There is an old saying: “Good fences make good neighbors.” Having healthy boundaries in relationships is important for everyone, especially for people with a chronic condition like pulmonary hypertension (PH). Setting and defending boundaries allows you to protect your physical and mental health and focus on feeling your best while living with PH.

Setting boundaries can be hard. Your friends and family may not be used to you saying no or establishing limits for when and how you are available to them. They may expect you to have the same energy you had before you developed PH and symptoms like pain, fatigue, or breathlessness. No matter what, you are entitled to establish the boundaries you need to maintain your emotional and physical wellbeing. Setting boundaries to take care of yourself does not make you mean or selfish – it helps you focus on what you need to do to care for your PH.

Here are a few tips for setting boundaries clearly and compassionately:

1. Use clear, direct language. For example, “I cannot attend the birthday party” is clearer and more direct than “I’m not sure I’ll be able to attend the birthday party.”
2. Use “I” language and avoid accusations. For example, “I go to sleep early. I am not able to take calls after 9 p.m.” is less accusing than “You always call late and wake me up!”
3. Don’t try to justify or over-explain your boundary. “No” is a complete sentence. For example, “I’m not able to take on new obligations right now,” is better than “I can’t organize the fundraiser because it will stress me out, and stress can cause my PH symptoms to flare.”

After setting boundaries, do not be surprised if you need to defend them. Some people will likely test your boundaries, especially when they are new. Expect some pushback and consider what a good response might be.

Here are some examples of boundary testing and possible responses:

1. After saying you cannot attend a party, someone attempts to use guilt to pressure you to go. You could explain that PH isn’t taking that day off, so you will still be unavailable. You could point out that PH feels bad enough without adding guilt, so you don’t feel guilty about saying no to things that will be bad for you.
2. After setting a boundary of no phone calls after 9 p.m., someone calls at 9:15. You could choose to let the call go to voicemail. You could answer and ask whether the call is about an emergency. If it’s not an emergency, ask them to call back in the morning, wish them a good night, and hang up.
3. After saying no to one new obligation, you are asked to take on another. You can point out that PH is a chronic condition, meaning that it isn’t going away any time soon. Therefore your avoidance of new obligations applies to any new obligations, and if they ask again, the answer will be the same.

After testing your boundaries a few times, most people will understand that they are well-defended and learn to respect them. If you have allies who understand the challenges of pulmonary hypertension, ask them to help you defend your limits with others. Remember, you don’t need to apologize for setting good boundaries that help you stay healthy, manage your symptoms, and feel your best while living with PH.

Here are some conversations from myPHteam about setting and defending boundaries:

"I am sharing my experiences, hopes, fears, and concerns with long-distance friends who truly understand what this is like - not being able to breathe, being so darn exhausted, having pains, brain fog, and having to say no."

"Be your own patient advocate and don't just leave it up to the doctor."

"It does get easier as you find what your limits are and actually plan for those days that are not so good."

Have you successfully set boundaries that help you manage PH?
What tips would you recommend to help set healthy limits with others?
Share in the comments below or directly on myPHteam.