Within risk management constructs, external risk is as equally valid as internal risk. Natural disasters, external hazardous materials releases, and workplace violence from outside the organization can harm employees and affect organizational operations as much or more than inter-workplace hazards.

In many cases, organizations look to regulations, solvency, liability, and optics as guidance for their risk management of these situations; if an organization fails to plan and prepare for a hurricane, an active shooter event, or a shelter-in-place situation, for example, this oversight can have negative consequences on the organization’s operations, finances, and reputation. The fact that the organization’s operations did not create the hazard does not negate the need to plan for it; likewise, seeking to invalidate the situation or simply hope it goes away can lead to regulatory noncompliance and even legal violations.

Like other external risks, non-work-related employee trauma and chronic illness are other situations that may not be related to an organization’s operations (in some cases, these situations may be directly related to workplace exposures or events and other related hazards such as hazardous materials, bloodborne pathogens, body fluids, workplace violence, or others, but these situations would be directly related to compensation claims), but ignoring the situations or addressing them in an adverse manner can lead to work-related safety concerns, employee dissatisfaction, regulatory noncompliance, litigation, reputational damage, and other negative outcomes.

On the contrary, understanding employee trauma and chronic illness and its effects on the organization and its operations can lead to status as a high reliability organization and an employer of preference.  


Chronic illness

The clinical explanation of an autoimmune disease is, “Autoimmune disease happens when the body’s natural defense system can’t tell the difference between your own cells and foreign cells, causing the body to mistakenly attack normal cells. There are more than 80 types of autoimmune diseases that affect a wide range of body parts” (Hopkins Medicine, n.d.); these include Vasculitis, Multiple Sclerosis, Lupus, and many others. The facts that there are so many different autoimmune diseases and that they all share similar characteristics means diagnoses can be exceedingly difficult to get for those experiencing symptoms but without definitive laboratory findings, imaging, or other diagnostics.

As Hopkins Medicine relays, “There’s usually no single test to diagnose autoimmune disease. You have to have certain symptoms combined with specific blood markers…It’s not just one factor” (Hopkins Medicine, n.d.).

In many patients’ experiences, years have passed with multiple hospitalizations, chronic pain, and difficulty with both everyday tasks and specific functions but no confirmed diagnosis to explain any of it. This uncertainty may mean no defined treatment or medication; the disease may be debilitating in many ways but not terminal. Ultimately, this means many must live with these diseases without hope of a cure or even mitigation in some cases and must continue to work, regardless of the pain, fatigue, and discomfort, lest the patient experience financial distress, loss of insurance, and/or other negative outcomes. However, working with an autoimmune disorder is a challenging proposition, as acute and chronic distress and/or a sudden, severe onset of autoimmune inflammation can lead to acute trauma such as intestinal necrosis, a brain aneurysm, and other outcomes. These severe situations can lead to further hospitalizations, medical treatment, and other factors that can further aggravate employment conditions.


Prognoses and potentially toxic situations

Due to significant improvements in medical science, living and working with autoimmune disease(s) is now often an option and expectation. For example, in the past Multiple Scoliosis had no effective Disease Modifying Therapy (DMT) options to prevent disease progression until the mid-1990s. By that time, the disease status for many Multiple Scoliosis patients had progressed too far for any daily medications to be effective. Individuals in this category were left with two options: adjust their work life to fit their deteriorating health or go on Social Security Disability Insurance (SSDI) and, by effect, retire.

Most autoimmune diseases are, for the most part, proverbial invisible illnesses, meaning the disease’ symptoms are not recognizable during daily life. As a result, afflicted individuals are often treated like any other individual in the workplace, an outcome both positive and negative. For example, if one breaks their arm or leg, there is usually a visual sign, such as a cast or sling but, with an autoimmune condition, there is often no outward sign of injury or disability. If there are no outward indicators of an illness or condition, others may not and often do not recognize the individual to be in pain or discomfort. However, to the individual, what is happening internally can be quite different from what is easily visible.

