Relationships are the number one source of happiness for most people and having Rheumatoid arthritis is not an insurmountable obstacle by any means. But many wonder, when do you tell someone you have RA that you have begun dating? How do you negotiate feeling tired with your partner whether it’s about doing stuff at home, fun things out, or having sex? How do you content with anxieties about your body, how it looks and feels to allow sex to be fun and a source of closeness for you and your partner?

I recently participated in an online talk show with Deborah Norville (whose mother had RA) for a website called newway RA (www.newwayra.com) to discuss just this topic. In addition I spoke with 2 women with RA who describe just the kinds of struggles women often face when balancing their romantic relationships with dealing with this chronic medical issue.  Of course your personal mindset, wealth of information about your illness and ability to communicate are probably the biggest factors affecting your ability to develop and maintain a long term relationship.

We touch on the importance of being flexible as a couple, about everything from when and how you have sex, to getting other needs met such as feeling supported, avoiding caregiver burn out and negotiating childcare.

Because RA affects the way your body feels and looks, it may particularly impact both partners feeling about sex. Sex is a hugely important and valued part of any marriage and many long term romantic relationships. It is not something you should or need to give up, in fact with a chronic illness I could argue you need that kind of loving intimate contact even more. But what defines sex is really that there is intimate pleasure shared between the two of you. This can be through touching, oral contact or genital contact. Too often couples feel the need to adhere to a very rigid definition of “sex life” and both partners loose out. Talking about what works and how to optimize it is not only important, it’s a form of foreplay, of warming up and feeling understood which is very sexy on its own.

To see more information about dating, relationships and sex with RA as well as other episodes covering nutrition, fashion and medical care go to www.newwayra.com.

Hypochondriasis is a person’s inaccurate interpretation of real physical sensations that have no actual medical cause. The preoccupation with having a serious disease causes a lot of distress and compromises a person’s ability to function in important areas of their life. About five percent of people have this condition. It affects men and women equally and it most often develops in a person’s 20s. It often comes along with depression and/or anxiety. Despite tests a doctor may give demonstrating that the person is well physically, she or he is convinced otherwise. Over time, the person may become convinced she has developed a new disease.

There are several theories as to the cause of hypochondriasis:

1. A lower pain threshold which leads to a misinterpretation of any normal pain experienced.
2. A wish to be sick so as to escape insurmountable stresses and be excused from difficult responsibilities.
3. A defense against feelings of guilt and a belief of being a bad person. The pain becomes a “deserved” punishment for past real or imagined wrongdoings.
4. A variation on symptoms of depression or anxiety.

Hypochondriasis often arises after a traumatic event like the death or serious illness of a loved one. This usually goes away with time. Children can also experience hypochondriasis; it usually goes away during the late teenage years.

Most hypochondriacs do not want to understand the psychological reason for their problem because they firmly believe the cause is physical, not psychological. A regular check up is helpful. This assures the patient that she is fine physically and gives her attention from the doctor which hypochondriacs often seek.

On the other hand, doing unnecessary tests or procedures is not a good idea and will only increase the concern that something is wrong. Attention to stress in the person’s life and identifying any relationship problems with loved ones can be helpful — these are often the underlying source of the problem. However positive reinforcement to the person for playing the “sick role” is a very bad idea — it will only lock in the belief that they really do have an illness.

Group therapy is often helpful. Feedback from others going through the same thing provides a social support that reduces anxiety and tends to make the person less afraid of illness.

While it’s tough to live with a hypochondriac, it isn’t helpful to ignore them or tell them they don’t feel anything, because they do. The pain they feel is real. Reacting to their stress without buying into the illness is the best road to take. And, of course, encourage them to seek psychological treatment.

Have you or someone you know ever had hypochondriasis? What has been your experience with this? Share your thoughts below.

While we may not all agree on a person’s right to choose an abortion, we certainly can all agree that teenage pregnancy needs to be addressed and reduced. In addition, I am sure we would all agree that HIV and other STD’s need to be addressed and reduced.

Telling teens not to have sex sounds good and I think parents should do that, but given the realities (not every teen will listen; not every teen will hold firm in the heat of the moment) we also need to tell them the real risks they face if they do have sex.

How can you talk about HIV, STD’s, pregnancy, raising a baby and the consequences if you are not allowed to do any sexual education? As a nation, we can promote abstinence and teach sex education so that our teens are best equipped to deal with the consequences and risks involved with sexual activity. In my experience it is not enough to tell a teen “No”, you have to tell them “why not”. Knowledge is power and we need to make all our adolescents more powerful in this 2008 world of access to alcohol, drugs, internet use and growing up too soon with too much pressure.

