Other mental health issues

Two friends chattingAs well as more common emotional changes that occur in MS, there are rarer issues that some people might experience.

These include:

​As well as these emotional/psychological issues, there are also behavioural symptoms including:

All these mental health issues can often be managed with medication and talking therapies. Find out more about getting help.

Bi-polar disorder

Bi-polar affective disorder, sometimes known as 'manic depression', is much less common than clinical depression in people with MS. It is a mood disorder where moods can swing from extremes – mania (very very high) to depression (very very low).

Depressive symptoms are the same as those in depression. Manic symptoms are a combination of over-activity, with a decreased need for sleep and racing thoughts, elevated or euphoric mood, and 'grandiose' thought content.

For some people, euphoria may be replaced by irritability, and grandiose thoughts by beliefs of being persecuted. When coming to terms with this symptom, talking therapies can help change the way you feel about it.

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Psychosis is where people are unable to distinguish between what is real and what is imaginary.

This is very rare in MS, as it is in the rest of the population.

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Mood swings and emotionalism

Some people living with MS describe mood swings, where moods switch rapidly from one state to another.

Others describe emotional upheavals, like bouts of anger or heightened sensitivity, where they become very emotional very easily and seem unable to stop.

These symptoms affect only a small minority of people with MS.

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Emotional lability

Emotional lability is a state where emotions and the way they are expressed can no longer be controlled as they once were. Instead, people experience rapid ups and downs in their feelings.

People may find their emotions are easily aroused, freely expressed and tend to change quickly and spontaneously. For example, you may easily burst into tears or suddenly get very angry over something, in a way that seems exaggerated or out of proportion.

Whether these outbursts involve crying, anger, laughter or anything else, they are usually brought on by a specific event.

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Uncontrollable laughing or crying

This probably affects about 10 per cent of people with MS. It is thought to result from MS related damage to nerves in the brain.

People can find themselves laughing when they are sad, or crying when they are happy. These involuntary outbursts are completely independent of their state of mind at the time, are unrelated to events going on around them, and cannot be controlled.

This can be confusing, embarrassing and upsetting for all those affected, including family and carers. It can also mean that people do not recognise when someone with MS is really troubled (because they are laughing), and that real problems are not taken seriously.

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Emotional crescendo

Emotional crescendo, sometimes referred to as increased sensitivity, lies somewhere between emotional lability and uncontrolled laughing and crying.

With this symptom, people find that relatively unimportant or trivial issues can easily set off a very emotional response that seems uncontrollable and quickly reaches a 'crescendo'.

Unlike uncontrolled laughing and crying, the outward expression of emotions does reflect how the person is feeling.

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Euphoria is characterised by persistently cheerful mood, particularly at times of difficulty. People may seem strangely unconcerned about their ongoing physical deterioration, and may have a sense of optimism that appears out of place, given their situation.

In some people, both their mood and the way they express their feelings is euphoric. In others, their outward expression of optimism fails to give the true impression of their inner feelings of despair.

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Behavioural symptoms associated with MS

There are various behavioural symptoms associated with MS that are very rare and little researched.

These symptoms overlap with cognitive difficulties that can cause problems with the way thoughts are processed, concentration, or the way plans are made.

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Man looking under pressure in the corner of a room

Disinhibition is one of the rarest behavioural symptoms of MS and only a very small percentage of people are affected. It is linked to MS-related damage in the brain.

People experiencing disinhibition lose control over their impulses, leading to inappropriate behaviour and a loss of their sense of social rules. They may have little or no awareness of others' feelings regarding their actions.

For example, someone may make a hurtful or inappropriate comment, break into a rage, or behave in a sexually disinhibited manner – all of which they would have considered outrageous previously. It is important to recognise that people experiencing this symptom cannot control their behaviour.

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Lack of insight

In certain situations, some people are unable to understand what is happening to them or around them.

Their judgement of safety may not be as good as it was, or they may have no insight into the way their behaviour affects others.

Again, this only affects a small percentage of people with MS and may be linked to nerve damage in the brain.

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Lack of initiative

Initiating actions, for example, getting dressed, doing housework and getting involved in social or leisure activities, is controlled by a part of the brain called the frontal lobe.

If someone has extensive nerve damage in this area, they may experience a lack of initiative.

They may be fine to carry on doing something once they have begun, but unable to take the first steps towards doing it alone.

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