Type 1 Diabetes: Our Disease

Shared Illness Appraisal

“We’re pregnant!” your brother announces.

“We’re?” you chuckle under your breath, imagining your brother and his wife strolling hand in hand, both with very large baby bumps. “Umm . . . don’t you mean she?”

While credit does need to be given where credit is due, groundbreaking research shows that “we” language in couples can actually benefit relationships and health (Rentscher et al., 2017). In the world of chronic illness, it’s called “shared illness appraisal,” and in simple terms, means couples see one partner’s condition as “ours;” it’s not just “his/hers” or “mine.” This “ours mentality” naturally leads couples to pool resources and engage in “joint input, mutual effort, and a team approach” to coping with or solving the problem (Berg et al., 2008a, 2011).

The good news is that this also proves true for couples living with type 1 diabetes (T1D) (Helgeson et al., 2016; Helgeson et al., 2018).

T1D and Shared Illness Appraisal

In a recent study, Helgeson and colleagues took a closer look at how considering T1D as “our disease,” not just “his/her” or “my” disease impacts couples and health (2019).

In their extensive study of nearly 200 couples wherein one partner had T1D and one did not, researchers observed that when individuals with T1D viewed their illness as shared, they felt more supported in T1D management than those in relationships where T1D was just “mine.” And interestingly, this was the case whether or not their partners appraised the illness as shared. Why? It could be that when individuals with T1D see it as shared, partners’ behaviors feel supportive even if they aren’t. It’s kind of like looking through rose-colored glasses.

While individuals with T1D may feel supported regardless of partners’ illness appraisals, the research shows that it was not until both partners appraised T1D as shared that those with T1D showed significant health improvements, both physical and psychological. This included better A1c (average glucose across three months), less diabetes-related stress, higher relationship satisfaction, and increased feelings of support and collaboration.

Appraisals of the partner without the illness do matter.

Viewing T1D as shared leads partner behaviors to go from just seemingly supportive to actually supportive, making real differences in the health of the individuals with T1D.

In all, the research provides promising results for individuals with T1D when they can share some ownership of the disease with their partner, especially if their partners accept.

Developing Shared Illness Appraisal

Among many couples, individuals with T1D maintain complete ownership of their disease and partners tend to see it the same. (The “mine” mentality among those with T1D makes sense; most are diagnosed in childhood, long before romantic relationships start (Helgeson et al., 2019)). Some research has suggested that each couple has their own unique style of illness management, that ranges on a continuum of illness sharing (Yorgason et al., 2010). Although each couple may develop their own patterns around T1D, those with low concordance miss out on potential resources from partners that support illness management.

In another common scenario, partners without T1D appraise it as shared while the individuals with T1D do not. Partners without T1D may try to provide support, but it comes off as criticism, overprotection, or micromanagement, leaving the relationship and physical health in a poor place.

So, how do partners develop shared illness appraisal in order to facilitate a team approach to managing T1D? 

1. Awareness - Awareness means thinking about your partner and your relationship in context of T1D. How does it affect your partner? How does it affect you? And how does it affect your relationship? It may be helpful to write about this or talk it over with your partner in an exploratory, non-judgmental way. Thinking in this way can help you see that T1D affects both of you and thus should be coped with together. 

1. Authenticity - Authenticity means giving permission to yourself and your partner to be honest and open about your true, genuine feelings. It isn’t about blaming, exaggerating, or gossiping. It’s about being vulnerable in sharing your feelings to connect against the common foe; in other words, to develop shared illness appraisal. Additionally, authenticity permits partners to understand each other’s real needs and offer more helpful support. 

1. Empathy – Empathy means trying to understand your partner’s point of view and providing space for his/her emotions. It isn’t so much about fixing the problem as it is about letting your partner know you hear, want to understand, and love him/her regardless of the struggles. As individuals in a relationship practice empathy, their visions broaden from their own suffering to that of their partners’, helping them realize that T1D isn’t just “his/hers” or “mine,” but “ours” and is best coped with together. 

Awareness, authenticity, and empathy are lifelong relationship practices, meaning they develop with consistent and intentional practice. Each is essential to developing shared illness appraisal, as well as unity in the rest of the relationship (Kayser et al., 2007).

What can you and your partner do to practice these relationship skills?

Would scheduling a time to sit down and talk about your day help you practice awareness, and empathy? Maybe engaging in family traditions or going on a date once a week would allow you time to intentionally practice these traits. Perhaps it’s just talking openly while you prepare and eat dinner together that would make all the difference! Whatever it is, as you and your partner intentionally work to develop these relationship skills, especially in the context of T1D, you will notice T1D beginning to feel more like a couple-level adventure, feelings of support will increase, and T1D management will improve.

So just like both partners are important during pregnancy, both partners are important for type 1 diabetes.