We all want the best for our kids but our division about how to help them has gotten in our way. More public examples of kids having kids will not solve the issue. Parents need to take an active role in making sure their children have all the information they need. Parents also need to help their children understand the specific values of their own family, so that the children know what can be replied upon as begin the treacherous journey of growing up.

The issue of attraction to one’s partner is very complicated and rarely is it simply a reaction only to weight gain. Spouses not making the effort to lose weight may be doing so because they are already unhappy in the relationship, they are avoiding sex and intimacy, they are depressed for other reasons or they really have no idea how their mate feels because it has not been discussed. A partner can make a huge difference in one’s ability to lose weight, as well as getting in the way of dieting. That does not mean it is the partner’s fault if the mate doesn’t lose weight, but it does mean the partner can act as an ally and help the situation, or they can be a saboteur and block dieting. Bringing junk food into the house, encouraging indulgence, eating high calorie foods in front of your partner and being inactive together are methods of inhibiting weight loss for your partner.

I got a huge amount of email from readers on this topic with responses ranging from:

• Marriage is for better or worse and it is unacceptable to leave a partner due to lack of attraction or sex.
• Beauty comes from within and it shouldn’t matter what you weigh.
• Men are visual creatures and can’t be expected to be attracted to an obese woman; he should leave her.
• If you care about your partner and yourself you should lose the weight.

The responses ranged from one end of the spectrum all the way to the other BUT the anger for almost all responses was quite palpable. Both “sides” were actually quite enraged, at each other for their opinion, and at me for not voicing their opinion. The problem was that you readers are not able to see my email and therefore you don’t know about the other side of the argument.

So, I am posting this today because it seems to me this is both a common and heated problem and perhaps it would be helpful for each of you to talk about and hear the other side.

Post your comments here and try to be constructive, because it is helping your mate to understand how each side feels that creates empathy. It is empathy that allows one to feel understood and allows one to make real headway in communicating. It is real communication that makes change possible.

But the diagnosis in children has liberated some adults to go back to find out if what they thought was simply being a difficult person was really ADD.

Symptoms may look similar to your child’s symptoms, or be very different.

Overall, the problem is the sensation that thoughts are hard to hold onto, that you are often distracted by new thoughts before you got to complete the last one.

• There is both a distractibility that makes it hard to follow a sequential line of thinking or task completion, and also possibly a hyper-focusing on something that especially catches your eye, to the exclusion of anything else.
• Feeling a rush to impulsively act on whatever comes to mind (in combination with a low tolerance for frustration) means you are a person who may say or do things that don’t seem terribly appropriate at the moment.
• Overall organization is difficult and so nothing gets completed, just lots of bits and pieces.
• A mental and physical restlessness pervades, making it hard to relax without feeling anxious or tied down.

On the flipside many adults with ADD are highly intelligent and creative people, many are high-achievers. They can feel exciting, zesty and spirited in all kinds of great ways. There are a number of treatments available. Most are aimed at coping skills to contend with the weaknesses created by ADD, while boosting the individual’s strengths. Sometimes medication is helpful, but often it is not needed, or needed for only a short while. See an experienced psychiatrist who has lots of expertise in treating adults with ADD.

For more information on ADD or ADHD go to www.DRHallowell.com

On the other hand, social perfectionism (the belief that others will only value you if you are perfect) leads to extremes of feeling depressed, anxious and even potentially suicidal. This kind of perfectionism about oneself can also lead to eating disorders like anorexia. Girls feel that they have to be perfect and their attempt to do this can lead to starving themselves in order to control their bodies. Perfectionism leaves one vulnerable to real difficulty when things do go wrong in life, as is bound to eventually happen. A perfectionist can’t accept anything going wrong and feels utterly helpless and overwhelmed if it does.

Perfectionism about others tends to wreak havoc in relationships. Demanding perfection from your spouse, children, friends, and co-workers will inevitably end up in criticism, disappointment, and arguments.

The perfectionist tends to say to themselves things like “I have to be perfect or something bad will happen, or no one will love me,” or “I have to keep control of myself and others.” These are examples of the unconscious “stories” they have created and live by. Since it is really not possible to accomplish these things, they are vulnerable to feeling they have failed all the time.

What can you do if you think your perfectionism is getting in the way of feeling good about yourself and being productive in your life?

1. Figure out what areas of life you are striving to be a perfectionist in. Is it work that is the problem, relationships, yourself or body? This will help you focus on the arena of your life that you wish to make the effort to be more flexible and relaxed in.

