Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Psychological and Brain Sciences

Degree Program

Clinical Psychology, PhD

Committee Chair

Stetson, Barbara

Committee Co-Chair (if applicable)

Walter, Bernadette

Committee Member

Walter, Bernadette

Committee Member

Meeks, Suzanne

Committee Member

Mast, Benjamin

Committee Member

Beacham, Abbie

Author's Keywords

illness identity; psychological flexibility; diabetes; stigma


Introduction: Illness identity, defined as the extent to which one integrates their illness into their sense of self, may be a key psychological factor to consider in overall adjustment to and management of Type 2 Diabetes. Emerging research suggests illness identity integration is associated with aspects of diabetes-specific functioning. Psychological flexibility has also been found to be associated with positive diabetes-specific functioning. This modifiable cognitive factor may play a role in the relationship between illness identity and diabetes-specific functioning. This study aims to examine associations between illness identity enrichment, illness identity rejection, psychological flexibility, and aspects of diabetes-functioning, including self-management diet behavior, diabetes distress, and diabetes stigma in adults with Type 2 Diabetes. Methods: Participants were 224 adults with Type 2 Diabetes (Mage = 54.94; 49.6% female, 87.9% White) recruited from an online crowdsourcing platform. Participants took an online survey consisting of demographic information, diabetes health characteristics, and well-validated self-report measures examining illness identity, psychological flexibility, and aspects of diabetes-specific emotional, behavioral, and psychosocial vii functioning. Data was analyzed using descriptive statistics, bivariate Pearson correlations, and hierarchical multiple regression. Results: Hierarchical multiple regression revealed enrichment was positively associated with general diet behavior (β = .560, p < .001). Rejection was negatively associated with diet behavior (β = -.410, p = .010), and positively associated with stigma (β = 3.56, p < .001). Psychological inflexibility was found to be positively associated with diabetes stigma (β = .694, p Discussion: Findings suggest that dimensions of illness identity and psychological flexibility, when considered individually, play an important role in diabetes self-care behaviors, diabetes distress, and diabetes stigma. Consideration of illness identity integration in diabetes care may promote prevention and treatment efforts, as well as overall adjustment to living with Type 2 Diabetes. Future studies should examine associations between illness identity, specific facets of psychological flexibility, and diabetes-specific functioning. Longitudinal studies are needed to better understand the bidirectionality of associations, as well as how illness identity integration may change over time or across situations. Acceptance-based interventions focused on increasing illness identity enrichment and psychological flexibility may promote diabetes-specific functioning.