Stigma is associated with illness self‐concept in individuals with concealable chronic illnesses

Abstract

Objectives. Previous research suggests that chronic illnesses can elicit stigma, even when those illnesses are concealable. Such stigmatization is assumed to lead to a stigmatized identity. Additionally, chronic illness affects one's self-concept, as one reconstructs a sense of self with illness incorporated. However, no research has examined the interplay between stigma and self-concept in those with concealable chronic illnesses. Therefore, we investigated the extent to which experienced, anticipated, and internalized stigma are associated with illness self-concept in individuals living with concealable chronic illnesses. Furthermore, we explored if the aforementioned aspects of stigma are associated with enrichment in the self-concept in the same cohort.Design. An online correlational survey of people with concealable chronic illness (N = 446).Methods. Participants completed self-report measures of chronic illness-specific measures of stigma and illness self-concept, both negative and positive.Results. Results indicated that there is a positive relationship between experienced, anticipated, and internalized stigma and illness self-concept, indicating that stigma is associated with increased preoccupation and perceived impact of one's illness on the self. Although there is also a negative relationship between anticipated and internalized stigma and enrichment, only internalized stigma is associated with enrichment over and above the effects of control variables such as personal control.Conclusions. Our findings bridge the existing literature on illness self-concept and stigma for chronic illness groups, with a specific focus on those with concealable chronic illnesses. More varied approaches to coping with illness should be encouraged, including encouraging enrichment aspects to potentially act as a buffer between the effects of stigma and illness self-concept. Statement of contributionWhat is already known on this subject?Chronic illnesses can elicit stigma, even when those illnesses are concealable. This stigmatization leads to a stigmatized identity, where stigma can be anticipated and internalized. Chronic illness affects one's self-concept, as one reconstructs the self with illness incorporated.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Factors shaping the mental health and well-being of people experiencing persistent COVID-19 symptoms or ‘long COVID’: qualitative study

“…Previous work on chronic illness has theorised that these experiences of illness related stigma may reduce well-being via a reconstruction of an individual's identity with both illness and stigma incorporated. 33 Our findings identified the relevance of relapsing-remitting disease trajectories as important drivers of negative mental states because of related uncertainty about the future, which is well-established as a driver of anxiety and depression for people with various chronic diseases. 34 Other research, particularly from earlier on in the pandemic, also identified various barriers to healthcare, 1,14,22,31 including a lack of specialist service provision and limited understanding of the illness from healthcare professionals.…”

“…Previous work on chronic illness has theorised that these experiences of illness related stigma may reduce well-being via a reconstruction of an individual's identity with both illness and stigma incorporated. 33 …”

Stigma, health, and academic performance in university students with physical and mental chronic health conditions: Baseline data report.

“…Finally, unexamined variables—such as the level of identification with a CHC, visibility, concealability, and broader assessment of accessibility of the educational environment (e.g., resources and skills in navigating online courses)—may also be significantly associated with stigma constructs, academic performance, and health measurements used in the present study. For example, recent work has demonstrated that greater identification with concealable CHCs could exacerbate stigma-related processes (e.g., being vigilant for stigma-related cues and internalization of negative stereotypes; O’Donnell & Habenicht, 2022).…”

“…In addition, Royster and Marshall (2008) state that students with physical CHCs "face specific issues such as : : : unpredictable relapses during the term, and the invisibility of their illnesses, which can make them the subject to disbelief and claims of malingering" (p. 121). Taken together, students with either physical or mental CHCs have reported experiencing stigmas, despite how physical or mental CHCs can be concealed (O'Donnell & Habenicht, 2022;Reinka et al, 2020). Given the increased online instruction in the wake of the COVID-19 pandemic, it is likely that fewer students' CHCs are recognized by educational staff, faculty, and classmates.…”

“…As risks are identified, the educational environment can be adjusted to meet accessibility-related issues faced by students with difficulties engaging (e.g., avoiding class). Second, despite social identity threat frameworks being used in recent studies (e.g., O’Donnell & Habenicht, 2022), to the best of the author’s knowledge, no prior study has examined whether stigma-related processes may be associated with both academic performance and health in a sample of students with CHCs. Consistent with Aronson et al’s (2013) hypothesis, both health and academic performance can be undermined by stigma-related processes.…”