Chronic Illness and the Challenge of Friendship

Living with a chronic illness reshapes nearly every part of a person’s life, and friendships are no exception. While companionship and connection are fundamental human needs, they can become difficult to sustain or initiate when someone is navigating unpredictable symptoms, physical limitations, or the emotional weight of long-term illness. What many healthy people may take for granted (e.g. meeting for coffee, keeping up with texts, attending social events, or spontaneously making plans), can become daunting, exhausting, or simply impossible. For those living with chronic illness, maintaining old friendships and building new ones often requires more energy, vulnerability, and resilience than others realize.

One of the greatest challenges in managing friendships while chronically ill is the lack of consistency that illness often imposes. Symptoms may fluctuate from day to day - or even hour to hour - making it difficult to commit to plans or show up in ways friends might expect. Cancelling at the last minute, needing to leave early, or declining invitations altogether can lead to misunderstandings. Friends may begin to assume you’re uninterested or unreliable, not realizing how much you wanted to be there or how hard you tried to make it work. Over time, this can lead to distancing or even the quiet ending of a friendship.

There is also the emotional labour of explaining. People with chronic illnesses often find themselves having to educate others about their condition; what it is, how it affects them, and why they can’t just push through. While some friends are compassionate and open to learning, others may grow uncomfortable, impatient, or overwhelmed. And for the person who is ill, continually explaining their limitations can feel like reliving their losses. It’s vulnerable and draining (and do people even care?). It can start to feel easier to retreat than to risk rejection, disbelief or actual disinterest. (I've written more about the exhaustion of always having to explain yourself [here].)

Making new friends presents its own set of hurdles. Socializing is often physically demanding, and many traditional avenues for meeting people like through work, social events, travel, or fitness activities, may no longer be accessible. The effort required to initiate conversations, attend events, or form new connections can be overwhelming. There may also be fear: Will they understand? Will they judge? Will I have to hide this part of myself to be accepted? Forming new friendships can be difficult and even cause anxiety, especially after experiencing past losses or misunderstandings.

Moreover, chronic illness can change a person’s sense of identity and priorities. Things that once bonded friends like shared activities, ambitions, or lifestyles, may no longer be possible. Illness can introduce a level of depth, perspective, and emotional intensity that not all friends are comfortable with. Some may avoid those conversations; others may be unable to relate. The result can be a deep sense of loneliness, even when surrounded by people.

And yet, the friendships that endure, or those formed with others who truly understand, can be incredibly meaningful. Chronic illness has a way of stripping away the superficial and highlighting what really matters in relationships: empathy, patience and authenticity. Friends who can sit with discomfort, adapt to shifting needs, and stay connected even when life looks different become lifelines. And connecting with others who live with chronic illness can offer a kind of understanding that doesn’t require explanation but a mutual language of compassion and care.

Still, it’s important to acknowledge the grief that can come with the loss or absence of friendships. It’s not uncommon to feel left behind, invisible, or forgotten when your life no longer aligns with those around you. These are valid and painful experiences but grieving those losses can also create space for new kinds of connection; ones rooted in honesty and flexibility.

Living with chronic illness changes how we connect, but it doesn’t mean connection is out of reach. Meaningful relationships are still possible but they might just require more time, a different approach, or a smaller, more trusted circle. By advocating for themselves, setting boundaries without guilt, and seeking out safe and understanding spaces, people with chronic illness can continue to nurture friendships that honour both who they are and what they’re living through. Even with limitations, we all still need and deserve companionship.

If this is something you’ve been affected by, please leave a comment below. If there’s something important you’d like to add, please do so. I'd love to hear from you.

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Dr. Ingela Thuné-Boyle is a licensed Practitioner Health Psychologist and a Doctor in Behavioural Medicine who specializes in stress and loss, especially in improving the quality of life of people struggling with long-term health problems, chronic pain and trauma. She runs a private online (telehealth) practice at www.ingelathuneboyle.com.

Please note: Advice given in this blog is not meant to take the place of therapy or any other professional advice. The opinions and views offered by the author is not intended to treat or diagnose, nor is it intended to replace the treatment and care that you may be receiving from a licensed physician or mental health provider. The author is not responsible for the outcome or results following their information and advice on this blog.