Gail Berger
Adults having functional (symptoms without apparent cellular alterations) and organic (observable cellular changes in target tissue) diseases also have childhood stressful histories. Patients with rheumatoid arthritis not only report chronically stressful adult histories (e.g. unhappy marriages or relationships, difficulties at work, or with children, etc.), but also present histories of difficulties in earlier interactions with their mothers and experiences of considerable chronic threat (Baker, 1982). In addition, rheumatoid arthritis patients report childhood histories that are characterized by emotional neglect and abuse (Walker et al., 1997a). Later adult joint swelling is associated with an increased sense of depression in response to difficulty managing interpersonal conflict as well as conflictual coping with flares (Zautra et al., 1994, 1999; Marcenaro et al., 1999). Higher stress levels in this patient population are associated with androgen-stimulated estradoil negative feedback and higher stress neurohormonal prolactin activity. Both hormones have been positively correlated with the rheumatoid arthritis patient’s sense of depression (Zautra et al., 1994). With disease progression (or just prior to disease expression) patients assess and conclude that they cannot garner control over and cope with aversive interpersonal life events. This sense of “giving up” appears to underlie the chronicity of their physical illness (Zauntra et al., 1999). The intensity of this sense of loss of control is also associated with the degree of disease flare reactivity to stress.
