Feeling good and confident can be incredibly difficult when living with a chronic condition such as Rheumatoid Arthritis (RA). Body image, quality of life, and health are all interconnected. Each one plays a role on the other. When the body stops cooperating and begins to physically change in ways that are out of control, it is only natural that body image can suffer.
When people are diagnosed with RA, they learn that their body is going to change and that they may not be able to do all the things that they used to. Using fingers to do things such as knit, write, and even button clothing can become a painful struggle. Exercising may now seem impossible. Physique may change and muscles may not be as strong as they used to be. This not only decreases self-esteem, but also creates a feeling of helplessness. Nobody is without insecurities, but when these are magnified by RA, the struggle can be two-fold.
RA forces people to change the way they look at and plan their life. Gerald Goodman, PhD, and professor emeritus of clinical psychology at UCLA explains that “Body image is how we think and feel about our bodies, but it’s just one component of our self-concept. Body acceptance fits into a larger framework that influences our self-esteem.” RA changes the way that people view and feel about themselves.
Research into RA and self-esteem
The self-concept of people with RA is something that has been researched. These studies have shown that people with RA experience more negative thoughts and feelings about their body’s and themselves. Women with RA have been shown to have lower self-esteem, body image, and increased dissatisfaction with the way that their body looks and functions in comparison with women without RA.
Helen L. Coons, PhD, and president and clinical director of Health and Psychology Solutions in Denver describes how RA can affect people, “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.” When you can no longer do basic things such as walk the way that you used to, this can have a profound impact on your emotional state, sense of worth, confidence, and motivation.
Researchers and medical professionals are constantly working to come with new treatments and therapies for RA. Some of these can help slow progression of the disease while others are designed to help alleviate pain. Despite advances in medicine, research has shown that these treatments have not done much to help how women with RA view their bodies. In 2015 The Open Rheumatology Journal published a study that confirmed this. The way that study participants described their bodies revealed the effect that RA has on their body image. Words such as “crooked joints,” “smallish-looking legs,” and a “large body,” were used as self-descriptors. The authors of the journal said that the participants explained that “decreased body strength, decreased joint flexibility and visible changes in the look and shape of their bodies made them feel embarrassed in public.”
There have been additional studies that have supported these findings. According to a study published in Arthritis Care in 2007 thirty percent of people who have had RA for a long period of time reported that they did not find themselves attractive. Additionally, people who are newly diagnosed with RA develop concerns about their appearance. According to another study in Sydney, Australia people who are newly diagnosed may have few or no visible disfigurements but still report concerns about their physical appearance in the future at rates similar to those with visible body changes.
Long term consequences of poor body image
Dr. Coons discussed how changes in body image and self-concept can be distressing and lead to other psychological consequences. Poor body image plays a role in the development of depression and anxiety. A 2013 study in Musculoskeletal care supports this. The study found that individuals with RA had social anxiety revolving around their appearance that would lead to avoiding social events and interactions and eventually depression. Humans are social beings. When we become isolated because we are concerned about being seen by other people depression can follow quickly.
The 2007 study in Arthritis Care showed similar results. The authors found that appearance and physical disability and changes were indicators for future development of depression. The author Louise Sharpe, PhD, and professor of psychology at University of Sydney in Australia said that the exact details of the relationship between body image and depression are unclear. It is possible that depression causes body image issues, or it is possible that poor body image leads to depression. Either way, addressing the body image concerns in this population could prove helpful for their mental health.
There are many chronic illnesses that can affect people’s mood and self-concept. Additionally, society often can view people with chronic illnesses differently as well. This does not need to be intentional to do harm. This can intensify the lack of self-esteem that people with RA struggle with.
Women already have it hard enough in society today. Being constantly bombarded with media expectations of what we should look like, what is accepted as beautiful, and the narrow and often impossible and unhealthy standards that we are held to intensify this battle. For women without a chronic illness the media can make them feel inadequate and not feminine enough. Women with RA experience this even more.
Dr. Coons says that people who do not fit the narrow physical description that is accepted by society may feel isolated, unsupported, and self-conscious in social settings. She encourages people with anxiety and distress as result of their disease symptoms to seek help. Professional psychological counseling can benefit many by helping them to learn to adjust healthily to their life changes.
How can you improve your body image?
There are some things that people can do to help support a healthy body image. Doctors Goodman, Coons, and Sharpe have come up with some tips to help people with this process. They encourage people to look at themselves as a whole and not just the physical appearance that they see in the mirror, or the things that they cannot do as a result of their disease. There is more to each of us than that. Spending time focusing on what you can do can help you feel good about yourself. Not being able to do one thing because of your RA does not make you a failure, so do not put yourself into that box when you are struggling.
Maintain activity and a healthy lifestyle. This can help you feel good about what you are doing for your body while keeping you healthy. They also encourage setting challenging but realistic goals so that you feel good when you accomplish them. These do not have to be physical goals, but can be goals that involve your “dreams, values, or emotions.” Ignoring your feelings will also only make things more challenging for you in the long haul. Acknowledge the presence of your feelings and accept them as valid. They are a part of you.
Engaging in hobbies that you love can help build your self-esteem and distract you from the RA as well. Discussing your feelings about your body with people you trust can also help you process these feelings and receive positive reinforcement from others. Another way to regain some control of your life and situation is to work to advocate for people with RA and raise awareness. There are many communities that can help you to help yourself and others. Remember, there is a lot more to each of us than we often allow ourselves to see.