6 Ways Living With Crohn’s May Impact Your Mental Health – Some people with Crohn’s disease develop food-related anxieties, and because eating and pain often go hand in hand, they wind up restricting how much they eat or skipping meals to avoid getting sick.3 “These fears become problematic when people begin to have very restrictive diets, avoid meals for fear of symptoms, or constantly worry about how a food will potentially impact them,” Megan Riehl, PsyD, a psychologist specializing in gastroenterology and the clinical program director of the GI Behavioral Health Program at the University of Michigan, tells SELF.

You can alleviate some of this stress by learning about how different ingredients impact your symptoms, reading food labels, and studying menus before going out to eat. These adjustments are often hard work and can be a lifelong process—which is why Dr. Riehl recommends working with a dietitian who specializes in GI conditions like Crohn’s. They can help you identify foods that can trigger symptoms and share meal ideas to make the whole meal-planning process feel a little less overwhelming.

Coping with body image issues

Crohn’s—and the medications prescribed for it—can cause uncomfortable bloating, rapid weight loss, and acne, which, in turn, can affect your self-esteem and self-confidence, Dr. Sileo says. “When you’ve lost 20 pounds and you don’t resemble yourself, it can really take a toll on how you feel about yourself,” he says.

It’s easy, given the uncertainty of Crohn’s, to hyperfocus on something you may feel like you can control, like your appearance, Dr. Keefer says. You might criticize your body for suddenly looking so different or avoid social plans because you think you don’t look “good.”4 “Those are mean things we do to ourselves as a way to bring back control” when facing a condition that’s frequently uncontrollable, she says.

Try to reframe your POV when you look at yourself, Dr. Keefer recommends. For example, if you’re struggling with fatigue, instead of focusing on your eyes being bloodshot or puffy, take note of the shape and color of your eyes. Observing, not evaluating, your attributes, can drown out some of the harsher critiques you may tell yourself. “Just describe your body, don’t judge it,” Dr. Keefer says.

Figuring out how Crohn’s fits into your relationships

The symptoms of Crohn’s, like bowel incontinence, can cause people to feel unattractive or unhygienic, research shows,4 which may lead you to isolate or otherwise back away from close relationships. There’s also the added pressure of knowing whether you should keep some boundaries in place or be an open book about what it’s like to have Crohn’s.

Dr. Keefer says she’s treated many people who felt as though their relationships crumbled because they didn’t share, for example, that their fatigue prevented them from being able to go out or that their body image struggles soured their mood on a date. It can be uncomfortable to coach your SO on how to vouch for you if you end up in the ER and need treatment, or what to do if your symptoms strike during a sleepover. It can be equally tricky to figure out when to disclose you have Crohn’s and how the disease impacts your daily life. And then there’s the whole topic of dating—some people with Crohn’s use medical devices like a colostomy bag or J-pouch—so explaining and educating your partners about how these tools affect romantic relationships can feel embarrassing and uncomfortable.

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