MS Patient, Ph.D.: Can We Separate Anxiety and Gender in MS?

Neurologists ask me about anxiety a lot. The first question is, “Do you have children?” Following that is, “Are you an anxious person?” The two always seem to be connected, which makes me wonder if there’s some explicit instruction during training that links them.

I do have children. I’ve had them for almost 13 years now, so I’m pretty used to them, and they’re used to me. They are not a source of anxiety for me beyond what any reasonably engaged parent presumably feels. I don’t spend a ton of time angsting about their futures or whether they’ll be doctors or engineers or which college they’ll attend. They’re fun and interesting people right now, and I love hanging out with them. Rather than making me feel anxious, they make me feel happy and comfortable. I’d say peaceful, but they’re young and loud, so not that so much.

But I don't have anxiety and have never reported symptoms of it to doctors. On the rare occasions that I feel some angst—like last year when we faced down a 1,200-mile drive in January over two icy mountain ranges for a move in a minivan and a Penske truck with three children and a dog to a house we’d never seen in person—I know how it feels and how I react. But moving-in-winter nuttiness aside, I don’t lie awake at night (or day) worrying about much of anything. I’m happy, busy, and not at all generally anxious.

Over the years, I’ve seen straw polls here and there of MS patients and others, asking them how often they get asked the anxiety and children questions. I’m not the only one who’s wondered at these questions that arise apparently from nowhere. The upshot of these wholly unscientific surveys is that women find themselves hearing these queries a lot more often than men. That’s counter to what at least one study has reported, but the research seems sparse.

Research does indicate an anxiety gender gap, with women turning up with anxiety twice as often as men. But we don’t start out that way. Girls are actually less anxious than boys at the outset, but then that pattern appears to reverse during adolescence, possibly because of sociocultural factors related to gender and internalizing. But how that translates into “children→anxiety→I am seeing you for gait disturbance and paresthesias and that’s the first question you ask” is even less clear.

But then there’s the issue with MS and anxiety and their marriage of inconvenience. While anxiety affects just under a fifth of the U.S. population, about a third of people with MS might experience it. In one recent study, researchers found that 57% of participants with MS were “clinically anxious.” There is, however, some question of how much overlap there is on anxiety inventories with the symptoms of MS itself, which might contribute to inflation of these figures. But large studies show that about half of people with MS experience significant anxiety, and an equivalent percentage experience depression.

Despite this high rate of anxiety, evidently, not everyone in the process of an MS workup gets asked the anxiety question. And although the rate of depression is at least as high as that of anxiety among people with MS, neurologists don’t ask me about that at all. Just about children and anxiety. I used to just say “no” and expect to move on.

And then I realized—or think I realized—that my being female might have something to do with the question. And I’m not quite sure how evidence-based that is. Is it legitimate, based on higher anxiety rates among women, that women seemingly get asked the anxiety question more often? Or should everyone in the midst of an MS workup hear questions about both anxiety and depression because of their association with MS, not their gender?

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