Navigating the Dating Scene When You Live with Chronic Pain

Jane is 26 years old. She holds a master’s degree from a prestigious regional university, works in a professional job as an editor for an online enterprise, and is single. She was diagnosed with ulcerative colitis three years ago. She is currently treated with a biologic medication and pays close attention to how her lifestyle affects her condition. She is in the dating world and meets men through social media dating sites and by networking with friends. She hates dating.

“As much as I enjoy social contact, I am hoping the day will come that I’ll never have to date again,” Jane says. “I have a dream to be married, have children, and establish a stable family. I’m not interested in hook-ups, blind dates, or the getting-to-know-you stage of relationships. None of that is fun to me. Add the fact that I have a chronic gastrointestinal disease to the mix, and dating feels like work. It is hard enough to make the ‘how-do-you-dos’ and to talk about what I like and expect in a relationship. Considering the data that I sometimes have uncontrolled, painful diarrhea, and give myself injections in my stomach on a regular basis…well, it can be difficult territory to navigate.”

John is in his mid-50s. His wife of 23 years died two years ago after struggling with a chronic illness. He is an attractive, robust fellow who has begun to date again. “I had a very good marriage, and nothing will ever replace the love that I had for my wife,” he says. “We talked a good bit about this before she died, and she encouraged me to be involved with others. I don’t know that I ever want to be married again, but I am venturing out and dating.

“It is a strange new world from when I was younger. Dating now seems like a competitive sport. I meet women and we size up each other as potential mates before the first ‘hellos’ are out of our mouths. Things move fast, and they are likely to get physical quicker than I would’ve expected. I have psoriatic arthritis that gives me aches, pains, and plaques on the back of both thighs. It is medically well managed, but I feel like this is something that I should disclose before we end up in bed. I’ve decided very quickly that I don’t like to date.”

Jane and John’s stories are similar and are moderately cynical on the surface. However, their experiences, despite age, gender, and historical differences, are familiar in this day and time: Dating is a challenging enterprise, particularly if a person is looking for a potential mate and an intimate connection. Courtship rituals have changed and no longer hold the romance that Jane Austen promised. The problems caused by a chronic pain condition in the dating world add an additional and complicating variable to the experience.

Dating and loneliness

It is a paradox that Jane, John, and their cohort of singles speak of dating as a lonely process. Many compare the experience to marketing themselves. Jane said, “I have to be careful about dress, make-up, and the whole ‘look.’ Social media and sites likes OKCupid and give me a little bit of information about who I meet and may anticipate dating, but not enough to really know the person.”

John calls dating “…a competitive game. When I was younger, dating was a courtship ritual, and we were all awkward, naive, and a little bit goofy. But it felt safe. Now, I feel like I’m playing for emotional keeps. I know I’m still grieving the loss of my wife, so I feel lonely and like a stranger in the dating world anyway. I’ve been surprised that the stakes are so high.”

Jane agrees. “It is a lonely process. There is nothing intimate or easy about dating. While meeting and dating another flesh-and-bone living person feels more legitimate than just ‘looking for love’ on social media, there is a creepy sexualization I feel about how I need to present myself. It takes some time not to feel detached from myself or the other person. There are times when I date that I feel like I’m on the outside looking in on myself. In so many ways, that feeling of loneliness is why I would rather hang out with my girlfriends than have to present myself as a commodity to a stranger who just might be ‘the right one.’”

Johnathan Martin, PsyD, a clinical psychologist with the VA Medical Center in Salem, Virginia, and I co-authored the book Isolated and Alone: Therapeutic Interventions for Loneliness (Professional Resource Press, 2012). He says loneliness is more than simply being alone. “It is that feeling that holds a deep sense of isolation, emptiness, worthlessness, and feeling threatened,” he said. “It is the opposite of feeling related.”

