Internalized stigma, disclosure and self-esteem among psychiatric patients in a general hospital outpatient clinic

Abstract

Psychiatric patients often experience internalized stigma. This occurs when persons accept the negative attitudes of others towards them, then internalize and apply these beliefs to themselves. We assess the effects of internalized stigma on illness disclosure and on self-esteem in psychiatric outpatients, hypothesizing that internalized stigma is more pronounced in psychiatric patients than in medical patient controls and that internalized stigma is associated with avoidance of disclosure, as well as reduced self-esteem. Psychiatric and medical outpatients were randomly selected to participate in the study, conducted at a general hospital specialist outpatient clinic. Psychiatric patients demonstrated significantly lower self-esteem than controls. Internalized stigma was the highest for singles, and the lowest among married and older patients. Among psychiatric patients, a higher internalized stigma was significantly associated with experienced discrimination and with lower levels of self-esteem. Those who avoided disclosure had significantly higher internalized stigma than those who self-disclosed. The results confirmed our study hypotheses. Marriage and older age seemed to confer a protective effect on self-esteem.