resources to devote to other things, such as healing, digesting food, fighting an infection or growing (which is why all of those are made worse by stress).
The fundamental resource is ATP that is the energy source that all cells use for most things including moving muscles, pumping ions and neurotransmitters, digesting food, synthesizing proteins.
By far the largest source of ATP is mitochondria. They are the only place where ATP is made via oxidation of substrates. To maximize ATP production by mitochondria, it is necessary to fully disinhibit cytochrome c oxidase, the enzyme that actually metabolizes O2. The way that is done is by lowering the nitric oxide level.
Most nerves that control the gut are nitrergic that is they are controlled by nitric oxide. If you change the nitric oxide level via stress, it stands to reason that you would change the activity of nerves that are regulated by nitric oxide.
A “biologically normal gut” is affected by stress. That is what “butterflies” are. It is the normal effect of stress on a normal gut. If your body is under so much stress that it wants to free up the ATP it would otherwise use to digest what ever is in your stomach, it will get rid of it. There are a great many different degrees of stress, and they affect different people differently. If anyone is put under “enough” stress, they will exhibit these symptoms. Symptoms may be due to something other than stress, but stress can produce them all by itself.
A high NO state tends to be a state where one is more sensitive to nausea. This is seen in pregnancy, with placebos, during fevers. The report that people on the spectrum are less susceptible to motion sickness is something I hadn’t heard before, but is consistent with my low NO hypothesis of ASDs. I think it is the inherent low NO state that most people on the spectrum are in that makes them more susceptible to stress and the effects of stress that are mediated by low NO (that would be many of them).
Hi, I was directed to another thread here by someone on AFF and am finding it very helpful. Thanks. i’m NT, although poss. with some Aspie traits, and my son is awaiting assessment and likely to be dxed as aspie.
I just wanted to add to the comments on the physical symptoms of stress. Almost a year ago I came to the decision to leave an abusive marriage. Within a couple of days of that decision various pains and physical symptoms I had been suffering disappeared completely. For years I had been experiencing headaches which extended down the left hand side of my neck and across my shoulder blade, I had pains in my arms and legs, pins and needles and fequent numbness in my hands and feet, palpitations, shortness of breath and frequent stomach upsets. By the time I went to see my doctor I felt completely fine, but I described how I had been feeling and he told me that these were classic, text book symptoms of stress. As you say Aspies and others on the Spectrum have chronic stress as a result of day to day interactions and misunderstandings so I can entirely see that stress and gut problems may be linked, but not seen in this way. Another reason for digestive problems, which I have seen mentioned may also be due to restricted and irregular diets of many aspies – my son included!
I have asthma which is worsened by stress. Panic attacks can cause asthma attacks which make me panic even more.
I noticed one study also only looked at before diagnosis. Stress-related issues in autistics frequently are because of treatment, and some ‘biomedical’ treatments could probably damage your gut (for example, anti-candida medication certainly causes temporary gut problems, I wouldn’t be surprised if they caused permanent ones too).
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