Social pain is physical pain

Painful experiences are a part of life. The words used to describe social pain such as the experience of a romance breaking up or of a broken promise are most often the same words used to describe physical pain. Being insulted feels like “a slap in the face,” and Billy Ray Cyrus warned about the effect of ending love on his “achy breaky heart.” The language of feelings is not just poetic; the words describe physical sensation.

There is an overlap between human attitudes, behaviors, and thoughts about how we experience pain. Social psychologists have found growing evidence that physical pain and social pain share a common neural system. In other words, our brains detect and process a social threat like they do a physical threat.

Researchers also have investigated social anxiety, which is common in dating, and its relationship to the threat of social exclusion and loneliness and their overlaps with physical pain. The heightened anxious sense of what John called “the blood sport of dating” can indeed cause physical pain.

When a person has a chronic pain condition, the effects of an emotional blow can be amplified and are registered on the body as a physical ache. “There is strong research evidence demonstrating the potency of social connectedness and support with health, including lower blood pressure, better immunosurveillance, lower levels of stress hormones, and higher pain tolerance,” Martin says.

“When a person feels isolated, disconnected, or highly anxious, she is at greater risk for psychological depression and physical problems related with neuroendocrine, cardiovascular, and inflammatory responses,” he adds. “Loneliness is a unique predictor of psychological and physical pain. It is not too far of a leap to say that a lonely person with a chronic pain condition may hurt more than a person with a strong sense of social support.”

Jane said, “I just don’t know when or how to bring up the colitis problem. I have long periods of remission. That means I take good care of myself and eat carefully on a rigid schedule. If I am in a flare or there are the physical signs that one is around the corner, I become even more vigilant. Socially, I have to attend to my surroundings — I need quick access to a bathroom — and there are times that my energy levels are erratic.

“During a flare, I really must practice good energy conservation, because there are days that I just don’t have much ‘get up and go.’ I haven’t found a very successful way to disclose this to a dating partner. I’ve had some dates who have been interested and ask questions, and some who have turned and run the other way at the mention of anything complicated like my physical problem. Needing to talk about it makes me nervous, which just adds to all the other anxieties that I have about dating.”

Jane is speaking of the experience called social exclusion. This is the process that denies a person full access to opportunities that are normally available to members of a different group, including the resources fundamental to social integration within that particular group. It is the feeling that most of us have had at some point in our lives when we haven’t been allowed to be “a member of the club.” Alienation or disenfranchisement resulting from social exclusion can be the result of any kind of perceived difference, including discrimination because of problems with chronic pain conditions.

Jane said, “I didn’t have any idea that there would be a social consequence from having colitis. More often than not, I’ve found that talking about my physical health becomes a make-it-or-break-it condition of the relationship’s viability. There have been many times that things looked good, then I disclosed my GI problem, and the door just closed.”

Martin agrees. “When we are searching for intimacy, we look to move to the center of an emotional connection with another person,” he says. “Anything that marginalizes us or makes us feel like we’ve moved to the periphery gives rise to a feeling of being compromised. So often in dating, we’ll be involved in activities that we would otherwise not consider at different points, like attending a basketball game when you have little interest in team sports. We do this to find those emotional points of contact.

“A chronic pain condition, by nature, will already have a person feeling edgy as he or she begins to date someone new. Any emotional distance will perpetuate that sense of the personal void that leads to the emotional need to date and connect. What we look for is satiation of the void, and that comes from a sense of an empathic connection with another.”

Social exclusion is painful because it threatens the primary pain buffer of social support serving as a literal shield against physical pain. The value of social support has its origins in early history. Our human ancestors knew that cohesive groups could protect the tribe from attacks of predators or competitors. The more tight-knit the group, the better it was able to offer protection against incoming danger, improving the survival skills of the group. John laughed about this. He said, “I am a cave man. My friends feel free to talk about my dating adventures. Last week, after telling one of my buddies of my weekend plans, he just said, ‘Happy hunting!’”

