Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Bruce Rybarczyk

Second Advisor

Taylor Crouch

Third Advisor

Natalie Dautovich

Fourth Advisor

Jared Keeley

Fifth Advisor

Paul Perrin


Among individuals with chronic illness, sleep difficulties and chronic pain are prevalent and interrelated. Sleep- and pain-related cognitions are known contributors to insomnia severity and sleep quality. Yet, no one has explored to what extent two social-cognitive constructs known to influence pain and pain perceptions, illness invalidation and perceived injustice, may influence sleep quality in the context of chronic illness broadly and chronic insomnia with and without chronic pain, specifically. The purpose of the present study was to elucidate the relationships among illness invalidation, perceived injustice, sleep, and pain in a sample of adults, to add to the literature on psychosocial factors influencing chronic health outcomes. A subsample of 639 adults was taken from a larger cross-sectional sample of 999 individuals who completed a series of questionnaires via Amazon Mechanical Turk. Analysis of variance was used to assess the levels of illness invalidation and perceived injustice in those with and without insomnia and chronic pain. Subsequently, a path analysis examined the theoretical relationships among two illness invalidation subscales (discounting and lack of understanding), perceived injustice, and sleep quality. Results revealed that both invalidation subscales and perceived injustice were higher in participants with insomnia than in participants without insomnia. Illness invalidation— discounting and perceived injustice, but not illness invalidation—lack of understanding, were xi higher in those with chronic pain than in those without chronic pain. Path analysis revealed that perceived injustice partially mediated the relationship between illness invalidation—discounting and sleep quality. This pattern was stable across individuals with and without insomnia and chronic pain. The theoretical implications of these novel findings are discussed in the context of study limitations. Directions for future research and clinical implications are also explored.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission


Available for download on Saturday, April 01, 2028