Parsing the relationship of stigma and insight to psychological well-being in psychotic disorders.

Background: It has been postulated that the effects of the stigma of mental illness on the psychological well-being of patients is mediated through internalization of the stigma. On the other hand, there is reason to suppose that simple awareness of public stigma could also have an impact to the extent that an individual is aware of being ill.

Objective: To investigate whether internalization of the stigma of having a psychotic disorder and an interaction between perceived public stigma and awareness of being ill make independent contributions to the prediction of psychological well-being in patients with psychotic disorder.

Methods: 102 patients in an early intervention program for psychoses were assessed for awareness of public stigma, internalization of stigmatizing beliefs, insight and various aspects of psychological well-being including self-esteem, depression, anxiety, anger/hostility and engulfment.

Results: Internalization of stigma was associated with lower levels of psychological well-being. In addition, perception of public stigma also contributed to lower well-being for those individuals with greater awareness of being ill.

Conclusions: While internalization of stigma is an important contribution to psychological well-being in patients with psychosis, awareness of public stigma, even if this is not internalized, also is associated with lower self-esteem, and greater anxiety, anger/hostility, and engulfment in patients with better insight.