Anthropologists found that people who were successful in forming strong relationships and integrating into groups were not only more likely to avoid pain but also more likely to survive, reproduce, and raise offspring to reproductive age. On the other hand, social exclusion was often the literal equivalent of physical pain or death. Over time, people learned to avoid social exclusion by making strategic attempts to be socially acceptable by changing their opinions, moderating their attitudes, and regulating their moods. In other words: playing by the rules.

“I wish I knew the rules,” Jane says. “They change all the time. For us millennials, the only guarantee about the rules it that they will change, just about the time you know how you are playing. This makes dating harder.”

Social support and pain

How does physical pain factor into the dating equation? Pain leads to an increased motivation for social support. A basic psychological premise is that all humans have an unconscious attachment system that guides us into closer proximity with others in times of stress. Current research has proven that nearness to others offers comfort and relief in times of need. Higher levels of social support, defined by this emotional sense of connection, are associated with lower levels of chronic pain.

If it is true that social support buffers people and inclusion in social groups is a fundamental cushion from physical pain, then threats to one’s social support, i.e., social exclusion, may be perceived as painful at a basic level. Jane agrees. “I know the pain of feeling lonely when my dating life is not going well,” she says. “When I am with someone I enjoy, I can tolerate more physical pain. I also remember the bone-chilling feeling that I got one night when I told a guy I really liked about the colitis. He could’ve just slammed a door in my face and it wouldn’t have hurt so much as his personal distance. I felt devalued and like damaged goods. The colitis hurts too much physically to have it hurt emotionally. It is a part of me and has to be regarded as something unfortunate that I have to deal with it, but is a part of me and that has to be OK.”

John concurs. “At my age, most of the women I date seem to be more forgiving of aches, pains, and frailties. I have had the experience, though, of those who are put off by my arthritis. I understand it, but I don’t want to be dating someone who can’t appreciate that I have to deal with it all of the time. When I am hurting, a little TLC goes a lot further than if I try to tough it out. I know that I’m with someone good when she tries to understand me and doesn’t feel like I am using pain to complain or to avoid. I know that I want to be in solid relationships with others, but I can’t deny parts of me that aren’t the prettiest or easiest to deal with.”

So what does this mean?

The world of dating is changing, and social rules are fluid. A person with a chronic pain condition will have to define personal parameters and boundaries for disclosure to his or her partners. Social support is vital to emotional and physical health. As Jane says, “I date because I want an intimate relationship, so I endure all of the problems that come with it.” John agrees, saying, “I don’t know that I want to be married, but I do want that special person in my life.”

When should I talk about my health condition?

There are no hard and fast rules for disclosure. However, psychologists agree on some general guidelines to help you navigate the discussion of a chronic pain condition. Johnathan Martin, PsyD, offers guidelines for disclosing a chronic pain problem when dating.

• Find a level of comfort in talking about your condition. Learn the language of the condition in diagnostic terms. Practice talking in concrete terms to your mirror about the problem and how you live with it until you are fluent in conversations with others. Check for any feelings of embarrassment or shame, and practice conversations until the feelings are neutralized.

• Sooner is better. While disclosing a chronic pain condition isn’t the best place to start a conversation, revealing it as a matter-of-fact is best accomplished early in the relationship. Your health condition should not be hidden. The sooner the problem is discussed, the less potential there is for self-stigmatization.

• Measure your partner’s response. If you feel any sense of social exclusion, or that you are “damaged goods,” as Jane described it, know that the person sitting across from you may need some additional consideration as a romantic partner. Ask about the distance. Solicit an ongoing conversation. Watch for red flags, and trust your feelings.

• Take care of yourself physically. There are times that your health condition will take priority. If a dating partner is respectful of the demands of the illness, that is a good marker for the possibility of deepening the relationship.

Jackson Rainer is a board-certified clinical psychologist who practices with the Care and Counseling Center in Atlanta, helping people living with chronic illnesses. He answers readers’ questions in our column Pain Q&A.

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