This study examined the applicability of Mishel's model of uncertainty in illness (1990) to the adaptation process of women diagnosed with fibromyalgia. The power of uncertainty and social support to predict an uncertainty appraisal and its corresponding coping strategy utilized in this population were examined.Structural equation modeling was employed to clarify the relationships among uncertainty, social support, the appraisal of uncertainty as either danger or opportunity, and coping as either emotion-focused or problem-focused. One hundred sixty-five participants completed the Mishel Uncertainty in Illness Scale (MUIS-A), the Appraisal of Uncertainty Scale (AUS), the Jalowiec Coping Scale (JCS), and the Social Provision Scale (SPS). After an analysis of several measures of goodness-of-fit, the original model was modified based on theory, the modification indices, and a review of the maximum likelihood estimates (mle) for structural paths. These modifications resulted in a competing model. Finally, a Chi-square test was performed comparing the goodness-of-fit indices of the competing models.Results indicated that Mishel's model is a useful model within which to conceptualize the issues faced by women diagnosed with fibromyalgia. Mishel's model performed adequately; however, the overall goodness-of-fit was significantly improved by modifications which placed greater emphasis on social support. Social support and uncertainty exerted approximately equal effect on a danger appraisal and in the revised model only social support predicted an opportunity appraisal. Results also suggested that uncertainty had a direct effect on emotion-focused coping regardless of the appraisal of the uncertainty as danger or opportunity. The current study did not unequivocally support Mishel's assertion that uncertainty may be evaluated as an opportunity. Although uncertainty demonstrated a significant inverse relationship with an opportunity appraisal in the original model, in the revised model, which considered the direct effects of social support on the appraisal process, uncertainty failed to have a significant effect. Given the depth of evidence and applicability of Mishel's original model, additional research is necessary to determine whether these results are specific to the experience of fibromyalgia or perhaps social support is an under-appreciated factor in Mishel's model. Implications for treatment and directions for future research are explored. / Department of Counseling Psychology and Guidance Services

Mode of access: World Wide Web. / Thesis (Ph. D.)--University of Hawaii at Manoa, 2005. / Evidence suggests that routine screening of primary care patients for exposure to traumatic life events, and particularly assaultive trauma, may yield both clinical and cost benefits for healthcare systems (e.g., Green, Epstein, Krupnick, & Rowland, 1997; Lecrubier, 2004). However, although advocated by authorities, such screening has yet to be widely adopted. A sample of female university healthcare patients (N = 339) was assessed for exposure to trauma in order to examine several unaddressed issues that may diminish the clinical utility of screening for trauma in primary care patients. First, because the length of the traditional trauma history assessment makes it less acceptable for use in time-pressured primary care settings, the discriminative validity of a brief, self-administered screening question about exposure to trauma, the Structured Clinical Interview for DSM-IV (SCID) posttraumatic stress disorder (PTSD) module's screening question (First, Spitzer, Williams & Gibbon, 1997) was compared to a longer, inventory method of assessment, the Traumatic Life Events Questionnaire (TLEQ, Kubany et al., 2000). Second, because it is unclear whether patients who have experienced assaultive trauma will disclose these experiences when asked in a primary care setting, the relative predictive efficacy of informing respondents that their responses would, or would not be, disclosed to health center personnel was evaluated. Two versions of the brief screening question were assessed across two instructional sets regarding disclosure, to determine each condition's relative classification accuracy for identifying respondents who reported experiences of sexual or physical assault, and/or symptoms of PTSD. The brief screen identified more than three-quarters of the survivors of traumatic assault; and more importantly, identified almost all of the women who reported significant PTSD symptomatology: the inventory method identified only 2 additional women of the 47 who met criteria for PTSD. Although survivors of sexual assault were significantly less likely to disclose their history to their provider, no differences were found for those assault survivors who also reported symptoms of PTSD. Results suggest that a brief screening question about traumatic life events may be an acceptable option in settings where more time-consuming assessment procedures are not practical. / Includes bibliographical references (leaves 83-98). / Electronic reproduction. / Also available by subscription via World Wide Web / x, 98 leaves, bound 29 cm

Shared characteristics and predictors of psychological distress are beginning to be identified in research on women seeking genetic testing for BRCA1 and BRCA2 gene mutations. This study further explored patterns of psychological distress for 51 community women waiting to receive such genetic test results. There was no significant relationship between psychological distress and family cancer history, personal cancer history, social support networks, and family environment. Women in this sample tended to rely more on females and relatives for support than males and friends. Social support satisfaction was not related to gender or number of relatives providing support. Thirty-four of the 36 women classified on the family environment type were from Personal Growth-Oriented families. Comparisons with normal and distressed family means revealed increased cohesion and expressiveness with decreased conflict, indicative of supportive family environments. Limitations and implications are discussed.

This dissertation layers trauma studies theory with feminist theories of performance and autobiography to investigate how women's autobiographically based performances of illness experience disrupt and/or reinforce master discourses of medicine, identity, and knowledge. Feminist theories of performance and autobiography share with trauma studies the distrust of traditional frames and mechanisms of representation, and seek to discover new methods of interpreting experiences that lie "outside the realm" of normative discourse. These theories are further linked by their shared focus on agency and identity construction and an understanding of autobiography that emphasizes the limitations of language and memory which allows for aporia, contradiction, and dissonance, and the belief that testimony functions as a politicized performative of truth. Employing these theoretical perspectives, Carr investigates how these performances witness to radical reconfigurations of identity through the transference of trauma into conveyable life narrative -- even when those narratives falls outside the paradigm of traditional storytelling structures. Carr questions how the structures and content of these performances reveal what traumas are inflicted not only through illness, but also through treatment and care within the western medical model. Throughout the study Carr examines the moments when the cognitive structures of trauma are transmitted into performance through a variety of feminist and avant-garde performance techniques. Carr investigates the work of specific performers and contextualizes the performances within popular culture and medical discourse. Performances analyzed include; Robbie McCauley's Sugar, Susan Miller's My Left Breast, Brandyn Barbara Artis's Sister Girl, and Deb Margolin's bringing the fishermen home and Three Seconds in the Key. Carr questions how the formerly or currently ill female body performing in public disrupts notions of fixed and stable identity while examining the myriad identity constructions embedded within illness narrative. Rather than simplistic triumphant stories of individual cure and recovery, these complex expressions of traumatic experience reveal patterns of cultural oppression that keep the ill female body isolated and silenced. This study attempts to intervene in that silence by foregrounding these politicized performances.