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How to Create and Keep Boundaries When You Have a Chronic Illness

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Photo courtesy Natalie Kelley/Design by Alexis Lira

Photo courtesy Natalie Kelley/Design by Alexis Lira

by Natalie Kelley

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Medically Reviewed by:

Tiffany Taft, PsyD

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by Natalie Kelley

•••••

Medically Reviewed by:

Tiffany Taft, PsyD

•••••

•••••

Knowing your own values and self-worth can help you stop putting other people’s needs first.

Welcome to Mindset Matters — a space to learn about the mental and emotional aspects of living with chronic illness. Mindset Matters is led by Nat Kelley, a certified life and mindset coach and founder of Plenty and Well. For Nat, mindset work was the missing puzzle piece in her journey navigating ulcerative colitis, and she’s passionate about helping empower others in their journeys.

Boundary setting: something we know is necessary but feels so. dang. hard. to actually put into place, especially when you’re living with a chronic illness. Why is that?

For me personally, boundaries became harder once I was diagnosed with ulcerative colitis because I saw my illness as something I had to constantly “make up for.” It was as if I was always walking on thin ice around the people in my life, waiting for my illness to annoy them, trigger them, or make their lives feel harder.

Because of this, I didn’t feel like I was worthy of having boundaries. My chronic illness was already such an inconvenience to everyone in my life. How could I possibly set boundaries and expect any of them to be honored?

I had already experienced having people leave when things got hard with my illness and when they wouldn’t respect my boundaries, so I felt like that would always be the outcome. What I wasn’t remembering was that if my illness — and the boundaries I have that go along with it — push people in my life away, that is a reflection on them and not on me.

It shows me that they weren’t meant to be in my life in the first place.

My illness and boundaries aren’t too much. Some people just may not have had the emotional capacity or maturity needed to be active participants in my journey, and that’s OK.

But as I said earlier, boundaries are necessary — for both our physical AND mental health.

Without boundaries, we tend to push our bodies too far, which can cause symptoms to flare. A lack of boundaries can lead to us staying out too late, eating foods we know make us feel sick, staying involved in hurtful conversations, or taking on more work than we’re physically able to keep up with.

With boundaries in place, we’re more capable of caring for our bodies and minds.

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Working on confidence

For me, the first step to successfully setting and keeping boundaries while living with chronic illness was addressing my confidence and feelings of self-worth.

When I was first diagnosed with ulcerative colitis, I lost a lot of my confidence due to feeling different than many of my peers. After many years I developed that confidence again by truly getting to know myself again.

Taking the time to explore my values, morals, passions, and desires — and truly learn about who I am at my core — helped boost my confidence tremendously because I finally had a deep sense of self. Therefore, others’ opinions of me or of the boundaries I needed to set couldn’t shake me as much because I held my own opinion of myself in such high regard.

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Ditching the people-pleasing

The second step to successfully setting and keeping my boundaries was ditching my people-pleasing tendencies.

I’ve always been a bit of a people-pleaser, but once I was diagnosed, I felt like my ulcerative colitis was such a burden that I had to work overtime to make sure everyone in my life was happy.

If someone needed me to run an errand for them, I’d say yes, even if I felt sick. If someone needed me to pick up some extra assignments at work, I’d say yes. If a friend asked if I had the time and energy to listen to them vent, I’d say yes, even if it wasn’t true. I felt like I had this thing that automatically made me a bad friend, employee, partner, etc., so I had to “pick up the slack” everywhere I could.

Having open conversations with the people in my life about my diagnosis and what that looks like for me was a big first step in ditching the people-pleasing because it became harder for me to hide when I was pushing myself too far.

Also, reminding myself that I still bring SO much to the table in friendships, relationships, and workplaces — even with a chronic illness, and even when it looks different than how other people show up in similar relationships and spaces — helped me finally see my own worth as a friend, partner, etc.

Putting up boundaries became so much easier once I started shedding the people-pleasing tendencies because I could prioritize my own needs over the needs of others.

Be OK with the consequences

The third thing that helped me so much with confidently setting boundaries was first making sure I would be 100% OK with the consequences.

For example, you may set a boundary with a friend by saying, “I don’t feel comfortable with you bringing up weight and diet culture topics when we hang out since I’ve struggled with my weight so much since my diagnosis. If you don’t think you can cut back on those discussions, I think we need to spend less time together.”

The consequence here is that you may not see this friend as often. As hopeful as you might be that your friend would respect your wishes and cut back on weight and diet-related talk, they may not be willing or able to do that.

So, before setting a boundary, make sure you will be able to handle any possible outcome so that you don’t go back on your own boundary and inadvertently teach that person that it’s OK not to respect you and your needs.

In fact, many boundaries we need to set could result in people in our lives walking away or becoming distant. As someone with abandonment issues and an anxious attachment style, I have a big fear of people leaving my life. This has often held me back from putting up necessary boundaries.

Once I worked through this and realized that I didn’t want people to stay in my life if they weren’t going to respect my needs and boundaries, I could start setting boundaries with much more ease.

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Setting internal boundaries

You may even have some internal boundaries with yourself — and those are just as important.

For example, if you want to set a boundary to help you have a better work-life balance, you could tell yourself that your laptop has to be closed by 5:30 p.m. each evening. Actually sticking to this can feel so hard, though, which is why I like using the habit loop to help.

The habit loop is a cycle of cue-habit-reward. In the example above, your previous habit loop may have looked like:

Cue: Close your laptop at 5:30 p.m. and eat dinner.
Habit: Reach for your laptop to do more work until 8 p.m.
Reward: Feel extra productive (despite a feeling of burnout as well).

The new loop may look the same at first, but you interrupt it by linking a new habit to the cue and enjoying a better reward.

Cue: Close your laptop at 5:30 p.m. and eat dinner.
Habit: Keep your laptop shut and engage in a self-care activity like reading a book, watching TV, or making a fun after-dinner mocktail.
Reward: More time to actually relax, helping you sleep better and feel better physically.

Over time, your brain will start associating the new habit of reaching for self-care instead of work with feeling better physically and mentally. You can also create a longer term reward to motivate yourself even further, like buying yourself a new set of cozy PJs or a new book once you stop working at 5:30 p.m. for a week straight.

The takeaway

As you can see, setting and keeping boundaries takes work, but it’s so worth it in the end once you push past the discomfort of doing it. Boundaries will allow you to take control of not only your health — but also your life.

Medically reviewed on June 29, 2023


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About the author

Natalie Kelley

Natalie Kelley, the founder of Plenty and Well, is a chronic illness mindset and lifestyle coach, and the host of the “Plenty and Well Podcast.” After years of symptoms, she received a diagnosis of ulcerative colitis in 2017 at age 21. She then changed paths to discuss life with a chronic illness and provide support for others. After a life-altering flare-up, Natalie realized her purpose ran deeper, and she obtained her holistic health coaching certification. She offers personal coaching to women with chronic illnesses. Her group program, The Path to Empowered Acceptance, helps individuals find acceptance, confidence, and joy on their health journeys.

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