silhouette two heads to illustrate bipolar disorder

Despite decades of educational efforts and awareness campaigns, many people cling to the mistaken belief that individuals with mental health disorders are dangerous, incompetent, or otherwise inherently and irrevocably flawed – and when this happens to people with a mental health disorder, it’s called self-stigma, which is a remarkably common phenomenon among people with bipolar disorder.

The unrelenting stigmatization of mental illness can have a profound negative impact on those who are living with depression, schizophrenia, personality disorders, and other mental health concerns. The many potential effects of mental health stigma include:

  • Diminished interpersonal support
  • Delayed academic progress
  • Difficulties finding and keeping a job
  • Fewer opportunities for career advancement
  • Increased risk of being bullied or otherwise harassed
  • Social withdrawal or ostracization
  • Failure to seek treatment

The judgements and misinformed opinions of others can cause significant harm, but stigma is not solely an external influence. As we mention above, people who have mental illnesses often internalize the hurtful comments that they have heard or been told directly.

Self-stigma can understandably undermine the confidence and self-esteem of anyone with any type of mental health disorder. Recent research indicates problematic among people with bipolar disorder.

The Roots of Self-Stigma

Self-stigma occurs when a person with a mental illness begins to believe the negative thoughts and opinions that they have heard expressed about people who struggle with mental health concerns.

But where did these external viewpoints originate? Why do so many people continue to view mental illness (and the people who develop them) in such a harsh and unforgiving light?

In a detailed review of mental health stigma in the journal EMBO Reports, author Wulf Rössler reported that this unfortunate phenomenon has existed for thousands of years. For example, during the Middle Ages, mental illness was viewed as a punishment from God, and was often addressed by putting the mentally ill individual to death.

Unfortunately, the fears that caused this horrific approach continue to permeate the modern world. Rössler observes:

“The stigma attached to mental illness is ubiquitous. There is no country, society or culture where people with mental illness have the same societal value as people without a mental illness.”

Many forces contribute to stigma, Rössler explained, drawing attention to factors such as:

  • Unfamiliarity. Rössler reported that people with schizophrenia face much greater stigmatization than people with depression. He hypothesized that this is because people are more familiar with depression.
  • Mass media. Both fictional accounts of mental illness and sensationalized news reports reinforce problematic stereotypes.
  • The healthcare industry. Rössler connects the time when we hid people with mental illness in institutions to modern studies that reveal bias among professionals toward people with mental illness.

When someone grows up in a culture where mental health stigma is virtually omnipresent, Rössler wrote, they often apply this negative viewpoint to themselves if they, themselves, develop a mental illness.

In other words, someone who conditioned to believe that mental illness results from weak character or other inherent flaws may view themselves as weak or flawed when they receive a mental health diagnosis.

What Self-Stigma Feels Like

Kelly C. Kirby, MS, LPCC, is a mental health professional who has bipolar disorder. In a post on the website of the International Bipolar Foundation (IBF), Kirby reported that she sometimes views this disorder as an enemy, and sometimes considers it as her “partner in life.”

“When I reflect on this ideological difference, I wish I could blame external events or influential people for my shifting perspective,” Kirby wrote. “However, I know that my focus changes most drastically because of self-stigma.”

For Kirby, self-stigma manifests as a fear that she isn’t up to the challenge of managing her symptoms while also meeting her personal and professional responsibilities. Here’s how she describes this:

The clouds roll in, though, and I can quickly turn on myself. My thoughts change from “I’m doing well” to “I’m going to fail” sharply and almost without notice sometimes. …
The thought that causes me the most difficulty is “I can’t handle this.” Once I’m there, self-stigma strongly settles in. I begin to doubt my loved ones and their intentions, believing that I need to “protect them” from my thoughts and feelings. I consider that others in my profession judge me for having this diagnosis and suddenly feel like I need to compensate in some way; I will take on extra work or create a new project for myself, all in an effort to “prove” that I “still have worth” in some way.

