Confruntarea autostigmei în tulburările din spectrul schizofreniei
Confronting self-stigma in the schizophrenia spectrum
Data primire articol: 29 Iulie 2025
Data acceptare articol: 22 August 2025
Editorial Group: MEDICHUB MEDIA
10.26416/Psih.82.3.2025.11010
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Abstract
Background/objectives. Stigma and self-stigma in serious mental illness (SMI) – particularly in schizophrenia – is a crucial, yet poorly researched phenomenon that has a significant effect on the sufferers of the disorder. This article aims to summarize and present recent findings on the topic, the current paradigm surrounding it, as well as any recent approaches suggested in its management and treatment.
Methodology. We have selected articles out of the PubMed database, as well as other supporting references, and we have summarized information on three topics: prevalence, impact and suggested approaches.
Results. Self-stigma is significantly prevalent globally. The impact is noted in the cited works. The literature suggests a number of approaches on various levels of medical, social and political life.
Conclusions. Self-stigma affects approximately one-third of individuals with SMI, with higher rates observed in schizophrenia and variations according to geography and culture. The phenomenon impairs the social function, clinical states and outcomes, and overall quality of life, and it takes place earlier than previously thought. Suggested courses of action include, but are not limited to, various kinds of therapy, community involvement, media and legislative approaches, and more.
Keywords
stigmaself-stigmaschizophreniaserious mental illnessRezumat
Context/obiective. Stigmatizarea și autostigmatizarea în bolile mintale grave (BMG), în special în schizofrenie, reprezintă un fenomen crucial, dar slab cercetat, care are un efect semnificativ asupra persoanelor care suferă de această tulburare. Articolul își propune să rezume și să prezinte descoperirile recente pe această temă, paradigma actuală din jurul acesteia, precum și orice abordări recente privitoare la gestionarea și tratamentul acesteia, sugerate în literatura de specialitate.
Metodologie.Am selectat articole din baza de date PubMed, precum și alte referințe suplimentare, și am reorganizat informațiile din aceste surse pe trei teme: prevalență, impact și abordări sugerate.
Rezultate. Autostigmatizarea are, la nivel global, o prevalență semnificativă. Impactul este descris în lucrările citate. Literatura de specialitate sugerează o serie de abordări pe diverse paliere ale vieții medicale, sociale și politice.
Concluzii. Autostigmatizarea afectează aproximativ o treime dintre persoanele suferinde de BMG, cu rate mai mari observate în schizofrenie și variații în funcție de geografie și cultură. Fenomenul afectează funcționarea socială, statusurile clinice și prognosticele, precum și calitatea generală a vieții; de asemenea, el apare mai devreme decât se credea anterior. Printre acțiunile sugerate se numără, nu exclusiv, diverse tipuri de terapie, implicarea comunității, abordări media și legislative și multe altele.
Cuvinte Cheie
stigmatizareautostigmatizareschizofrenieBMGIntroduction
As Durkheim states in the third chapter of The Rules of Sociological Method, “Imagine a community of saints in an exemplary and perfect monastery. In it, crime as such will be unknown, but faults that appear venial to the ordinary person will arouse the same scandal as does normal crime in ordinary consciences. If, therefore, that community has the power to judge and punish, it will term such acts criminal and deal with them as such.”(1)
Stigma infiltrates almost every facet of our lives as social beings, with effects that we can easily see and understand. Out of all possible forms of stigma, of particular interest to both ourselves and to this journal is stigma that follows medical disorder, particularly the psychiatric one. While illness-related stigma has been well-documented for quite some time, the sub-phenomenon of self-stigma is largely unknown, not only in our country, but – we believe – worldwide.
Models for illness-related stigma, like the Link & Phelan model(2), have existed for decades at this point, whereas models for self-stigma have appeared rather recently – for instance, the Corrigan progressive model in 2011(3) and its first applications much more recently(4).
This article aims to look at the most relevant recent literature in the PubMed database that deals with the subject of self-stigma and to summarize the propositions that the authors of these works make for its amelioration, in the hope of achieving a better understanding of, as well as with, our patients.
