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A few years ago, my good friend was sick, and we didn’t know what was wrong with her. She couldn’t sleep and her appetite was disturbed. Her hair was falling out and no matter how much she exercised, she couldn’t lose weight. Most notably, my friend was cranky. And I mean cranky. This was not her. She got loud with others, snapped at people for asking questions, rolled her eyes continuously, and said hurtful things. My friend was sick, and we just didn’t know what it was. 

Many suffer for a long time, trying to determine the source of their fatigue, irritability, skin problems and digestion difficulties, often with no conclusive results, only to find out much later that they have been suffering from autoimmune disease. Many aren’t aware that autoimmune diseases have physical effects which can lead to mental health issues.

Autoimmune disease: The silent culprit

The most well-known autoimmune diseases are lupus, rheumatoid arthritis, and Type I diabetes. But the aggravating symptoms associated with psoriasis, Graves’ disease, celiac disease and diseases related to hypothyroidism often go unchecked. Considering the overall prevalence of autoimmune diseases, we seem to know little about what causes them, how to accurately diagnose them and how to alleviate the symptoms. The Cleveland Clinic estimates 1 in 15 Americans have an autoimmune disease and there is still so much ambiguity. What we do know is autoimmune diseases such as hypothyroidism, Type I diabetes, ulcerative colitis and lupus directly affect the brain, (Keyser & Dalmau, 2011) but we don’t often extend grace to those affected when their mood and behaviors take a turn for the worse.  

According to the Lupus Research Alliance, between 80 and 90% of people with lupus develop what is called neuropsychiatric lupus, which can result in mental fog and depression, and 25% of these individuals will develop severe depressive and anxiety symptoms. These symptoms coupled with exhaustion and chronic pain can make being effective at work, socializing with friends and even rearing children substantially difficult. Irritability and mood swings can lead to social isolation, worsening the impact of the disorder to beyond physical symptoms, resulting in notable emotional and social consequences. Recent research, e.g., Jeppesen and Benros (2019), suggests that even psychosis, a severe symptom presentation that might include hallucinations, delusions and significantly disorganized thinking, may be related to autoimmune disease. 

So why aren’t we spending more energy and resources addressing these widespread challenges? 

The race factor

Possibly because these diseases affect women more than men (Pugle, 2021), and according to a study completed by the University of Michigan, young Black women are the most likely to suffer from lupus specifically than any other age/gender/racial group. The pathology department at Johns Hopkins states that not only are autoimmune diseases more common in women, the disease’s slow development allows for them to escape diagnostic recognition sometimes for years. In the meantime, countless women are experiencing exhaustion, swollen glands, hair loss and gastrointestinal discomfort with no answers and no cure.  

They may also be experiencing condition-induced psychological symptoms that are impacting their romantic relationships, how they are viewed at work, and their ability to maintain friendships. Sometimes, the very medications prescribed to treat the autoimmune disease cause depressive symptoms and anxiety symptoms that can manifest as irritability. Since we are more likely to commit the fundamental attribution error, the tendency to attribute displays of negative emotionality to internal factors, – especially for women and people of color – due to gender and racial stereotypes, the true culprit often goes undiscovered. Instead, we perceive autoimmune sufferers as “b*tchy” due to their character, rather than to an external or situational factor. 

Light at the end of the tunnel

The Global Autoimmune Institute details the immeasurable toll on the mental health of the chronically ill and suggests some methods of reclaiming emotional stability. First, find a therapist, preferably one specializing in chronic illness, to learn techniques to increase mood and decrease crankiness. Second, many doctors will prescribe anxiety and/or depression medications along with autoimmune therapy due to the comorbidity of symptoms. Take them if necessary. Finally, tell your story. Attend a support group for people with autoimmune diseases to validate your experiences, be vulnerable with those committed to you, and try not to isolate yourself due to fears that others won’t believe or understand you. 

My friend wasn’t just being a b*tch. She was sick, and we didn’t know what it was. She wasn’t herself and that was OK, because she was hurting in a way we couldn’t understand until she told us what was going on with her. She had an autoimmune disease and it was impacting her mental health. We now know how to best support her and to be true friends as she manages her autoimmune disease and her life.

For more information about autoimmune diseases, please visit the Cleveland Clinic

If you are experiencing a mental health crisis, then visit the National Alliance on Mental Health to get help.