Assessing Habitual Self-stigma: a Validation Study of the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) Scale in People with Mental Illness

Abstract

Introduction Endorsing self-stigmatizing thought per se needs not produce chronic distress. Only when it occurs frequently and automatically as a mental habit does this create constant mental turmoil. The cognitive content and the habitual process of self-stigma should be assessed independently among people with mental illness. Although existing measures can assess the content of self-stigma (i.e., the extent of self-concurrence with negative stereotypes of mental illness), none of them assesses the process (i.e., the habitual quality of self-stigmatizing thinking). Objectives The present study aims to develop and validate a measure of the habitual process of self-stigma, that is, the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) scale. Methods Ninety five people with mental illness completed an initial version of the STAR together with a measure of the cognitive content of self-stigma (i.e., the Self-Stigma Scale—Short Form [SSS-SF]). Results Exploratory factor analysis suggested a 2-factor structure of the STAR (i.e., repetition and automaticity of self-stigmatization). The four highest-loading items on each factor were selected to constitute the final version of the STAR. The 8-item STAR and its subscales demonstrated excellent internal consistency. The STAR showed significant but moderate correlation with the SSS-SF. Conclusions With the validation of the STAR, the time is ripe to move beyond a global evaluation of self-stigma as a content-oriented construct and to understand both the content and process of self-stigma, so that the diversity and complexity of its impact on people with mental illness can be more fully captured.