Materials and method
This article is based on sources retrieved from the PubMed database, maintained by the National Library of Medicine. The selected articles were published within the past five years and were chosen based on their relevance, as determined by PubMed’s relevance-based search criteria.
The main search terms that the search methodology used were “schizophrenia” and “self-stigma”. Our aim was to select the 25 most relevant, in English language, full-text titles based on the recommendations of the PubMed search algorithm, set to provide results that best match the search terms. The results were set to be displayed in order of relevancy in the PubMed search engine.
However, after all filters were applied, we were left with eight articles that served as the primary sources for this work, most of them summarizing previously published articles of their own. We find this relevant in the larger discussion pertaining to research performed thus far on the subject of self-stigma in psychiatric disorders.
This paper is a narrative review based on an analysis of these remaining sources, focusing on understanding and countering stigma and self-stigma. It aims to summarize the most important findings in the literature, as well as potential applications of these findings, particularly in guiding preventive efforts against stigma in this and related areas.
Results
First of all, we will start off by defining the central terms and concepts that the present work engages with.
We are interested in discussing stigma and, more specifically, self-stigma in individuals with “serious mental illnesses” (SMI), by which we refer to a persistent psychiatric condition that significantly impacts their day-to-day functioning(5).
By “stigma” we mean a larger ensemble of social mechanics of disapproval or discrimination against an individual or group of individuals based on characteristics that distinguish those stigmatized from other members of society(2).
“Self-stigma”, then, is the act of the patient’s internalizing and self-application of the stigmatizing notions developed by the larger stigmatizing group(6). P.W. Corrigan’s progressive self-stigma model describes it as a successive four-step process, as follows:
- Awareness – the patient’s understanding of the stereotype being applied (we use the term “stereotype” here to mean the attribution of perceived negative traits, as in the Link & Phelan stigma model(2));
- Agreement – the sufferer begins, in this stage, to agree with the stereotype they are being attributed, as concerns the stigmatized category at large;
- Application – the sufferer’s belief that the stereotype is a correct description of themselves, personally, and not just of the stigmatized group that they’re a part of;
- Harm – the direct effect of the process, characterized by a decrease in self-esteem, leading to self-harming actions and behaviors; for instance, considering oneself “less than” the population at large, or guilty of one’s disorder, and engaging less socially, or accepting a diminished access to resources on account of this loss of self-esteem(7).

Prevalence
Across the world, the prevalence of self-stigma tends to be significant in patients suffering from SMI, with multiple sources offering high prevalences of self-stigma, especially in Europe and North America(8). On average, about one-third of individuals with SMI reported high self-stigma(8). Another source also cites significant prevalence values for self-stigma (described as “internalized stigma”) in Africa and Nepal(9).
Discussing schizophrenia in particular, Dubreucq et al. mention the highest rate of self-stigma out of all studied SMI(8). Other sources(10) cite another paper by Dubreucq mentioning prevalences of 32.6% to 44.2% globally.
Another source(11) gives the prevalence of self-stigma in schizophrenia and other psychotic disorders at about half of total cases. Interestingly, the source also mentions a consequence of self-stigma – namely, social withdrawal – at about the same 50% rate, “as a direct consequence of self-stigma”(11).
It bears mentioning that, while Dubreucq et al.(8) are our most in-depth source when it comes to data on the prevalence and geographical distribution of the phenomenon, other cited articles(9,12) also touch upon geographical differences.
Interestingly enough, the aforementioned sources describe geographical differences in prevalence due to the influence of cultural factors, which is of particular interest to us; culture-bound interpretations such as shirking one’s duty and responsibility, moral or supernatural causes such as spiritual possession, social fears of humiliation and discrimination, personal weakness, lack of will or self-control, even divine punishment(8,9), have all been cited as important sociological factors in the lived experiences of sufferers of SMI, especially in non-Eurocentric or American cultural milieus.
Especially in Asian cultures, “loss of face”, or loss of honor, is a specific driver of stigma, where the interpretation is that of the psychiatric disorder being a sign of personal weakness or a source of shame for the sufferer’s family(8-10).
In Europe and North America, meanwhile, stigma seems to be driven by the fear of the patient’s supposed dangerousness and unpredictability, as well as on expectations of “acting normally”, also supposedly left unsatisfied by the sufferer(9,12). Another important theme in this wide cultural milieu is individual responsibility for illness, as well as personal autonomy and its emphasis in western cultures(12).
