Self Injury in Relation With the General Perception of Mental Illness Stigma

Zachary Schomberg

Abstract• The extent to which degree of stigma corresponds to

severity of mental illness was under examination. Level of perceived stigma was measured in relation to type of mental illness. Stigma was measured in the case of three separate mental illness groups: depression (n=36), self injury (n=36), and a control group of no mental illness (n=35). Participants indicated the level to which they agreed with stigmatized statements towards each mental illness condition. The self injury condition had the highest stigma scores, followed by the depression and control groups respectively. These findings suggest that there is an existing relationship between greater degree of stigma and severity of mental illness.

Issue of Stigma and Mental Health in America

• 26% of population experiences diagnosable mental illness within the course of a calendar year. 6% of population experiences severe mental illness. (NIMH, 2010)

• Despite the widespread prevalence of Mental Illnesses there still exists a public stigma towards those who admit and seek treatment for mental health problems.

• Stigma can be defined as a visible or concealable mark that is considered by the majority of a social group to be representative of deviance or immorality. Stigma encompasses prejudice, stereotypes, and discrimination as well as the tendency to attribute all negative attributes of an individual to the stigmatized group (Stier & Hinshaw, 2007)

Function of Stigma• The stigmatized group is generally excluded as a

means of protection or as a way to benefit the larger group.

• The stigmatized group may be incapable or unable to engage in social interaction within the larger group.

• They may possess some physical deformity or injury that sets them apart.

• May be excluded as a way to benefit or serve those within the larger in-group (Major and O’Brien, 2004).

General Perception of Mental Illness• Prejudice towards a group dependent upon

perceived controllability and stability of the condition.

• Severe mental illness such as psychosis thought of as being controllable compared to conditions such as cancer or AIDS.

• Also thought of as being more persistent and more difficult to recover from than cancer. (Corrigan et al., 2000).

Greater Stigma Towards Severe Mental Illnesses •Vignettes describing symptoms of

schizophrenia more negatively evaluated than vignettes describing major depression.

•Labeling vignettes as schizophrenia increased negative attributions compared to labeling of depression vignettes. Angermeyer and Matschinger (2003)

Stigma’s Impact on Individuals with Mental Illness

•Stigma acts as an external force that can potentially increase negative self esteem or self blame or push an individual back into a pattern of abnormal behavior (Stier and Hinshaw, 2007)

•Thus in order to avoid social judgment and the consequences of stigma an individual can conceal the condition. The decision to conceal the condition can lead to further psychological distress (Pachankis, 2007).

Concealing Mental Illness• The degree to which a concealable stigma produces psychological

distress depends upon the degree of anticipated stigma as well as the centrality, how closely an individual relates their identity to the stigmatized condition, and the salience, how frequently the stigmatized condition affects the individual (Quinn and Chaudoir, 2009).

• Currently there seems to be little respite for many with mental illness as both public and self stigmas have been found to lessen the engagement in and effectiveness of mental health treatment.

• Vogel, Wade, and Hackler (2007) found that an increased perception of general stigma creates an increased self stigma which can then influence attitudes towards the counseling process and affect a person’s overall willingness to seek and engage in psychological treatment.

Self Injury and Stigma• Research provides evidence of severe mental illnesses

being more greatly stigmatized.

• Research about self injury currently lacking compared to other mental illnesses.

• Self Injury is unique in that the behavior causes physical as well as mental damage to individuals.

• Potential for high level of stigma on basis of not only impaired social interaction and functionality, but also along lines of physical disfigurement.

“Despite the antiquity, ubiquity, and relatively high prevalence of deviant self-mutilation, psychiatric attention has seldom been focused upon it because of the perception—shared by the general public and many mental health professionals—that it is a senseless, repugnant, frightening, mysterious behavior.” (Favazza, 1997, p. 288)

•Stigma towards self injury may perpetuate or worsen the behaviors. Stigma could create pressure to conceal the condition which would then lead to greater psychological distress and anxiety which could in turn incite more self injurious behavior.

•Stigma used as a deterrent for majority, but for those experiencing mental illness it can potentially worsen conditions.

• Hypothesized that stigma and severity of mental illness are linked. More severe mental illnesses with illicit greater stigma from the general population.

• Mental illness such as self injury will be more highly stigmatized than common mental illness such as depression

• Experiment was constructed to measure degree of perceived stigma as a response to either a severe (self injury), or common (depression) mental illness.

Participants

•Random selection of Carthage freshman from heritage classes.

•107 total participants •35 control group, 36 self injury group, 36

depression group

Materials

• Three separate character vignettes were created for the experiment The vignettes were identical aside from the indication of the individual previously being treated for either depression or self injury. The control vignette omitted the sentence indicating past mental illness.

