The Content and Process of Self-Stigma in People With Mental Illness

Although many individuals with mental illness may self-concur with the "content" of stigmatizing thoughts at some point in their lives, they may have varying degrees of habitual recurrence of such thoughts, which could exacerbate their experience of self-stigma and perpetuate its damaging effects on their mental health. Although it is important to understand the "process" of how self-stigmatizing thoughts are sustained and perpetuated over time, no research to date has conceptualized and distinguished the habitual process of self-stigma from its cognitive content. Thus, the present study aims to develop and validate a measure of the habitual process of self-stigma-the Self-stigmatizing Thinking's Automaticity and Repetition Scale (STARS). In this study, 189 individuals with mental illness completed the STARS, along with several explicit (self-report) and implicit (response latency) measures of theoretically related constructs. Consistent with theories of mental habit, an exploratory factor analysis of the STARS items identified a 2-factor structure that represents the repetition (4 items) and automaticity (4 items) of self-stigmatization. The reliability of the STARS was supported by a Cronbach's alpha of .90, and its validity was supported by its significant correlations with theoretical predictors (content of self-stigma, experiential avoidance, and lack of mindfulness), expected outcomes (decreased self-esteem, life satisfaction, and recovery), and the Brief Implicit Association Tests measuring the automatic processing of self-stigmatizing information. With the validation of the STARS, future research can consider both the content and process of self-stigma so that a richer picture of its development, perpetuation, and influence can be captured.