2. Look for the roots of it. Underneath the need to be perfect is often the need to be accepted and loved and the fear that you won’t be. When you were growing up, did you feel you were loveable enough; were you worried about rejection? Review the time in your life when you first remember needing to be in control and be perfect.

3. Make a conscious decision. Make the choice to let some things go that you really know are not done to top standards. It will be hard and you may feel nervous about it, but once you do it repeatedly, it will help you see that the world does not end and people still value you even when you are not perfect.

4. Consider therapy. It’s great to make efforts on your own, but sometimes you need an objective. A trained therapist can help you see the extent of the problem and help you change it.

Similarly, we all have an emotionally charged meaning to the way we view our bodies. How we view ourselves if we are overweight, underweight, like what we see, or get attention from others because of our bodies:  Body as lovable, sexual, vulnerable, strong. Combined, these make eating and dieting have a huge emotional component driving all the behaviors.

The typical emotional stories driving difficulties with losing weight are:

1. Food as comfort.
Almost everyone deals with feelings of sadness, anxiety, loneliness, and frustration at times. When a negative feeling is more intense than one can comfortably tolerate, then one will look for a way to make themselves feel better. Food is one of the most common “rescues” to bad moods.

Psychologically, it feels like being nurtured in the way mom gave you food as part of taking care of you and making you feel better. This is why common choices may be those “foods of childhood” like mac-n-cheese, chips, and cookies. Food also provides a more direct positive behavioral feedback by stimulating areas in the brain responsible for satiation.

Solutions to this roadblock to dieting are identifying which negative affect/feeling you struggle with, what tends to set it off, and thinking of several other coping mechanisms that you find soothing, such as writing in a journal, listening to music, taking a warm bath (using other “sensory” stimulators as comfort and distraction).

2. Food as punishment.
When someone is struggling with low self esteem or with guilt, they may use overeating and staying overweight as a means of self punishment. An extreme version of this is binging: When you know full well that eating an entire package of Mallomars will be followed by feeling sick, gaining weight and feeling very badly about it, but you continue to do it anyway, think guilt.

People can feel guilt for all sorts of seemingly nonsensical reasons. You may not even be aware that it is guilt, but rather have a sense of being an undeserving person, or a bad person. Some people experience thoughts like “Why bother,” “There is no use,” “I will never look good.”

The key here is to figure out that you fit here, that there is something unconscious that is making you feel guilty, like a person deserving of punishment. Even if you intellectually know you didn’t really do anything terrible, allow yourself to think of the strange ways you may think you are wrong or have done wrong. Then think this over to see if you can change them once you compare them to reality.

3. Fear of success.
This is much bigger than many women realize. If you have lost weight many times and then get increasingly and oddly uncomfortable as the weight comes off, so it somehow magically comes back on, this could be you.

Many women are quietly afraid of getting attention or of having men become interested in them. They are frightened by their own sexual and intimate desires and have dealt with that by staying so heavy they kept others away and don’t have to deal with it: Once the pounds come off, the fear of how to handle a man’s desire, her own desire, and getting into the game with fears of rejection, too. (“What if he rejects me and I can’t say it’s because I am fat.”)

Sometimes a woman in this boat can really benefit from professional help to understand why she is so afraid of sexuality, her own, and/or a man’s. It can relate to a past experience, relationship, or simply the meaning of sexuality has gotten corrupted early in life. Understanding the root of this is key to moving past this roadblock.

What have your experiences with emotional eating been like?

People who have had abandonment and betrayal in their lives can be overwhelmed by jealousy, as can children who felt left by a parents’ divorce or parents who were otherwise emotionally unavailable. If you witnessed parents’ infidelity in your childhood, you may feel afraid that your partner will cheat too, even if they give you no cause to feel this way. If deep down you feel you are not really a desirable person or partner, then you may always think, “I’ve got to hold onto them and keep control or they will leave me.”

There are two jealousy scenarios that will erode and eventually destroy a marriage. One is when you feel constantly jealous of your partner and the other is when they are always jealous towards you.

Trying to control who your husband sees and talks to is not only impossible, it is smothering. Sadly, many women live in fear of his straying and even feel threatened when he spends time with his guy friends. Some women also feel jealous of his work because it is another place he attends to rather than her. What drives this insatiable jealousy? Insecurity! It is the woman’s belief if he is not thinking of her every moment, than he doesn’t love her as much as she loves him. She feels vulnerable and afraid of being hurt or abandoned.

The other jealousy scenario is women struggling with the intensely jealous husband who tries to control her every move. This lack of trust and need to constantly prove your love and their centrality to you can be exhausting and eventually produces the opposite effect. Eventually she wants nothing more then to get away from him and be free, which makes him even more controlling. It’s a vicious cycle and often ends the marriage. Sometimes a partner who constantly accuses the other of cheating will actually drive them to an affair — if they are going to do the time, they figure they might as well do the crime.

