The symptoms of psoriatic arthritis (PsA) are usually quite visible – painful, swollen joints, skin reactions and fatigue. Less apparent, but just as impactful, is the emotional toll the disease can take.
“They tell me that it’s taxing,” Julie Nelligan, PhD, a Portland Oregon-based psychologist, says of her psoriatic arthritis patients. “They may say things like, ‘Nobody understands me, I feel like I’m not contributing. I’m lonely, I’m anxious because I don’t know when I can get things done and I can’t commit to doing things,’” she adds.
Living with a disease that has both subtle and obvious symptoms can be a double-edged sword. When you don’t have any noticeable skin lesions, friends and family might not realize how much pain you’re in, and fail to take your illness seriously.
When you do have obvious plaques, you have to deal with the embarrassment and constant fear of others judging you. “It’s pretty devastating to patients because some of them have had the experience of salons refusing service. Swimming pools and gyms have kicked them out,” Nelligan says. Fear of judgment and low self-esteem can keep you at home; isolated and lonely.
Psoriatic arthritis can affect every aspect of your life: work, exercise, dating, traveling and doing many things you once loved. “You can often feel like you don’t fit in or you can’t do your job, which can be pretty depressing,” says Nelligan.
It seems that the mechanism of the disease affects your emotions directly, too. “It appears that the same inflammatory substances that create the warm joints, swelling and pain also cause depression,” says Nelligan. That may be why a significant number of people with psoriatic arthritis – more than 20% – have depression, according to one study.
Managing Painful Emotions
When you’re in a good place emotionally, it’s easier to withstand the challenges your disease can cause, whether it’s the stare of a supermarket cashier, or the downplaying of your symptoms by a well-meaning relative.
How can you become more emotionally resilient? Start by talking with someone who understands both psoriasis and the depression it can cause. Find a psychologist who works with people who have chronic conditions. You can get a referral from your doctor, or search online resources, such as Health Grades and Psychology Today.
You can also get emotional support from a peer. The National Psoriasis Foundation offers a One to One mentoring program that pairs you with another psoriatic arthritis patient – someone who knows what it’s like to deal with this disease every day. You can also find a support group online or locally, which will give you access to people who’ve been through similar experiences. “I think it’s really helpful to talk to somebody who gets it,” Nelligan says.
Try to stay involved, even if you don’t feel up to it. Getting out can distract you from the pain and fatigue. If you don’t feel well enough to venture out, call or text a friend to stay connected. Nelligan also recommends keeping a journal to express your emotions, and to record your symptoms so you can start to understand your limitations and work around them.
Another way to beat the blues is with exercise. Physical activity not only relieves soreness and stiffness, but it also releases brain chemicals that boost mood. You don’t have to take an hour-long spin class to see benefits. A 10-minute daily walk or swim can do wonders for both your physical and mental state. An activity like yoga or tai chi combines exercise and relaxation to simultaneously combat pain, stiffness, fatigue and depression. Choose whichever program best fits your abilities.
Finally, don’t be too hard on yourself when fatigue or pain interrupts your life. “Just be compassionate toward yourself for what’s happening, because it’s not your fault,” Nelligan advises.
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