Dating, relationships and sex with RA

May 26, 2011

Dating, having a relationship that is functional and having a healthy sex life are hard. They are hard enough without the added stresses of contending with a chronic illness, such as rheumatoid arthritis. I see many individuals and couples trying to navigate the tricky road of intimacy, including the road created by an autoimmune disease that strikes young vibrant adults making them feel tired, have inflamed and painful joints and worry about what the future will bring.

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 ( 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



February 19, 2010

The term hypochondriasis is derived from the old medical term hypochondrium which means “below the ribs” because most people with this condition have abdominal complaints. When we think of a hypochondriac we tend to think of Woody Allen and characters he’s played that are constantly in fear of having some terrible medical illness which, of course, never really exists.

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:

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Sex Education and Teen Pregnancy

February 8, 2010

As a psychiatrist who has written on the topic of sex education, it is hard to understand the continued push by politicians for abstinence-only education. Multiple studies done over the last several years have shown no decrease in sexual activity amongst teens that have gone through abstinence-only education.

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Weight Gain and Marriage

January 31, 2010

I hear often from both men and women who say that they have abandoned their sex lives as a result of the loss of attraction to a mate who has gained significant amounts of weight. Weight gain can, in certain instances, be a result of a medical problem, but more often than not it is an emotional or psychological issue that keeps a person unable to either diet or exercise enough to keep weight off.

The issue of attraction to one’s partner is very complicated and rarely is it simply a reaction only to weight gain. Read the rest of this entry »

Attention Deficit Disorder In Adults

January 24, 2010

Attention Deficit Disorder is a collection of symptoms usually thought about in terms of children who are struggling in school, children who seem impulsive, easily distracted and fidgety. Increasingly, children are getting a diagnosis, and then one of their parents becomes shocked to realize that their child’s symptoms are the same as his or her own from childhood. Instead of being diagnosed with ADD and benefiting from treatment, this earlier generation was told they were difficult kids, losers, dumb or simply bad. Sadly, many of them/you grew up believing that all of that was true, and it shattered your self-esteem and became a self-fulfilling prophecy as you struggled with underachieving at work and having difficulty in relationships.

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.

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Are You a Perfectionist?

January 17, 2010

We are currently a society very focused on high achievement. Many people feel driven to do more than do a “good” job, it has to be perfect. In fact, they feel THEY and the people in their lives have to be perfect. Perfectionism that has only to do with having high personal standards for yourself combined with having good coping skills (the ability to approach and complete the task) can really be very adaptive. Some of the most high achieving professionals and athletes are perfectionists.

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?

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Emotional Eating

January 10, 2010

Behind every eater is an emotional human being. We are programmed to want food and to be satisfied by food. Food is also central to our upbringing, and therefore represents different things to each individual depending on the way their parents dealt with eating and particular foods: Food as love, food as reward, food as punishment.

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:

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