There are two different views about the both the origins of jealousy and the differences between men and women experiencing jealousy. One school of thought is that jealousy is an adaptive evolutionary mechanism. Researchers in this camp have found that men tend to be more jealous about sexual infidelity whereas women are more disturbed by emotional infidelity. Their reasoning is that men needed to know that their work done to feed and protect their mate was actually propagating their genes, and not some other man’s. Women, on the other hand, needed to hold onto a man’s emotional love in order to be fed, protected and sheltered. Another group of researchers found that there was more of a difference between different cultures among men and women than between men and women. This group found both men and women to be most jealous over sexual infidelity and they think that jealousy is far more influenced by a person’s societal and family experiences and that evolution does not dictate jealous feelings. Wherever jealousy originates, there is no question that it can be both adaptive (by alerting one to the risk of their partner straying and causing them to work at deterring that behavior) and destructive (by inducing angry, attacking behavior that may drive your partner away). It’s all a matter of how jealous you are.

Getting control of your jealousy does not mean exerting more control over your partner; it means getting a handle on yourself. Here are four places to start.

1. Uncover where it came from. Where was your jealousy born? Did your dad leave after a divorce or was your older sibling the clear favorite of your mother? Did your last spouse cheat on you? Figure out the situation that led you to feel so insecure about any partner.

2. Look at your self confidence. If you don’t love yourself, how can you really believe anyone else would? Ask why you don’t like yourself and think about how to make changes or see yourself more accurately and positively.

3. Stop enabling. If it’s your partner who is jealous, don’t allow the control they exert. When you operate under their strict control, you feel angry and resentful and act that out in ways that makes them even more insecure. Tell them calmly and nicely (not during a fight) that you love them, but it is they that have the problem and you are not going to operate under lock and key.

4. Set fair ground rules. Everyone needs friends and interests outside their relationship. Discuss this openly and honestly with your partner and make some compromises about how much time you will spend with them. Do not sneak around to get your time with friends, this will only make your partner more suspicious and jealous. The more open and up front you can be, the better.

Where does it come from — your feelings of how you love another or what makes you feel loved?

Much of it is molded by your first love — mom and dad. How you felt loved by them and how you saw them love each other often sets the stage for what you seek out in a love relationship — for better or worse. If your parent was aloof and distant, you may seek the same, but then feel constantly tortured by the endless struggle to get more attention. If your parent was smothering and controlling, you may not feel loved unless your partner is practically up your nose 24/7. The model of your parents’ relationship may also set the stage for how you consider a relationship should function. If they fought a lot, you may provoke fights in order to feel “loved.”

This need to repeat the past (called repetition compulsion) can hold you in its grip unless you take a look back at what shaped you and why. Once you have that knowledge then you can do it differently. Feeling loved is a state of mind and it has a lot to do with early feelings of bonding. Staying in a loving relationship has to do with more than feeling swept up in love — it has to do with choosing to make love work.

Do you love but want out because you are not in love? I hear this quite often, and let me tell you that the new feelings of “in love” have a lot to do with newness and lust. Your relationship will naturally become old if you stay together, and lust often fades and turns to a more mature but still satisfying sexual attraction. “In love” often means that you have this new person idealized — they can do no wrong, they seem perfect and you can’t get enough. But that is both the newness — you not having time to see their faults (which everyone has) — and the nuerochemical dopamine being released and keeping you doped up for a while. The only way to keep feeling this way all the time is to keep getting new partners. If you want to stay in a marriage, then loving but not “in love” is no reason to break up. And it is not a reasonable expectation. All love relationships have ups and downs. Loving is a decision to commit, to compromise, to give to the other, to care about their needs, sometimes to sacrifice and to enjoy them for who they are.

In addition, men and women seem to have different definitions of fun. Men define play by a shared activity, like going to a game or playing tennis together. Women define play by getting to have intimate conversation like they would with a close friend. This means that each needs to know what fun is to the other and make some attempt to meld those two wishes.

Watching TV or being on the computer do not qualify as having fun together: They are really solitary experiences. Fun is best achieved through doing something new and even somewhat exciting! This builds great memories and a history together of good times. So try something you haven’t done before with your mate, stretch yourself and make it alittle exciting, too (rock climbing anyone?)  When time is short try cooking together while talking or going to the coffee shop for a quick cup.

Any other ideas for couples looking to have a little fun?  Do you and your partner take time to have fun together? Please leave a comment with your thoughts.