People-pleasing and Chronic Illness: The Hidden Cost of a Familiar Trap

Every time a new client sits across from me in therapy, I ask them to name their weaknesses. And I swear to God, 9 out of 10 of them give me the exact same answer: 'I'm a people pleaser. Like, to my own detriment.' They cannot draw a boundary between being helpful and being overrun.

Living with chronic illness or disability means that you’re most often running on limited energy, or fewer spoons, but when you add in the pressure of people pleasing, it’s like never giving yourself a chance to recharge. I know what its like. When I’m having a particularly bad flare up and my pain is high, the stubborn old biddy inside my wants to just power through to avoid disappointing someone else, but it never helps the situation. Your chronic illness doesn’t care how accommodating you want to be, and the need to people please might be making your health worse.

Let’s talk a bit more about why this happens, what it’s really costing you and most importantly, how you can break free of the people-pleasing trap once and for all..

The Unique Connection Between Chronic Illness and People Pleasing

People pleasing and living with a chronic illness are so often intertwined because of the unique experiences that a chronically ill or disabled person goes through.

Most people experience years of medical gaslighting whilst awaiting diagnosis (or let's be honest, also post-diagnosis) and this creates the perfect breeding ground for people pleasing. You have years of not being believed, being seen as 'difficult' by stuffy doctors, so you learn to adapt. You know to withhold how much medical information you have so that you don't piss off the doctor who thinks they're better than you because they have a medical degree. You learn to be polite and overly grateful to healthcare staff so that you can be seen to be cooperative and not just 'looking for more pain meds'. You carefully consider how you dress before appointments, so that you look acceptable, but still sick because woe betide you look too well and therefore you must be lying about how unwell you feel.

As a chronically ill person who lives in an ableist society, you are given messages every day that you are not enough, and so you adapt how you behave to please society, to make them less uncomfortable. This shows up in things like the lack of lifts, so you 'just push through' the pain to climb the stairs. The lack of access to accessible toilets, so you buy something you don't want to be able to use a customer toilet. The lack of food available at the work do for people with restrictive dietary requirements, so you just eat it knowing you'll pay for it later. These seemingly 'small' things are constant unconscious reminders that you must bend to fit in with society; they are not going to move to accommodate you, and so you must be a 'good' person and fall into that people-pleasing trap repeatedly.

Then there's also the factor of living with limited energy and how that creates more pressure to use it "well". This pressure is often then geared toward using it "worthily" for others, rather than for yourself. You think "oh I've been in bed for the last few days, so now I'm feeling a bit better, I'd better take Mum out shopping to make up for ignoring her all week", then you spend the day on your feet and the flare that was nearly gone is suddenly right back up to 95% again.

Signs You're People Pleasing Despite Your Limited Energy

Let me paint you a picture of what people pleasing with chronic illness actually looks like, and I bet you'll spot yourself in here somewhere.

First up, you're pushing through symptoms to meet others' expectations even when your body is screaming at you to stop. Like where you promised your friend you'd make it to their birthday drinks, so you take extra painkillers and cancel all plans for the next day (because you know you'll be wrecked), and spend the entire night calculating how soon you can leave without seeming rude. Meanwhile, the pain is at an 8, but you've got your "I'm totally fine" face plastered on.

Then there's the over-explaining marathon. "Sorry I can't make it, I've got a flare, but I was at the doctor yesterday and they've changed my meds, and I tried to rest but my neighbour's dog was barking, and I really wanted to come but..." People without chronic illness just say "Can't make it, sorry!" But we feel this constant pressure to justify why our boundaries exist, as if illness alone isn't a valid enough reason.

Another big sign is when you're fully prioritising others' comfort over your own literal health needs. Like when you sit in that restaurant chair that's absolute agony for your back because you don't want to make a fuss asking for a different one. Or when you stay in environments with triggers (like your old neighbour next door at your mum’s house party who has drowned herself in perfume) because you don't want to seem "difficult."

And let's not forget the guilt Olympics you're competing in every time you need to rest. You're lying there, body forcing you to stop, and instead of just resting, your brain is running through all the people you're "letting down" by being unwell.

Sound familiar? The trouble is, these behaviours are actively making your health worse.

