Rheumatoid Arthritis and Body Image

“Body image” is your perception of your physical being. You can define it as how you see and feel about yourself in terms of your physical attributes, your attractiveness, your ability to function, your potential, or even your sexuality. Body image can also affect how you interpret the way others value and see you. Body image affects emotions, thoughts, and behaviors in everyday life. Most important, body image affects and influences your relationship to yourself and to others.

Body image does not exist in a vacuum. We live in a culture obsessed by physical fitness and with a narrow standard of beauty. On the one hand, strength, independence, and good health are promoted and affirmed. On the other, feelings and fears about weakness, pain, vulnerability, imperfection, and lack of control often cause people to reject people and things that embody these attributes. Such societal norms, whether healthy or not, become the measuring stick for our “self-concept,” or mental image of ourselves. Consequently, having a chronic condition such as rheumatoid arthritis (RA) often leaves people feeling devalued, inadequate, and socially unacceptable. Unfortunately, these messages start early in life, are internalized at an early age, and can greatly influence our quality of life. Because body image is such an important part of self-concept, understanding and working to improve your own body image are key elements in managing your RA.

Body image and your diagnosis

Whether you are newly diagnosed or have chronic RA, your self-concept is affected by how you view yourself within the context of your diagnosis. You may or may not have visible signs of RA, but you no doubt have some strong feelings attached to the fact that you have RA. If you are newly diagnosed, you may be asking questions about how your condition is going to affect your life: Will my functional ability diminish? Will I have the energy to do the things that I enjoy in life? Will my appearance change? How will I feel about these changes?

If you are living with chronic RA, you have probably asked yourself these questions already, but they will remain questions for you as you continue dealing with RA and its periods of flare-ups and remission. If you ever wonder whether anyone else has had these thoughts and concerns, you can be sure that they have. In fact, there have been numerous studies on how feelings about having RA can affect people with RA. The results of these studies are summarized below.

What the research shows

Issues of body image in people with RA often relate to four main themes: physical changes in appearance, functional changes, nonvisible changes such as joint pain and fatigue, and the “medicalizing” of the body. In addition, several studies have shown that an individual’s perception of how an illness will affect him or her in the future is strongly related to emotions such as anxiety, depression, and anger. Research relating specifically to body image and RA also shows that quality of life may vary based on self-esteem, attitudes toward the illness, sense of control over health, perceived support, and severity of impairment. In other words, while it is a natural response to sense loss as a result of RA, the impact of that loss really depends on the meaning you attach to it. The research findings confirm that you actually have a lot of control over how you feel just by the way you view things and make meaning out of them. That is the golden nugget of wisdom to take from the research.

Factors influencing body image

Your own feelings and concerns about RA are just one of the elements creating your picture of yourself. Four other factors can be critical influences on how you see yourself: media, culture, family, and peer group.

The media barrage us daily with pictures of what we are “supposed” to look like. These pictures become our societal norm, and it is difficult not to internalize them and measure ourselves against their impossible standards. It is probably no news to you that the images we hold as ideal are of people who have had professional makeup, cosmetic procedures and surgeries, and some help from airbrushing and other photo-enhancement techniques.

Our culture also plays a role in how comfortable we are within our own skin. American culture values youth, thin and toned bodies, excessively white teeth, and perfectly symmetrical facial features. However, there are other cultures throughout the world that value different sets of norms, such as age, wisdom, and even body fat. Because of changing demographics in our country, we can see our cultural norms shifting slowly to accept a broader view of what is socially acceptable and desirable. However, we are not yet where we need to be.

Family is another major influence on how we see ourselves and whether we feel good about ourselves. Family may confirm the cultural norm or offer a different reference for what is beautiful and acceptable; it has the ability to be emotionally supportive or damaging. A family that is loving and supportive can give us the confidence to rise above the media and societal standards.

The final critical factor influencing how we see ourselves is our peer group. Our friends and colleagues can either show appreciation of our individual qualities or pressure us to conform to the larger cultural norms.

How to attain and maintain a healthy body image

Understanding the concept of body image and its importance in your daily life is the first step to feeling better about yourself. Knowing why you feel or behave a certain way can give you the mental clarity to see beyond present circumstances and allow for personal growth. Many people refer to this clarity as their “aha” moment, which can be an enormously freeing and rewarding experience. After all, if I recognize that what I have in front of me is a nail, then I know to use a hammer.

