Self-stigma undermines empowerment and interferes with growth and healthcare.Key points
- A recent study examined self-stigma in clinical depression.
- People with high self-stigma may delay seeking care, stop treatment, or report lower levels of satisfaction.
- Self-stigma may lead to reduced empowerment, which can interfere with treatment success.
Self-stigma has long been a subject of curiosity for me, both in my clinical work and my own life experience. There is a significant body of literature focusing on mental health stigma in its many forms—whether internalized, perpetuated by the public, or baked into the system itself. As the classic horror movie line goes, “The call is coming from inside the house.”
Pangs for the Memories
Stigma is intimately related to shame and guilt, those pangs of sharp emotional pain as well as the dull, persistent aches that can linger for years. Internalized stigma is a key concept not only in mental health but also in other realms where we see internalized -isms: internalized racism, misogyny, antisemitism, anti-Asian bias, ableism, and a host of other cultural polarities. These all serve to undermine the foundation of a healthy sense of self, quietly eroding self-worth from within—while also reinforcing societal stigma and driving intergenerational transmission of hatred.
It is worth noting that research on self-stigma in psychiatry has traditionally focused more on schizophrenia, related psychotic conditions, and bipolar disorder. These are diagnoses that, for complex reasons, tend to attract more public stigma. And while it seems almost self-evident that self-stigma would play a critical role in other conditions—major depressive disorder (MDD), anxiety disorders, PTSD, OCD, ADHD, and more—there has been less research in these domains. The reasons for this gap aren’t entirely clear. I wonder if it’s because professionals find it easier to study conditions where external stigma is more readily apparent, or perhaps those ostensibly “more severe” disorders are easier to study for defensive reasons, being less personally relatable to those in the profession.
Studying Self-Stigma, Empowerment and Major Depressive Disorder
A recent study in the Journal of Affective Disorders (Lasalvia et al., 2025) addresses this gap by examining self-stigma in clinical depression, with a particular focus on empowerment—a concept closely intertwined with classic depression symptoms such as low self-esteem, shame, and guilt. Empowerment, in this context, is associated with better engagement in treatment, increased self-efficacy, and improved overall well-being.
The researchers conducted a cross-sectional study involving people across 34 countries with a diagnosis of major depressive disorder, reportedly as part of the ASPEN/INDIGO-Depression project. They evaluated empowerment, self-esteem, and self-stigma using standardized instruments: the Boston University Empowerment Scale (BUES) for empowerment, the Rosenberg Self-Esteem Scale (RSES) for self-esteem, and the Internalized Stigma of Mental Illness (ISMI) scale for self-stigma. Data were collected from 1,058 participants. To incorporate a cultural lens, they also examined correlations with the United Nations Human Development Index, which measures a country’s overall population health and longevity, education, and standard of living.
The authors highlight several key points that frame their study. First, they clarify that the internalization of self-stigma from public and structural sources occurs in three stages: (1) being aware of mental health stereotypes, (2) accepting these stereotypes as true, and (3) identifying with and applying these stereotypes to oneself. They note that self-stigma comes with a host of risks, serving as a significant barrier to health and personal growth. People with high self-stigma may delay seeking care, stop treatment prematurely, have a higher likelihood of discontinuing necessary medications, and report lower levels of life satisfaction.