Autoimmune disease sufferers can experience symptoms including, but not limited to, stress, pain, bladder incontinence, and extreme fatigue and, when these symptoms are not overtly visible, others may purposefully or inadvertently invalidate or discredit the patient’s experience. This can lead to the patient working beyond his or her physical comfort level, trying to meet employment expectations of someone with no medical conditions. In some cases, the affected employee may choose not to disclose the medical conditions for fear of negative reactions. In other cases, the affected employee’s personal physician may not submit documentation of the condition as he or she feels uncomfortable documenting a condition without overt indicators, images, or diagnostics; this denies the affected employee the medical validation necessary for Americans with Disabilities Act (ADA) accommodations, Family Medical Leave Act (FMLA) benefits, and more.

Without indicators, diagnoses, or documentation of the “invisible” condition and working under expectations of non-disabled productivity, this can lead to burnout or worsening of the condition. Similarly, if the employer creates doubt of the condition and either requires work beyond the employee’s ability or seeks to ‘discover’ the employee’s health condition, work functions may aggravate the patient’s condition or, seeking to validate an ‘invisible’ disease, tread on dangerous Healthcare Insurance Portability Accountability Act (HIPAA) territory by requesting private medical information, not recognize Americans with Disabilities Act (ADA)-related needs, or otherwise promulgate a toxic culture where autoimmune sufferers feel devalued, distrusted, or even accused of malingering, compensation fraud, drug addiction, or other negative behaviors. Several affected employees have spoken of situations in which their employers have, not believing the employee has a medical condition, sought to access the employees’ medical charts, asked inappropriate questions of the employee and/or the employee’s physician, requested HIPAA waivers to access information, or otherwise treaded upon the employees’ privacy.

Later, with validation of the medical condition, some employers sought to unethically create false employment records of supposed bad productivity to justify terminating employees with medical conditions and/or refused to consider requests for ADA reasonable accommodations. In other cases, affected employees have noted situations in which they were prescribed medications such as steroids that caused side effects such as weight gain or treatments such as chemotherapy that caused weight loss, both situations that led to employer accusations of drug abuse (including opioid use accusations buoyed by the opioid crisis), compensation fraud, or reprisal for requests for medical leave to undergo the treatment or procedures.

In all of these separate situations, increased and substantial distress to the affected employee was caused by the employer, who in each scenario was stated to have justified or covered their actions with false allegations of negative productivity or loopholes in occupational health law.


Treatment and sustainability

Between chronic symptoms and the process of navigating life and employment with them, stress is one of the biggest challenges for someone with an autoimmune condition. Stress generally refers to the psychological perception of pressure and the body's response to it, involving multiple systems from metabolism to muscles to memory. Working usually means stress for any individual, and for those who live with an autoimmune condition, that means their entire systems can be consistently inflamed.


Employee and employer mitigation

With proactive treatment and mitigation, life and work with an autoimmune disorder and/or resultant trauma is possible. In the case of the employee, he or she will invariably need to decide whether to disclose his or her condition to the employer. From that decision, the employee will then need to utilize communication skills to determine a balance between self-care, medical treatments, and employment expectations. Caution is stressed regarding knowledge of personal rights and maintaining documentation of all work, schedules, and other needs to ensure evidence in the event of a miscommunication or allegation.

Employees are also cautioned to follow applicable ADA processes, request reasonable accommodations as necessary, and document each step of the process.

On the employer’s part, pre-determinations of which employment classifications require which essential functions and thus which hazard controls are necessary. This provides fairness to ensure expectations are known for each job classification’s essential functions and to ensure proper hiring can take place. For example, if a position’s essential functions include entry into areas potentially contaminated with inhalation hazards, respiratory protection requirements should be disclosed at the earliest opportunity so that all applicants are aware that a medical evaluation, training, and Fit Testing will be required along with ongoing requirements for no facial hair affecting the negative pressure seal on the respirator.

With transparency and equity for both the employee and employer, there is more likelihood that employees will have increased job satisfaction within their personal situations while employers’ operations can continue safely.  