• adapted form of Link’s devaluation discrimination scale (Link, 1987). Participants were given a list of 12 statements relating to how the individual is treated or perceived by most people.

• The participants indicated the level to which they agreed or disagreed with each statement using a 6 item Likert scale ranging in value from strongly disagrees to strongly agree.

Design and Procedure• The independent variable has three conditions: the self injury

condition, the depression condition, and the control condition where no mental illness is present. The independent variable is manipulated by altering the vignette given to participants.

• Participants were randomly assigned to an experimental group, either the depression vignette group, self injury vignette group, or control vignette group.

• The dependent variable, the participants’ perceived level of stigma towards the individual described in the vignette, was measured by the participants’ level of agreement with each of the statements.

Results• Total stigma scores were compiled by summing the Likert

responses for each participant higher positive score represented greater stigma. A one way analysis of variance (ANOVA) and Tukey test were calculated.

• The ANOVA was significant, F (2, 104) =5.405, p=.006.

• Participants showed higher perception of stigma towards the self injury group (M=35.06, SD=8.947) than the depression group (M=29.83, SD=7.998) and the no mental illness group (M=29.89, SD=5.855).

• The self injury group was significantly different than both the

depression group, p=.014, and the non mental illness group, p=.016. The depression group however was not found to be significantly different from the non mental illness group.

Summary StatisticsN Mean Std. Deviation Std. Error

Self Injury 36 35.06 8.947 1.491

Depression 36 29.83 7.998 1.333

Control 35 29.89 5.855 .990

Total 107 31.61 8.040 .777

Series112

22

32

42

52

62

72

Type of Mental IllnessSelf InjuryDepressionControl(No Mental Illness Treatment)

Stig

ma

Scor

e

Discussion• Evidence that stigma towards more severe

mental health conditions is in fact higher.

• Stigma present despite past incidence and possibility of condition no longer being an issue.

• Depression may no longer be viewed with stigma

the same way more severe mental illnesses are. Shows signs of progress and greater acceptance among younger or more educated populations.

Discussion• Need further research to determine what aspects of

severe mental illness, specifically self injury, creates stigma in order to reduce stigma and increase treatment seeking among individuals with severe mental illness.

• More refined measurement tools and instruments for measuring stigma. Possibly a need for separate instruments for each mental illness.

• Further research measuring how stigma can influence individual self construal and behavior in terms of mental illness.

References• Angermeyer, M., & Matschinger, H. (2003). The stigma of mental illness: Effects of

labeling on public attitudes towards people with mental disorder. Acta Psychiatrica Scandinavica, 108(4), 304-309. doi:10.1034/j.1600-0447.2003.00150.x.

• Corrigan, P., River, L., Lundin, R., Uphoff Wasowski, K., Campion, J., Mathisen, J., et al. (2000). Stigmatizing attributions about mental illness. Journal of Community Psychology, 28(1), 91-102. doi:10.1002/(SICI)1520-6629(200001)28:1<91::AID-JCOP9>3.0.CO;2-M.

• Favazza, Armando. (1996). Bodies under siege. Baltimore: The John Hopkins University Press.

• Link, B. (1987). Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection. American Sociological Review, 52(1), 96-112.

• Major, B., & O'Brien, L. (2005). The Social Psychology of Stigma. Annual Review of Psychology,

• 56393-421. doi:10.1146/annurev.psych.56.091103.070137.

• National Institute of Mental Health, Initials. (2010, May 7). The Numbers count: mental disorders in America. Retrieved from http://www.nimh.nih.gov/health/publications/the-numbers-count- mental-disorders-in-america/index.shtml#CensusBureauTable2

References• Nock, M., & Mendes, W. (2008). Physiological arousal, distress tolerance, and social

problem-solving deficits among adolescent self-injurers. Journal of Consulting and Clinical Psychology, 76(1), 28-38. doi:10.1037/0022-006X.76.1.28.

• Pachankis, J. (2007). The psychological implications of concealing a stigma: A cognitive-affective-behavioral model. Psychological Bulletin, 133(2), 328-345. doi:10.1037/0033-2909.133.2.328.

• Quinn, D., & Chaudoir, S. (2009). Living with a concealable stigmatized identity: The impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. Journal of Personality and Social Psychology, 97(4), 634-651. doi:10.1037/a0015815.

• Stier, A., & Hinshaw, S. (2007). Explicit and implicit stigma against individuals with mental illness. Australian Psychologist, 42(2), 106-117. doi:10.1080/00050060701280599.

• Vogel, D., Wade, N., & Hackler, A. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology, 54(1), 40-50. doi:10.1037/0022-0167.54.1.40.