RA and Your Body Image
It’s hard to feel good about yourself when your body is betraying you. Before your diagnosis, you felt great about your body. You loved your muscles, curves or leanness; you celebrated your nimble knitting fingers or your meringue-whisking arms. Or maybe you’ve always struggled with body acceptance and tended to focus on self-perceived flaws. Now your RA is forcing you to deal with a different reality.
When you have a chronic illness like rheumatoid arthritis (RA), you face physical limitations, chronic pain and changing plans for the future. You are forced to reevaluate assumptions about your body, daily life and self-concept.
“Body image is how we think and feel about our bodies, but it’s just one component of our self-concept,” explains Gerald Goodman, PhD, professor emeritus of clinical psychology at UCLA. “Body acceptance fits into a larger framework that influences our self-esteem.”
Research confirms that people with RA experience negative changes to body image. Multiple studies show that women with RA have lower self-esteem, poorer body image and higher levels of body dissatisfaction compared with healthy women.
“RA can affect your outward appearance. Many individuals experience swelling and changes in the shape of fingers, feet and other joints; weight gain or loss; and difficulty walking. These body changes can affect how a person views herself and her body,” says Helen L. Coons, PhD, president and clinical director of Health Psychology Solutions in Denver.
You may think that because treatments have come such a long way over the years that worries about body changes might not be so prevalent. However, researchers in a 2015 study published in The Open Rheumatology Journal found that new treatments haven’t had much effect on how women with RA perceive their bodies. The study authors reported that study participants used words such as “crooked joints,” “smallish-looking legs” and “large body” to describe their bodies. The authors reported that “decreased body strength, decreased joint flexibility and visible changes in the look and shape of their bodies made them feel embarrassed in public.”
Other studies echo these themes. A 2007 study published in Arthritis Care and Research found that 30% of the people who had RA for a long time reported feeling unattractive. This was similar to the proportion of patients with recently diagnosed RA (34%) who were concerned with their appearance. According to study author Louise Sharpe, PhD, professor of psychology at University of Sydney in Australia, “Participants in the recently diagnosed group were still in the early stages of the disease and had few, if any, objectively observable disfigurements, but had rates of concerns similar to those with chronic RA.”
Consequences of Negative Body Image
According to Coons, any shift in your body and self-perception can be emotionally distressing, and in some cases can lead to anxiety and depression. Indeed, a 2013 study published in Musculoskeletal Care found that among people with RA, appearance-related social anxiety and social avoidance were associated with depression.
Sharpe’s 2007 study also found that appearance and physical disability were predictive of depression among people with RA. Sharpe explains, “It is unclear whether depressed mood causes body image disturbance or [that] body image concerns lead to depression. But it is likely that targeting body image concerns could be therapeutically useful for some people.”
Chronic illness can negatively affect your body image and self-concept. And the social stigma that may come with illness can deal an additional blow to your self-esteem. People with physical disabilities can face daily challenges of being seen as different or even inferior.
In particular, women with physical differences may feel they don’t fit the narrow definitions of beauty displayed in the media. This can lead others – and themselves – to perceive them as not feminine or not “real” women.
Coons notes that adults who are physically different or challenged may feel unsupported by others, self-conscious in public, become critical of their body and sometimes isolate themselves from others.
Coons urges that if your disease, pain and body frustrations trigger distress, anxiety or depression, you should reach out for help. Find a behavioral health provider to talk to -- a clinical psychologist, psychiatrist or social worker with expertise in adults with chronic physical conditions.
How to Nurture a Positive Body Image
Goodman, Coons and Sharpe share tips for nurturing a positive self-image.
- Appreciate yourself as a whole person. Don’t be defined by your illness. You may have limitations to your physical functioning, but don’t impose those limitations on your whole being.
- Focus on and develop your abilities so you can feel good about the things you can do.
- Don’t over-generalize. If there is something you can’t do as a result of your RA, don’t conclude that you are an overall failure.
- Commit to your body in positive ways. Manage your weight; be physically active; get involved in activities that promote a positive attitude.
- Set challenging, yet realistic, goals outside of your body that link to your dreams, values or emotions.
- Distract yourself from focusing too much on your RA – read, watch a movie, enjoy hobbies or do volunteer work.
- Accept the validity of your feelings. If you deny them, you deny yourself.
- Explore body-image issues with people you trust: a partner, friend, counselor or colleague. Surround yourself with individuals who are supportive, respectful and encouraging.
- Advocate for yourself and for people with disabilities. Work to challenge stereotypes and prejudices. Join the Arthritis Foundation Advocacy network.