Psoriatic Arthritis and Body Image

By: Beth Axtell

Do scaling skin, crumbly nails and joint pain make you feel as though your body has betrayed you inside and out? The visible signs of psoriatic disease may make you feel embarrassed or self-conscious. This can lead to a negative body image.

What exactly is body image? Naomi Finkelstein, director of programs and communications at The Body Positive, defines it is as, “the way you hold your body in your mind; the opinions and feelings about how your body looks and functions.” In people with psoriatic arthritis (PsA), studies show an altered body image can cause people to cover up, feel sexually inhibited, and limit physical activity.

Richard Fried, MD, PhD, dermatologist, psychologist and member of the Board of Directors of Association for Psychoneurocutaneous Medicine of North America (APMNA) says, “Anybody navigating life against visible reminders of skin disease, skin that itches and burns, painful joints and mobility problems is at great risk for self-image problems, anxiety, depression and reduced quality of life.”

Genital, or inverse, psoriasis involves smooth, dry, red patches on the skin that burn, itch and hurt more than other psoriasis types. It can lead to having less intercourse, avoiding sexual relationships, and feeling less sexual desire, according to a 2018 review published in Psoriasis.  

People with genital psoriasis often feel self-conscious and terrified of allowing anyone to see them naked, says Dr. Fried. “Rather than being a source of pleasure, their genitals can become counter to what they are ‘supposed’ to be in their minds.”

Fortunately, inverse psoriasis is responsive to treatment with biologic drugs and, because the skin on the genitals is thin, topical treatments work well on any remaining plaques.

First and foremost, says Dr. Fried, make sure you’re PsA is treated adequately. If you have significant plaques, nail changes, joint pain or mobility limitations, talk to your doctors. With aggressive treatment, clear skin and controlled disease are within reach.

Finkelstein advises using self-compassion to foster a kinder relationship with your body and self. Start with being aware of your self-talk. “Self-criticism can feel like it is simply the truth. But the criticism is often expressing an unmet need,” says Finkelstein. Often, that unmet need is acceptance.

“Nurture feelings of acceptance, and your critical voice will no longer need to tear you down,” she says.

A program called Expand Your Horizon helps people with chronic disease shift their focus from appearance to body function by writing in a journal every day. Jessica Alleva, PhD, and colleagues at Centre for Appearance Research at the University of the West of England developed and tested the program.

It hasn’t been tested yet in PsA, but the one-week writing activity produced up to month-long improvements in body image and depression in people with rheumatoid arthritis.

Try these exercises at home:

1. Each day, write one thing your body can do—and why it’s meaningful to you.
2. Name one thing you value about your body. 
3. Appreciate what your body is doing during the day. For example, if you’re relaxing outside, write “I appreciate that my body can smell this fresh-cut grass.” 
4. Try physical activities that help you value your body and ease your arthritis pain. Go for a walk or take a yoga class.