How Rheumatoid Arthritis Affects Body Image

“The three most common emotions I see in people with rheumatoid arthritis are embarrassment, anger, and a deep sense of feeling out of control,” says Susan Albers, PsyD, a psychologist at the women’s health center at Cleveland Clinic in Wooster, Ohio.

“Embarrassment often comes from the visible changes in the body,” she says. “There is also a lot of anger. It can feel unfair that your body is changing in ways you did not choose or cannot control. And underneath that, there is often a feeling of losing control or even betrayal. That can be just as distressing as the physical symptoms.”

While RA’s impact on your body image may affect you greatly, there are ways to lessen the distress that stems from it and come to a place of greater acceptance, neutrality, and compassion.

Experiencing pain, developing a limp, and moving more slowly than you used to are also common RA-related physical changes, says Theodore R. Fields, MD, a rheumatologist at the Hospital for Special Surgery in New York City.

Sometimes, people are reluctant to accommodate physical changes because of body image concerns.

“The general psychological effect that patients talk about … is that it is making them ‘a different person,’” Fields says.

Dr. Albers agrees. There is “a shift in identity,” she says. “People often say they no longer feel like the version of themselves they are used to.”

A sense of betrayal can also hit those with RA hard. “Many people feel like their body is no longer on their side. When your body feels unpredictable, it can shake your sense of trust in it,” says Albers.

“Even simple things like going out in public or seeing friends can start to feel more emotionally loaded,” Albers says.

If the physical effects of RA have led you to develop a negative body image, there are a number of ways to improve how you feel.

Mindfulness

“That might be noticing your breath, the ability to move in a way that feels okay, or even small moments of comfort,” she says. “This approach can take some of the pressure off. You are not trying to force positive feelings. You are simply creating space to relate to your body in a more neutral and compassionate way.”

Albers also suggests focusing on sensory experiences. “The feeling of soft clothing, a warm shower, or even stepping outside and noticing a breeze,” she says. “These moments may seem simple, but they help rebuild a positive connection with the body.”

Movement

But exercise can be hard with RA-related physical changes. “Movement that once boosted mood or helped someone feel energized can start to feel painful or draining,” says Albers. “Instead of being a source of relief, it can feel like something to avoid.”

“Over time, some people cope by emotionally checking out from their body altogether. They may try to numb or ignore what they are feeling because it is overwhelming,” she says. “But when you disconnect in that way, it does not just dull the discomfort. It can also dull positive sensations.”

Optimizing Your Treatment Plan

It may also help to be proactive about fine-tuning your treatment regimen, to reduce the impact of side effects and improve your ability to function as much as possible. “At the same time, it is important to acknowledge that this is not always a perfect tradeoff,” says Albers.

“Sometimes the most effective treatments do come with side effects, and people may still have mixed feelings. You can feel grateful for relief and frustrated by the changes at the same time.”

Psychotherapy

“Acceptance and commitment therapy, or ACT, is especially powerful here,” Albers says. “Instead of trying to fight or eliminate difficult thoughts or feelings, ACT helps people make space for them while still engaging in what matters most to them.”

She also says that DBT can be beneficial. “[It] can help with emotional regulation. It gives people tools to manage intense feelings like frustration, anger, or shame, without turning to unhelpful coping strategies.”

CBT works by helping people become aware of — and learn how to change — unhelpful thought patterns. “For example, if someone is thinking, ‘My body is broken’ or ‘I look terrible,’ CBT helps reframe those thoughts into something more balanced and less harsh,” Albers says.

• Rheumatoid arthritis (RA) can cause changes throughout the body, and as a result, it can sometimes negatively affect your body image.
• Physical changes such as joint swelling, using assistive devices, and appearance-related side effects of medication can all affect how you feel about and perceive your body.
• But there are a number of ways you can lessen the impact of RA on your body image, including optimizing effective medical treatment of RA, mindfulness, moving your body in ways that feel good, and getting help from a psychotherapist.