As Kirby’s example indicates, self-stigma can begin with a sense of personal deficiency, and quickly morph into a downward spiral of shame and distrust.

While Kirby recognizes and addresses self-stigma before these emotions cause significant harm, others – without similar coping skills – may allow their negative feelings about themselves to undermine their mental health and sabotage their relationships.

The Impact of Self-Stigma

In August 2023, the Journal of Affective Disorders published a review of previously released research on self-stigma and bipolar disorder. This review, conducted by Sophie Favre and Hélène Richard-Lepouriel of Geneva (Switzerland) University Hospital, included 66 studies published before February 2022.

Favre’s and Richard-Lepouriel’s research shows the degree to which self-stigma can negatively impact people with bipolar disorder:

  • The consequences of self-stigma among people with bipolar disorder include low self-esteem, social anxiety, social withdrawal, poverty of relationships, low self-efficacy, diminished functioning, hopelessness, and poor quality of life.
  • Among people with bipolar disorder, those who had high levels of self-stigma were less likely to seek professional help and more likely to be hospitalized.
  • Self-stigma has a demonstrable negative influence on the “clinical expression, course, and prognosis of bipolar disorder and was associated with global functional impairment in several domains.”

Favre and Richard-Lepouriel also found that self-stigma can prevent people from benefitting from certain types of treatment for bipolar disorder. This may be especially true when it comes to the prescription medications that many people rely on to alleviate the symptoms that this disorder can cause.

Many of the medications that are used to treat bipolar disorder can cause obvious side effects, such as weight gain, persistent exhaustion, restlessness, and impaired speech.

These effects, Favre and Richard-Lepouriel noted, can exacerbate self-stigma. This can cause the individual to discontinue their medication use, which can lead to a worsening of their mental health condition. This may be one reason why a recent study found that 63% of bipolar disorder patients fail to adhere to treatment guidance.

Overcoming Self-Stigma

Given both the ubiquity and the potential harm of self-stigma, it’s a topic that therapists address in treatment.

In their Journal of Affective Disorders article, Favre and Richard-Lepouriel noted the following approaches help decrease self-stigma among patients with bipolar disorder.

Decreasing Self-Stigma: 4 Helpful Approaches

  • Psychoeducational efforts that focus on self-stigma
  • Cognitive behavior therapy (CBT) and similar restructuring techniques
  • Interventions that discuss how to disclose a mental illness
  • Multicomponent interventions that combine several of these techniques

Unfortunately, they wrote, studies indicate these efforts only lead to minor improvements. Also, researchers have not explored the long-term benefits of such interventions.

Favre and Richard-Lepouriel refer to a 2007 study that called on clinicians to take the following steps to address stigma among their patients:

Decreasing Self-Stigma: Additional Approaches

  • Increase awareness of the stigmatizing aspects of clinical practice
  • Ensure meaningful involvement of the patient and their family members
  • Recognize that challenging stigma and discrimination is an inherent part of the profession
  • Campaign for adequate resources for treatment and research focused on fighting self-stigma

Of course, since the roots of self-stigma often take hold long before a person enters treatment, countering this form of internalized discrimination must also occur outside the clinical environment.

In his EMBO Reports article, Rössler recommended a three-pronged approach that all people can take to reduce both stigma and self-stigma.

Decreasing Self-Stigma: What We Can All Do

  • Disseminate information and education about mental illness
  • Protest against unfair descriptions of mental illness when you encounter them
  • Promote more direct contact with people with mental illness

Rössler described efforts to increase contact with people with mental illness as the “least spectacular but presumably most effective” way to reduce stigma. In many cases, this may not necessitate meeting new people. Instead, it may be a matter of opening our eyes to what our friends and neighbors experience on a daily basis.

“It is most likely that we meet someone with a mental disorder each day and that everybody knows someone who suffers or has suffered from such illnesses,” Rössler wrote. “If we are more aware of patients in our daily lives, we get a much more realistic picture of mental illness, which helps us to examine our stereotypes and adapt to reality.”