Impact
Based on known literature and the works cited, self-stigma is associated with poor clinical and functional outcomes in SMI, and it is considered one of the greatest barriers to recovery(8,10,12). It appears to affect self-efficacy, self-esteem, quality of life and various clinical outcomes that will be discussed later(8,10), as well as social withdrawal, decreased empowerment and help-seeking(8,10-13). Mental health stigma also affects economic agents, influencing employee “absenteeism, presenteeism, and turnover, with a great economic cost to organizational structures”(9). Another source mentions self-stigma as having negative consequences upon recovery after psychotic episodes(11). Other sources mention discrimination and negative consequences on social functioning(10,14), up to and including poverty, homelessness and violence, whereas yet another one looks at the mitigating effect of education/psychoeducation on the social and clinical impact of self-stigma overall(10).
Overall social functioning and vocational functioning are also impacted by self-stigma, also leading to degraded social relationships, as well as decreased workplace performance; the phenomenon also appears to diminish the benefits resulting from vocational rehabilitation(8-12).
Clinically, the sources mention an increase in positive symptoms among the effects of self-stigma(8,10-12), with consequences ranging from more frequent rehospitalizations to increased mortality rates(11). Negative symptoms are also aggravated by the presence of self-stigma, as some sources attest(11,12). Nonspecific psychiatric symptoms are likewise impacted by self-stigma(12), such as depressive mood and suicidal ideation/suicidality(8-12).
Beyond the simply clinical, the cited works mention phenomena such as decreased help-seeking, as previously mentioned(8,13), decreased adherence to treatment(8-12), and even negative, hostile attitudes toward psychiatric medication, a familiar difficulty to most working psychiatrists(9,12).
Unexpectedly, self-stigma appears to be associated with a higher risk for the development and onset of psychotic disorders, stress related to stigma having been identified as a predictor of psychosis(8,13).
An interesting, if paradoxical, find was the association of higher levels of illness insight with higher levels of self-stigma(8,11,12,14). The current interpretation of this finding is that increased awareness of their disorder may make individuals less likely to seek help due to fears of further stigmatization(11).
We would like to point out the Lamarca et al. work, that describe the effects of increased self-stigma, decreased help-seeking, more frequent hospitalizations, and higher mortality rates being in a bilateral association with the levels of self-stigma itself(11). This is consistent with other findings identified by the authors of this present review on the topic of COVID-19-related stigma, which also seemed to follow a similarly circular pattern of self-feedback.
As expected and previously mentioned, the quality of life is negatively influenced by the presence of self-stigma(8-13), decreasing self-esteem(8,10-12), self-efficacy(8,10,12) and hope(8,10,12,13). Emotionally, it appears to associate most frequently with shame(8,10,14), loneliness(8,12), fear, anger and worthlessness(10). Unsurprisingly, self-stigma is a major barrier to personal recovery(8,10-12).
A novelty approach for the authors is the umbrella-term “UHR”, standing for “ultra-high risk” for psychosis, by which the authors refer to the early clinical and preclinical stages of psychosis. Stigma as well as self-stigma appear to also be present in these early stages of the disorders, playing a significant part in their respective progressions and becoming risk factors all in themselves(8,13). This supports our theory that stigma and self-stigma are, essentially, self-propagating, recurring phenomena that employ positive self-feedback structures.
Suggested approaches
The cited works suggest a large array of possible approaches, from the direct, therapeutic level to the systemic and environmental changes believed necessary to ameliorate, if not solve, the matter at hand.
At its most basic, the matter can be approached through a variety of means and methods, but multiple concurrent approaches seem to have the best outcomes(11). Among the methods cited are psychoeducation, social skills training and cognitive therapeutic approaches(11). Psychoeducation is mentioned along the need for its contextualization and customization to the patient(9-11,13). Cognitive approaches such as cognitive behavioral therapy (CBT) or narrative enhancement cognitive therapy (NECT) have also been found to reduce self-stigma and enhance self-esteem, quality of life and hope(12,13).
