Why Boundaries Matter When You Live with Chronic Pain
When you live with chronic pain, boundaries protect more than just your time — they protect your energy, emotions, and dignity.
But boundaries can be especially hard when you’re dealing with people who don’t listen, guilt-trip, or make you doubt yourself.
As Dr Ramani Durvasula reminds us, some personalities thrive on control and conflict. She calls them “high-conflict” or “narcissistic” types — people who make everything about themselves and often push against your limits.
Understanding Narcissistic Dynamics
Dr Ramani describes narcissistic behaviour as a predictable pattern of:
Lack of empathy: they minimise or dismiss your pain.
Entitlement: they believe their needs matter more.
Control and manipulation: guilt-tripping, blaming, or twisting your words.
Fragile self-esteem: any boundary feels like a personal attack.
These dynamics make setting boundaries especially difficult — but not impossible.
Dr Ramani’s Core Principles for Boundaries
Principle, What It Means, How It Helps When You’re Living with Pain
1. It’s Not You
Their reaction to your boundary is not your responsibility.
You can stop blaming yourself when someone becomes angry, sulks, or withdraws.
2. Internal Boundaries First
Boundaries start with knowing your own limits and giving yourself permission to keep them.
Clarify what costs you too much energy or increases your pain — and protect those limits.
3. Be Clear and Brief
Avoid long explanations, defending, or debating.
Say what you need, kindly and firmly: “I can’t do that today.”
4. Stay Calm and Consistent
Narcissistic people feed off emotional reactions. Calm repetition communicates strength.
Practice neutral, steady responses to avoid escalation.
5. Expect Pushback
They may guilt-trip, dismiss, or test your boundaries. Expect it. Prepare for it. Don’t take the bait.
Anticipation keeps you grounded and less reactive.
6. Protect Your Peace, Not the Relationship
Your goal is to protect your wellbeing, not to get them to understand or approve.
Boundaries are self-care, not punishment.
7. Distance Is Sometimes the Healthiest Boundary
If someone continues to cross your limits, limit contact.
Chronic pain flares with chronic stress — protect your nervous system.
Practical Tools and Scripts
When stating a boundary:
Keep it simple and clear.
Avoid over explaining.
Repeat your statement if needed.
Examples:
“I can’t attend today — I need to rest.”
“That comment feels invalidating; I’d prefer we change the topic.”
“I’m not discussing my health decisions.”
“You may not agree, but this is what’s right for me.”
When faced with guilt-tripping or manipulation:
“I understand you’re disappointed.” (pause — no justification)
“That’s your opinion.”
“We’ll have to agree to disagree.”
“I’m ending this conversation for now.”
Pushback Is a Pattern, Not Proof You’re Wrong
Dr Ramani teaches that pushback is predictable — it’s part of the pattern.
Expect testing, blame, or withdrawal.
That doesn’t mean your boundary was wrong; it means it’s working.
Boundaries are not walls — they’re fences with gates that you control.
They allow love and support in, while keeping chaos and pain out.
When you live with chronic pain, protecting your peace is not selfish — it’s survival.
By Dr Michelle Beukes-King
