Advisor(s)

Burel Goodin
Kaylee Crockett

Committee Member(s)

Caroline Richter
Emily Wakefield
Reed Dimmitt
Sarah O'Kelley

Document Type

Dissertation

Date of Award

1-27-2026

Degree Name

Doctor of Philosophy (PhD)

School

College of Arts and Sciences

Department

Arts & Humanities

Abstract

Background. Painful disorders of gut-brain interaction (DGBI) affect approximately one in five children. In addition to functional impairments, DGBI increase risk for felt stigma (FS) from providers, school personnel, family members, and peers. Children with DGBI may also belong to other minoritized groups that intersect with pain-related FS. However, little is known about how intersectionality impacts the stigma and pain experiences of youth. Further, little is known about the protective capabilities of psychosocial resources (e.g., social support and hope) against FS. Thus, the current study aimed to investigate the impact of FS and its potential moderators in a sample of youth with painful DGBI. Methods. Children with painful DGBI were recruited from a gastroenterology clinic. A mixed-methods approach was used to quantitatively identify risk and protective factors in the overall sample (n=115) and qualitatively describe intersectional and pain-related FS in a subsample of Black participants (n=20). Results. Generally, FS was associated with lower functioning, hope, and social support. FS from medical providers was most strongly associated with pain severity, while FS from family was most strongly associated with depressive symptoms. Age significantly moderated the relationship between family-based FS and depressive symptoms, where the relationship was stronger for adolescents than school-aged children. Neither family relationship quality, peer relationship quality, nor hope emerged as protective factors against FS. However, results suggest that a mediation model, with FS as the mediator, may better account for the relationships between resilience factors (e.g., family relationship quality, peer relationship quality, hope) and poor health factors (e.g., depressive symptoms). Finally, qualitative interviews corroborated quantitative findings. Misunderstandings about DGBI increased risk for stigmatization. Black youth overwhelmingly identified caregivers’ responses to pain, whether stigmatizing or supportive, as most influential. They endorsed various means of coping with pain and stigma, which are discussed in detail. Implication. The results of this study elucidate how stigma contributes to poor functional outcomes in both general and marginalized pediatric populations with painful DGBI. Recommendations for mitigating stigma and managing pain, many of which respondents reported using, are outlined. Consequently, this work will be useful in developing interventions for coping with DGBI and related stigma.

Keywords

DGBI;intersectional stigma;pain-related stigma;resilience;youth

ProQuest Publication Number

32399146

ISBN

9798273380462

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