The sources note that group interventions seem to be more effective than individual ones in combatting self-stigma(11,12), as well as shorter times spent in therapy, approximately 12 sessions, or 10-12 weeks(11). Also, it bears mentioning that the clearly negative views that sufferers maintain about themselves should be targets of psychotherapeutic intervention(8).
Also, at this level, one source cited describes at length the effects of empowerment-based illness management, which focuses on improving medication adherence and recovery, using one’s own resources, while also engaging with external support such as family and loved ones. This approach also aims to teach sufferers their own personal needs, finally achieving improved states by overcoming self-stigma(15).
Other approaches include changing the disease-deficit paradigm of conceptualizing one’s situation for a strengths-based one, enhancing self-esteem and self-efficacy with examples found in the sufferer’s day-to-day life(8,10,12,15). Hope, via positive framings used when communicating, acts as both protective factor and an adjuvant in recovery(10). Furthermore, reframing or dismissing what Goffman referred to as “spoiled identity”(16), as well as being open towards others in this situation and helping them can also boost self-acceptance and self-esteem(10).
Community also plays a significant role in this phenomenon, as leveraging its support structures is cited in multiple works as highly beneficial in both a preventative and therapeutic capacity, generating hope, offering acceptance, preventing isolation and increasing social integration(9,10,15).
Ultimately, building stigma resistance is a goal mentioned in multiple sources cited, and it is a key target in further research that aims to address the issue on a direct level(10).
On the larger, systemic level, the sources cited mention such approaches as anti-stigma campaigns(8,13), recovery-oriented practices such as peer-supported self-management interventions, joint crisis plans and policies that aim to decrease perceived stigma-related stress and coercion(8,10), and improved training for mental health professionals on the topics of stigma reduction and recovery promotion(8-10). Improved inpatient care is also to be expected, leading to better patient outcomes after discharge(8).
Of the lesser-known approaches, we cite strategic disclosure programs that guide patients on the matter of disclosing illness-related information(8,9), early intervention services that address the UHR stage of the disorder(8,10,11,13), workplace interventions(9), supportive policymaking with increased resources(9), media engagement to promote awareness and halt the spread of stigmatising content(9,10), and more refined usage of the psychiatric diagnosis; the sources mention the open dialogue approach as a way to improve dialogue among all participants in the medical act(14).
Discussion
We would like to take the time to mention the similarities we have noticed to the phenomenon of COVID-19-related stigma, where, as previously mentioned, stigma was simultaneously cause and effect of its consequences, leading us to surmise that such a self-propagating structure might be common to the phenomenon at large, meriting further study.
Also, it is worth mentioning that, as it’s easy to observe, there is a dearth of studies into the subject matter, which is not only a grave absence in the overall accumulated knowledge on the nature and treatment of mental disorders, but also a factor that contributes to the persistence and propagation of needless suffering for our patients.
Also, we would like to mention that the multiple forms that stigma and self-stigma take, depending on the cultural factors at play, cannot be neglected, and should be – we believe – more systematically integrated into any and all further research being done on the subject.
Also, we are firmly of the opinion that increased participation of government and law-making entities, as well as researchers in the fields of sociology and other social studies would be a boon to our understanding of stigma and self-stigma, as these phenomena transcend mere medical research and are, as stated otherwise by the authors of this work, truly intersectional. We support the sources that mention the need for simultaneous intervention on all levels of society, from the individual to the government level.
Conclusions
Current research on the subject sees stigma and self-stigma as a fairly frequent hardship faced by SMI sufferers, with multiple ways in which it impacts their lives. From increased social difficulties such as discrimination, social isolation, decreased quality of life, up to and including severe clinical consequences, such as increased frequency and intensity of symptoms, even suicidality, the impact of the phenomena is far-reaching and dramatic, maybe even more prevalent than initially thought.
As pertains to proposed ideas of combatting stigma and limiting its spread, the sources cited propose a variety of approaches on multiple levels of social life, all geared toward improving the the quality of life for our patients. We summarize these propositions and suggestions in Table 1.

Corresponding author: Horia Marchean E-mail: horia.marchean@umfst.ro
Conflict of interest: none declared.
Financial support: none declared.
This work is permanently accessible online free of charge and published under the CC-BY licence.
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