Being diagnosed with a chronic illness like psoriatic arthritis (PsA) can stir up all sorts of feelings, including anger, resentment, self-pity, fear, shame, and other emotions that aren’t always comfortable or easy to navigate.
You have every right to those feelings, but, left unchecked, they may ultimately do more harm than good. Indeed, 33 percent of people with PsA have at least mild anxiety symptoms and 20 percent have at least mild depression symptoms.
How do you start to come to terms with this diagnosis so you’re not railing against it? The first step is cultivating the wisdom to know the difference between the things you can control and those you can’t. There is no undoing this diagnosis (though there is treatment). “If you spend all your time trying to change something that can’t be changed, you’re [more likely] to be very depressed,” says Teri Bourdeau, PhD, a psychologist in private practice in Florida who works with people navigating chronic pain.
But you can change how you think, talk, and feel about your psoriatic arthritis. These expert-approved tips can help you make progress along the journey toward a healthier relationship with PsA.
1. Find Ways to Adapt
If your PsA has made it more difficult to participate in activities you used to enjoy, try reframing how you talk about this experience, says Jessica Auslander, PhD, a clinical mental health counselor who has worked with the Arthritis Foundation’s patient education team.
“Instead of saying ‘I can’t play pickleball anymore,’ for example, I will maybe end that sentence with ‘in the way that you’re used to,’” she says. Look for ways to adapt your favorite activities to your changing needs, or still participate in the culture around that activity, she suggests.
Rather than dwell on what you can’t do at the moment, focus on what you can do and how you can modify and adapt. “For everything we take away, we’re going to find something to replace it, and that could potentially open doors,” she says.
Diagnosed with an arthritis-related condition as a child, Dr. Auslander has put this tip into practice herself. When her rheumatologist gently suggested it was time for her to stop running, a former major source of stress relief, she started going to a local CrossFit gym, “something I never thought I’d be able to do,” she says. “But I have found this amazing community, and I love it.”
2. Acknowledge When You’re Doing Your Best
Sometimes adapting means changing your plans entirely. For example, imagine a day you had planned to go out to lunch with a friend. The day arrives, and you find yourself dealing with a lot of pain because of your PsA. Instead of pushing yourself to go anyway, “consider alternative, self-compassionate thoughts,” says Ashwini Nadkarni, MD, an assistant professor of psychiatry at Harvard Medical School in Boston. Tell yourself something like, “I’m doing my best today, and that’s enough. I can reschedule this for another time and, instead, write a note of appreciation to my friend,” she says.
3. Try Out Some Different Stress-Relief Techniques
Everyone’s experience with PsA and how they come to terms with their diagnosis is different. Maybe meditation helped an acquaintance accept their unique scenario, but you can’t quite sit still, for example. This is normal: “If [one coping mechanism] doesn’t resonate with you, you may be processing things in the world differently from others,” Dr. Bourdeau says. That’s why it’s good to have multiple tools in your coping toolkit. “Sometimes you need a hammer, and sometimes you need a screwdriver,” she says.
High up on Auslander’s list? “Intentionally seeking joy and giving ourselves permission to be playful,” she says. Think about hobbies, pastimes, or activities you enjoyed as a kid or a teenager and find ways to pick those up again, she suggests.
She also recommends the occasional use of dark humor and more passive tools, like watching a couple of episodes of your favorite show. “We don’t want to binge-watch something for 10 hours in a row, but the brain needs a rest as much as the body does,” she says.
Stress is a top PsA trigger, exacerbating inflammation and symptoms like pain and fatigue, so it’s important to do what you can to manage it.
4. Strive for Body Neutrality
Body positivity, or loving one’s body, may feel a little too close to toxic positivity if you’re struggling to accept the way PsA has changed you. Instead, work toward neutrality, Auslander says. “You don’t have to love your body, but can you find some things that you like?” she says.
She herself has psoriatic arthritis, and she has often felt frustrated about the way psoriasis affects her toenails, for example. “I’m not going to rock those flip-flops all the time like I used to, but I can find some cute, closed-toe summer shoes or sneakers,” she says. “It’s about finding another way to neutralize or be proud of your body.”
5. Challenge Your Expectations
Cognitive behavioral therapy, or CBT, aims to challenge existing thought patterns, Dr. Nadkarni says. So if, for example, you avoid the beach because you’re concerned people might stare or point at your psoriasis plaques, you might work with a cognitive behavioral therapist to plan a few beach “exposures,” she says. Take yourself to the beach and notice when people ultimately don’t point out your plaques. This gives you evidence to refute your misplaced belief that you don’t belong at the beach and can help you feel more at peace.
6. Cultivate Empathy and Gratitude
That said, there may also be times when you do notice people staring or pointing. Try to remain empathetic in these moments: Remind yourself that you have no idea what kind of invisible, silent conditions those people may be dealing with, Bourdeau says.
Gratitude may also help. While the concept can feel a little trite, it is “a protective factor psychologically,” Auslander says. In fact, people with chronic illnesses who score higher on measures of gratitude tend to have lower rates of depression.
To be clear, you do not need to be grateful for your PsA. “You don’t have to experience gratitude around the issue you’re dealing with,” Auslander says. “You can just have gratitude that the sun is out or that you didn’t hit a single red light on your commute to work.”
7. Assert Yourself on Your Terms
There are moments for empathy and gratitude, and there may also be moments for education and outreach that can in turn improve your own perspective on your PsA. If you have the energy and the desire, it’s okay to speak up on your own behalf when someone stares, or, even worse, bullies you or someone else for having PsA.
“My response might be more assertive at times when people are … being very rude to me,” Bourdeau says. You might spend a few minutes educating them by sharing facts about psoriasis and PsA, for instance that it’s not contagious, in a way that ultimately helps you build confidence in your own relationship with the condition.
8. Consider Professional Support
It’s never a bad idea to reach out to a mental health care professional who can help you navigate this complicated, evolving relationship. “You don’t have to be in it alone,” Bourdeau says. Look for someone with experience working with people with PsA, if possible, or with chronic health issues more broadly.
And most importantly, find someone with whom you feel comfortable talking openly. “Most of the benefit that we get in mental health spaces is from the connection with the therapist,” Auslander says. “And therapy does not have to be months of sitting on a couch once a week. When I work with people affected by chronic illness, I might see them just two or three times, and then as needed,” she adds.
You may also be able to find virtual or in-person support groups for people with PsA. “That can be very helpful to be able to have conversations with people who understand and have those shared experiences,” Bourdeau says.
9. Reframe Your Diagnosis as an Opportunity
When you’ve been managing PsA symptoms for years but have been unable to get an accurate diagnosis, it may come as a bit of a relief to find out what’s going on. And it’s also an opportunity to explore the treatment options available to you.
“A diagnosis isn’t a sentence,” Auslander says. “A diagnosis is an understanding.” Lean into this positive association by exploring the opportunities this diagnosis provides you to receive more targeted, effective care.
Remember, everyone with PsA is different, and the journey toward acceptance or compassion for your diagnosis isn’t linear. With consistent effort, thoughtful intention, and the right support, you can improve your relationship with your PsA.
The Takeaway
- A psoriatic arthritis diagnosis can be difficult to accept, but reframing how you think, talk, and feel about it can help you manage.
- Have compassion for yourself and your situation. It may help you control your PsA symptoms to find ways to relieve stress and improve your mood.
- Coming to terms with a chronic condition isn’t easy. Consider seeking professional support and give yourself time.
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