Internalized Stigma Among Individuals With Bipolar Disorder: Associations With Sociodemographic and Clinical Characteristics From a Specialized Affective Disorders Unit

Abstract

Background:

Bipolar disorder (BD) is a complex mood disorder among the leading causes of disability worldwide. Internalized stigma refers to the awareness of negative stereotypes adopted by society and the agreement with these judgments, often associated with impaired functionality and social adaptation. Studies examining internalized stigma and related factors in BD are limited.

Aims:

Our study aimed to evaluate the associations between internalized stigma and sociodemographic, marital, and clinical characteristics of individuals with BD.

Method:

One hundred and eighteen individuals with BD followed up at a specialized affective disorders unit were included. Participants’ data were collected via follow-up documents and clinical interviews. The Internalized Stigma of Mental Illness Scale (ISMIS) was administered to assess internalized stigma.

Results:

The mean ISMIS total score was 56.50. Being unemployed (p = .012, B = 0.208), shorter BD duration (p < .001, B = −0.302), presence of inter-episode residual symptoms (p = .004, B = 0.248), and higher depressive scores (p = .001, B = 0.275) predicted increased internalized stigma. Younger age (p = .002, B = −0.264), being female (p = .007, B = 0.226), absence of mania dominance (p = .019, B = 0.190), and higher depressive scores (p = .002, B = 0.260) predicted alienation scores. The presence of inter-episode residual symptoms predicted both stereotype endorsement (p < .001, B = 0.320) and perceived discrimination (p < .001, B= 0.358). Younger age (p = .001, B= −0.281) and a total number of depressive episodes (p = .015, B = 0.212) also predicted perceived discrimination. Shorter BD duration (p = .005, B = −0.238), absence of seasonality (p = .047, B = 0.169), and higher depressive scores (p < .001, B = 0.320) predicted social withdrawal, while a history of hospitalization (p = .033, B = 0.203) predicted stigma resistance.

Conclusions:

Considering that internalized stigma is increased in earlier stages of BD, as well as in individuals with inter-episode residual symptoms, it might be important to implement effective psychosocial practices for internalized stigma, which might be modifiable through targeted interventions in the earlier periods. Therefore, a multidimensional and holistic approach toward internalized stigma may positively contribute to the functionality and quality of life of patients with BD.