Rheumatoid Arthritis and Your Body Image

This session was designed to explore how social, physiological, and emotional factors shape our beliefs and behaviors regarding our bodies - and then to learn how to change negative thoughts and behaviors and to develop healthy attitudes and habits. The goal is to give you tools to change so that you will feel better about yourself.

First, close your eyes and think about a body part of yours that you dislike. Then think about a part that you like. If you're like most people, it's much easier to identify parts that you dislike than those that you like. We're so used to thinking about the bad stuff that it's hard to come up with the good stuff.

Body Image

Body image refers to the body as a psychological experience and focuses on your individual feelings and attitudes towards your body. It can be broken into three aspects:

• perception - what you see (a combination of your visual ability and your psychological makeup) when you look at your body;
• attitude- your feelings about what you see;
• behavior- what you do in response to perception and attitude, i.e. does what you see make you feel depressed and send you out for ice cream.

The Statistics

• About 44 million Americans are overweight.
• 33% of American women are trying to lose weight at any given time.
• 20 to 24% of American men are trying to lose weight at any given time.
• Americans spend $33 billion annually on weight reduction products and services.
• Women who are active tend to have more positive body images and higher self-esteem.

Five Critical Influences on How We See Ourselves

• Media - portrayal of an ideal (not everyday folks) vs. what is the norm. (Body features are enhanced with airbrushing of blemishes, wrinkles, etc., as well as lighting, computer techniques and plastic surgery; body doubles are used in films when lead actors don't measure up to that ideal).
• Culture - acceptance of the ideal vs. the norm. (Remember, some other cultures value age, fat, and other factors that are not accepted in ours)
• Family - can be critical or controlling vs. one that is supportive, giving us confidence to rise above the media and culture
• Peers - pressure to conform to the culture by our friends and colleagues vs. appreciation of our individual qualities
• Self - whether you have low self-esteem and/or depression vs. confidence in yourself.

How We Build - or Wreck - our Body Image

The media says we must look like the ideal to be happy, popular and successful - and we can do so if we try hard enough, spend enough, and suffer enough. But it's not true - only 4% of American women have "model bodies."

Nonetheless, parents and friends who focus on their own weight and body shape often give the message that you should do the same. Teasing or unwelcome comments about your appearance can diminish self-esteem and confidence.

Thus, we tend to value certain body parts or functions because: they are a source of self-esteem or confidence; they allow for continuing social, sexual, and career functioning; and they enhance our self concept and the stability of our body image. Conversely, visible change in shape or form or functional ability can translate to lower self-esteem, self-worth, sexual desire, vocational capacity, discomfort in social situations - and a poor body image.

Personal appearance is a means to many highly valued goals in our society. When you perceive yourself as unattractive, your access to these goals is diminished, which can lead to anxiety and self-devaluation. It can be a vicious cycle when we "buy in" to society's ideals and use them as a measure of our self-worth. These unrealistic ideals set us up for disappointment - because no one can be perfect.

Body Issues Specific to Rheumatoid Arthritis

These issues may change how you see yourself even more than how others see you:

• Physical changes in appearance - changes in shape of hands or using a cane;
• Functional changes - changes in your ability to do things;
• Non-visible changes, such as joint pain and fatigue - requiring explanation to friends and family about why you can't do certain things;
• "Medicalizing" our bodies - feeling like a depersonalized "object" in the medical process, as something just to be tested and prodded.

It's important to realize that RA is just a part of your life, not your whole life.

Starting to Change Your Body Image

• Better Self-talk - Would you continue to be friends with someone if every time they saw you they said, "Your rear end is the size of Texas?" No. But do you do the same thing to yourself every time you look in the mirror, criticizing some body part? You need positive self-talk, not negative self-talk. Don't give yourself permission to insult yourself.
• Accepting Physiology - Hormones may influence your moods and cravings; illness may alter your functional ability and/or body size/shape; genetics give you a uniqueness you may not be able to change.

  --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."

  --Be realistic - Yes, there are things you can change, but you must be realistic.

Healthy Thinking

• Make health, not appearance, your goals in weight and health management.
• Try to focus on healthy eating, not denial. Eating should be an enjoyable experience. Work on modifying behavior, not forbidding yourself of eating pleasures.
• Set short-term and realistic goals, which result in better outcome, higher self-esteem, and greater confidence. With realistic goals - setting up short- and long-term goals - you can avoid setting yourself up for guilt.
• Know yourself. Keep your weaknesses in mind and build on your strengths.
• Allow for lapses because nobody is perfect.

Healthy Behaviors

• Exercise will do as much for your spirit as your body. It's been proven to ease depression.
• Keeping a diary of your moods, food intake, and symptoms is important. Self-monitoring is an essential part of self-care, self-learning, and behavior modification.
• Plan - and make - specific and gradual changes. Don't try to do everything at once.
• Learn to prioritize to ease stress in your life, which helps you feel better about yourself. Plan ahead for parties or busy days.
• Seek support from friends, family, colleagues and support groups.
• Reward yourself - for positive self-talk as well as for positive behaviors.

Integrating New Thoughts/Behaviors into Everyday Life

• Learn to stop automatic and over-learned behaviors.
• Learn to be conscious of and think about what you are telling yourself in order to change self-defeating behaviors.
• Learn to feel and behave differently.
• So if you look in the mirror and say "Yuck, I'm having a bad hair day," for instance, think about what you're doing when you have that self-talk and change it, even if you don't believe it initially. Tell yourself "I can change the way I've done my hair and put on an outfit that makes me feel special and find something positive about myself." And when you say it often enough, you will start feeling it. Because we have so many negatives coming at us, we have to do the positive self-talk in order to change.

Irrational Beliefs that Block Positive Self-Image and Happiness

• "I must be perfect - and stick to my diet perfectly. Lapses are catastrophes and mean I should give up."
• "I am a worthless person because I do not look like the popular ideal."
• "If others don't approve of my body, I will not be happy."

These are all false beliefs! Challenge these and other irrational thoughts. Avoid all or nothing thoughts. Learn to live with minor lapses and then get back on track. Understand that you are a person of value, who deserves to be happy, no matter what you look like. Once you realize that you don't have to be perfect, you can begin to find happiness and enjoyment in places both emotional and physical that you never imagined possible.

Summary: Stop, Think, Feel, and then Behave

Recognize and challenge irrational thoughts and change the self-defeating behaviors. To accomplish this, you will have to practice, practice, practice. The more you give yourself positive self-talk and treat yourself well, the more you will enjoy life.

Suggested Reading

Faith MS., Long Term Weight Management and Self Acceptance: An Ideal Union! New York: Albert Ellis Institute, 2000.
Greenberg D, Padesky C. Mind Over Mood. New York: Guilford Press, 1994.
Johnston, JE. Appearance Obsession: Learning th Love the Way You Look. Deerfield Beach: Health Communications Inc., 1994.
Shontz FC. The Psychological Aspects of Physical Illness and Disability. New York: Macmillan, 1975.

Learn about the Living with RA Workshop at HSS.

Updated: 9/4/2009

Summary prepared by Diana Benzaia.

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