Difference as an indicator of the self-stigma of mental illness

Background People with mental illness are viewed as different from the general population resulting in public stigma. When public stigma becomes internalized, it leads to self-stigma. The most distal stage of self-stigma is harm which can lead to negative self-concepts that inhibit recovery. Aim This study examines how perceptions of "differentness" reflect self-stigma. We developed the Differentness Self-Stigma Scale (DSSS) to assess four regressive stages of self-stigma - awareness, agreement, application, and harm - and aimed to see whether DSSS scores predict self-stigma more effectively than the Self-Stigma of Mental Illness Scale (SSMIS). Method Participants with lived experience (N = 291) completed a survey including the DSSS, SSMIS and outcomes assessing depression, self-esteem, recovery and the "why try" effect. Results DSSS scores differed significantly from the SSMIS in the agreement and harm stages of self-stigma. Higher self-stigma scores on the DSSS harm subscale predicted lower self-esteem and higher depression scores. However, the DSSS did not demonstrate a regressive pattern between all four stages of self-stigma like the SSMIS. Conclusion The increase of DSSS scores at the application stage may be explained by perceived public stigma (i.e. how the public understands differentness). Future research should unpack the effects of perceived difference on self-stigma for the DSSS.