The Real Cost of People Pleasing When You're Chronically Ill

So what’s this people pleasing habit is actually costing you? Because it's a lot more than just a few uncomfortable social situations.

First up, there's the physical toll. Every time you push past your body's limits to please someone else, you're not just dealing with the immediate pain, you're potentially triggering a proper flare. That "quick" coffee catch-up that you dragged yourself to despite feeling shit or the meeting you sat through in agony? That might cost you three days in bed recovering.

Then there's the emotional shitstorm that comes with constant people pleasing. The resentment that builds when you realise no one is bending over backwards for you the way you do for them. The anxiety that bubbles up every time your phone pings with an invitation, because now you have to choose between your health and disappointing someone. The anger at yourself for agreeing to something you knew your body couldn't handle.

Your relationship with yourself takes a massive hit too. Every time you prioritise someone else's feelings over your health needs, you're sending yourself the message that you don't matter as much. That your pain isn't valid enough to inconvenience others. That your worth is tied to what you can do for people, not who you are. It's like you're gaslighting yourself, reinforcing that inner critic that says you're "lazy" or "not enough" if you actually listen to what your body needs.

The worst part is, all this people pleasing rarely even gets you what you want. You think you're securing people's love or approval by saying yes to everything, but in reality, you're setting up relationships with an exhausting imbalance. You're training people to expect you to be available regardless of your health, and when you inevitably crash (because nobody can keep that up forever), they're shocked because you've never shown them your real limits.

What's worse is that this cycle feeds itself. The more you ignore your body's needs to please others, the worse your symptoms get. The worse your symptoms get, the more you feel like you need to compensate by being extra accommodating.

I know none of this is easy to accept. But recognising this pattern is the first step to breaking it. Your health and well-being deserve to be prioritised, and I promise there are ways to set boundaries without your world falling apart.

Breaking the People-Pleasing Cycle

So how do you actually make change? It's not like you can just start saying no to everyone overnight (though honestly, the world wouldn't end if you did!).

Firstly, you need to recognise that your worth isn't tied to what you can do for others.(Easier said than done, I know) .Your value as a person doesn't decrease when your symptoms increase. You deserve care and respect simply because you exist, not because you've earned it by pushing through pain to help someone move house.

Next, let's talk practical boundary-setting. Start small (you don't need to change your entire personality in one go). You could try some of these phrases:

"I'd love to, but I really need to rest today."

"I can’t do that, but I could [smaller alternative] instead."

"I need to leave by [time] or I’ll pay for it tomorrow."

 "I can do that, but I'll need [specific accommodation]."

Notice there's no "sorry" in any of these. You don't need to apologise for having a body with limitations. And you definitely don't need to share your medical history as justification.

Now, the guilt. Oh, the guilt. It's going to show up like spots on your school photo day to start. When it does, try to observe it rather than immediately react to it. Ask yourself: "Is this guilt actually helpful? Is it protecting me from something real, or is it just a habit?" Most of the time, it's just the discomfort of change.

Building a support system that actually respects your boundaries is crucial. This might mean having some uncomfortable conversations with the people already in your life, or it might mean seeking out new connections who get it. Chronic illness communities (online or in person) can be lifesavers, there's nothing quite like talking to someone who doesn't need you to explain why you cancelled last minute.

And as you can guess what I’ll say here, therapy can be a game changer for breaking these patterns. So many of my clients have spent years people pleasing as a survival strategy and unpacking that takes time and support. The medical trauma, the internalised ableism, the fear of abandonment if you're not "useful enough", these are deep issues that deserve proper attention.

Remember that this is a process, not an overnight transformation. You'll have days where you nail it and days where you fall back into old patterns. That's normal. Progress isn't linear, especially when you're dealing with a body that isn't predictable either. But each time you choose yourself, each time you respect your needs instead of pushing them aside, you're rewiring those old patterns. You're teaching people how to treat you, and more importantly, you're teaching yourself that you matter.

The real freedom comes when you realise that most people care far less about your choices than you think they do. And the ones who truly matter? They want you to take care of yourself. They'd rather have you present and well for fewer hours than burnt out and suffering just to please them.

As always, I’m here rooting for you and if you need any support, just give me a shout.

Kirsty x