Graduation Year

2025

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Mental Health Law and Policy

Major Professor

Kathleen Moore, Ph.D.

Co-Major Professor

Gregory Teague, Ph.D.

Committee Member

Amber Gum, Ph.D.

Committee Member

Dinorah Martinez-Tyson, Ph.D.

Keywords

autoimmune disease, medical gaslighting, mental thriving, positive deviance, psychological thriving, quality of life

Abstract

Autoimmune diseases encompass a variety of conditions that impact millions of Americans, with a higher prevalence among women than men. These diseases involve immune system dysregulation, leading to tissue damage and dysfunction. Despite progress in understanding their underlying mechanisms, important aspects remain inadequately understood, such as the relationships among immune dysregulation, medical outcomes, and psychiatric comorbidities. Preliminary qualitative research indicates that perceived diagnostic invalidation leads to the mental health needs among women with autoimmune diseases often being unmet, and behavioral health help-seeking behaviors being reduced. Although perceived diagnostic invalidation can lead to increased mental health symptomology and decreased help-seeking behaviors, some individuals exhibit positive responses, advocating for themselves and counteracting the effects of feeling invalidated. This mixed methods study takes a community-engaged, positively deviant research approach, allowing data collected by members of the autoimmune community to drive each subsequent study. The specific aims are to (1) explain the beliefs, attitudes, and behaviors of women with autoimmune disease(s) who are thriving mentally as compared to those who are not thriving mentally and (2) develop an initial framework for women with autoimmune disease(s) to approach, empower, and support them in successfully improving their mental well-being and overall health while increasing their ability to navigate health care systems. For specific aim one, data will be collected quantitatively through evidence-based assessments and analyzed using MANOVA. For the second specific aim, additional data will be collected qualitatively through semi-structured in-depth interviews and analyzed through thematic analysis. This study anticipates that this knowledge will provide potential solutions to women with diagnosed autoimmune disease(s) in conjunction with difficulties experienced with their mental health, physical health, and overall wellness. The aims of this study are designed to (1) elucidate the beliefs, attitudes, and behaviors of women with autoimmune diseases who exhibit positive mental well-being compared to their counterparts who do not and (2) establish an initial framework for women with autoimmune disease(s) to approach, empower, and support them in successfully improving their mental well-being and overall health while increasing their ability to navigate health care systems. Achieving these aims will allow for a deeper understanding of the positive mental well-being anomalies, providing insights for policymakers, practitioners, and researchers. Practically, these insights will allow for the first steps of developing targeted well-being interventions, educational campaigns, and support programs that can leverage the identified positively deviant behaviors to enhance the mental health outcomes in this population.

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