Once you have this understanding, you can work to apply its lessons to yourself. If you find yourself caught in the vicious cycle of negative thoughts and feelings about your body, you have the power to stop that pattern and create a healthy view of yourself. Start by taking a closer look at yourself from the inside out. The three important aspects that affect your relationship with your body and your quality of life are your perceptions of your body, your attitude and feelings about what you see, and your behaviors in response to those perceptions and attitudes. Do you look at your body size, or perhaps at fingers that show signs of RA, and feel bad? And does that feeling send you spiraling into behavior such as heading for the ice cream in the freezer or perhaps avoiding going out to social events? If this sounds familiar, you are not alone: You have joined the ranks of the majority, the many people who have bought into our culture’s unrealistic ideals of beauty. Stop the negative tape in your head immediately. I often ask people if they would continue to be friends with someone who always berates them. Most people answer no, in a heartbeat. Yet we listen to such negative thoughts in our own minds daily. You wouldn’t put up with it from a friend, so don’t make yourself an exception. The following strategies will help you start changing your body image.

Use kinder self-talk. Repeating positive affirmations every day is a great way to change the negative tape that tends to repeat itself in our heads. Be proactive about this — a great way to diminish the barrage of negative messages you get from outside is to keep a sign by your bed or mirror reminding yourself of the wonderful qualities you have and the things you have in your life for which you are grateful. You will inevitably find yourself returning to the negative tape from time to time, but as soon as you recognize it, stop yourself and repeat something positive instead. You may not believe what you’re saying right away, but if you say it enough you will start to believe and feel it. This may take a little practice, but you already know that change does not happen overnight.

Learn to accept. Genetics gives you unique qualities you may not be able to change, RA may alter your functional ability or appearance, and medicines may affect your body too. Remember the Serenity Prayer: “Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” In challenging moments, the power of acceptance can go a long way.

Be realistic. Be realistic about what you can do and what fits into your lifestyle. When considering strategies to improve your health, remember that you can always ask your health-care provider to recommend helpful Web sites, books, and other information. Keep in mind that health, not appearance, should drive your goals. Developing healthful habits means paying attention to your diet, to your exercise and sleep habits, and to your stress levels. You will be pleasantly surprised at how even small changes can have a tremendous effect on how you feel.

Set short-term and attainable goals. To be successful in setting goals and achieving them, you must plan small steps. It’s great to have long-term goals and even dreams, but not if they set you up for disappointment. Setting smaller goals that keep you moving in the right direction will prove more rewarding, because each goal that you reach will provide a sense of accomplishment that will sustain you for the longer haul.

Plan, prioritize, and pace yourself. These are known as the three P’s. Planning for things allows you ample time to do what you need or get where you need to go. Learning to prioritize will enable you to do the things that are most important to you so that you feel productive and successful. Pacing yourself ensures that you have enough energy to make it through the day. You will find that planning, prioritizing, and pacing yourself will reduce stress in your life. Make specific and gradual changes. The three P’s are a guide for helping you to get the most done while acknowledging that it can’t be done all at once.

Learn to recognize negative thoughts and behaviors. If you have ever caught yourself being short with a loved one because you were stressed, or finishing off the box of cookies because your jeans were tight (and no, they didn’t just come out of the dryer), you know that these actions do not solve the problem or make you feel any better. In fact, they make you feel awful about yourself. If you are like me, you are aware of precisely the moment you go down that negative road. That is the perfect opportunity for you to turn things around and say, “Wait a minute! I can do something else. I can respond differently.” Just in case you are thinking that you already blew it and there is no point in going back to make it better, think again! Lifestyle changes are a lifelong learning process, and there is an ebb and flow to them. This means that sometimes you will hit the mark and other times you will fall short, but what really matters is that you are trying. Having that awareness and wisdom will take you far in life.

Surround yourself with positives. Supportive friends, family, and colleagues can really help you to feel your best. If you find you must have contact with people who are negative, try to minimize your contact or perhaps have an honest talk with them and encourage their support.

Positive places and activities can also give you a boost. Look to go places and do things that make you happy. If you can’t physically go to the places you love most, guided imagery and visualization are neat ways to take yourself away from the daily stress of life. An easy way to introduce yourself to this practice is to take a magazine and find an appealing picture of a place you can envision yourself in, put on your favorite music, close your eyes, and take nice deep breaths. With every inhalation, breathe in wellness and peace, and with each exhalation let tension and anxiety go. Give yourself a few minutes to take yourself on a mini-vacation, inserting yourself in that picture and feeling that experience. You will find this exercise most restorative.

Some final thoughts

Know yourself. Build on your strengths and forgive your weaknesses. No one is or can ever be perfect, so think of striving to be your best rather than being perfect. Understand that you are a person of value who has every right to happiness and that your happiness should in no way be attached to a standard dictated to you by any other person. You are here and made in the infinite wisdom of the universe — trust in that! You have the power to be beautiful inside and out — trust in that! Your body image and your self-concept are in the story that you create and tell to yourself and the world.

Laura Jasphy is a Patient Educator and Guided Imagery Practitioner at the Hospital for Special Surgery in New York City.

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