With job expectations clear and any accommodations included in legitimate ADA processes with HIPAA checks and balances, employers should also ensure due diligence is done with all job task hazard controls. In many situations, methodical applications of the Hierarchy of Controls can determine hazard eliminations and substitutions and/or engineering or administrative controls that can help mitigate employee pain. For example, with the COVID-19 pandemic, many ADA accommodations requests were submitted by employees with underlying medical conditions requesting telecommuting, physical separation, or other exposure prevention controls to prevent an increased vulnerability to the virus. These requests were submitted on the pretense that regularly planned work would continue such as employees being in the same facility, within six feet of one another, and without face covers for source controls. But, with the Hierarchy of Control applied for disease exposure prevention, when possible, the most effective control is to eliminate as much of the risk as possible, which is to prevent congregations. With this, if the expectation is to utilize the Hierarchy of Controls and prevent congregations, ADA accommodations are not necessary because many employees with underlying medical conditions would have been telecommuting and wouldn’t be in positions of increased vulnerability. With this, these employees can experience greater job satisfaction, greater trust in their employer, and less stress.

From this point, employers can empower employees them to listen to and manage their body and mind. If they feel themselves getting stressed and their body is reacting physically to what they are feeling mentally, employers can work with employees to allow for micro-breaks and other wellness measures that will enable stress reduction while still ensuring task completion. This same empowerment also works well for ergonomics issues such as preventing repetitive motions, awkward positions, and other stressors. Relatively simple measures such as enabling and encouraging employees to take a short walk outside, use the restroom (also particularly important), or to get water.

Maintaining a high level of stress for a prolonged period will only hurt them more in the long run. Likewise, encouraging good rest shows employer concern and empathy for those with heightened needs for it, helps affected employees mediate medical conditions and mental health, and helps prevent workplace safety incidents as well.


Personal health support

If employees find themselves having panic/anxiety attacks regularly, at home or at the office, they should not be afraid to reach out to someone on their medical team and let their doctors what they are experiencing. Regular panic attacks can really impact abilities to do a job effectively and safely, particularly if the attacks are consistently happening at night and impacting quality of sleep.

Ultimately, a diagnosis of an autoimmune disorder is a high gravity situation for an employee that can affect her or his personal health, routine, and employment. If the employee senses her or his employer is distrusting, unwilling to provide effective safety controls or accommodations, and/or is intruding into the employee’s personal health information, this distress can make the situation worse. Chronic health conditions and resultant trauma, or trauma itself, are life-changing and bring fear and anxiety. Anxiety medications can be helpful but not a cure or complete treatment.

Employees should also be encouraged to be cautious with potential impairments if expected to drive on duty, operate equipment, or otherwise perform activities that may increase risks; if so, requests to manage tasks to prevent these tasks while on potentially impairing medication can be important, provided employers do not violate the employee’s privacy by demanding private information about the health condition or medication. Doctors will probably say that anxiety medications are a short-term aid that would allow one to navigate this life altering condition, but it does not need to be a permanent part of a lifelong medication regimen. 



For those who deal with autoimmune disorders and still work, whether by choice or because they must, having an ally in the workplace will help substantially. Ideally, this ally would be their direct supervisor, someone who could advocate for them within the organization. If their direct superior is not that person, it can be another member of their team. These colleagues probably sit near one another and spend a lot of time collaborating on projects. They know one another well and would most likely be able to discern when that individual is experiencing difficulties even if nothing is said. These allies can also help mental health by building trust instead of anxiety that the job is in jeopardy. Employees affected by a medical condition should try to reasonably pace themselves. Maintaining good levels of hydration, blood sugar, and regular, consistent rest will help.  

Ultimately, like all safety issues at work, dual accountability is necessary. Affected employees must know their conditions and seek to maintain health and wellness while employers must be mindful of what they expect the employee to do, that it has been managed to a safe level, and what has been communicated to the employee. With this, job functions can be planned for safety and employers can work with employees to enable self-care and job performance while preventing toxic workplace traits and worsening of conditions.



1. Department of Justice. (n.d.). Americans with Disabilities Act. Retrieved on September 4, 2021 from ada.gov.

2. Hopkins Medicine. (n.d.). What are common symptoms of autoimmune disease? Retrieved on September 4, 2021 from https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-are-common-symptoms-of-autoimmune-disease

3. Psychology Today. (n.d.). Stress. Retrieved on September 4, 2021 from https://www.psychologytoday.com/us/basics/stress