Changing with Chronic Illness: Exploring Multi-Dimensional Aspects of Identity Change

Chronic illness is often perceived as an assault to the body that threatens the integrity of self (Charmaz, 1995). In addition to the physiological changes that exist within chronic illness, psychosocial well-being changes occur as an individual’s health status and identity are simultaneously reappraised and reconstructed (Breitbart et al., 2015; Bury, 1982; Charmaz, 1991). Within the context of chronic illness, it is particularly important to garner a more complete understanding of how diagnoses affect personal, social, and communicative aspects of an individual’s identity so that practitioners and support networks alike can assist in patients’ coping and resilience processes. This dissertation investigates the links between chronic illness diagnosis, identity change, and well-being in three subsequent studies. In Study One, I explore the ways in which the perceived severity of chronic illness diagnosis creates multi-aspect, multi-dimensional identity change and influences psychological well-being. In Study Two, I utilize communication theory of identity (Hecht, 1993; Hecht et al., 2005) to explore how individuals diagnosed with Systematic Lupus Erythematosus (SLE) subjectively experience identity changes and identity gaps in their multilayered identity structure. In Study Three, I investigate how multi-aspect, multi-dimensional identity change impacts treatment adherence for those with chronic illnesses. Findings from Study One demonstrate that that identity change occurs uniquely across identity aspects (personal, relational, social, and performative) and across identity change dimensions (amount of identity and affective identity) to influence psychological well-being. Findings from Study Two demonstrate the subjective, complex, and fluid process by which identities change and the functional ambivalence of these identity changes. Lastly, findings from Study Three demonstrate how the amount of identity change in the personal, relational, and performative identity aspects can positively influence treatment adherence 10 or more years after diagnosis. Together, Study One, Study Two, and Study Three findings suggest that scholars, practitioners, and support-networks need to balance understanding and caring for the physical aspects of chronic illness with the psychological and social aspects of chronic illness