The Paradox of Self Stigma in Serious Mental Illnes

描述（由申请人提供）：许多精神疾病患者可能会通过自我污名化来应对污名化。自我耻辱感（定义为由于相信关于精神疾病的各种刻板印象而导致的自尊和自我效能降低）已被证明会破坏对经验合理的治疗方案的坚持，并破坏对康复目标的追求。然而，个人对耻辱的反应是一个相当复杂的经历，最好理解为一个悖论。一些患有精神疾病的人对精神刻板印象的反应是自尊心和自我效能的降低。然而，其他人则被刻板印象所激励，并以正义的愤怒回应。第三组人似乎对这种体验相对漠不关心。我们在这个探索性/发展性拨款申请中提出了两项研究，以更好地理解自我耻辱和我们的悖论模型。在研究1中，我们开发并评估了严重精神障碍患者的自我耻辱感测量方法。测试项目反映了自我耻感的三个组成部分：刻板印象的意识、刻板印象对自我的应用（刻板印象-自我认同）和自我认同导致自尊和自我效能的降低（自我认同-自尊降低）。我们采用Link （1987; et al., 2001）的贬值-歧视量表作为刻板印象意识的评估量表，并增加了相应的刻板印象自我认同和自我认同自尊下降的评估项目。在初步开发阶段，50名患有严重精神疾病的研究参与者将完成两次测试；随后的项目分析将产生一个更合理的心理测量方法。在第二阶段，另外70名患有严重精神疾病的参与者将接受修订后的量表，以及自尊、自我效能、抑郁、社会线索感知、疾病意识和思维障碍的测量。

DESCRIPTION (provided by applicant): Many people with mental illness may personally respond to stigma by self-stigmatizing. Self-stigma (defined as lowered self-esteem and diminished self-efficacy that result from believing the various stereotypes that exist about mental illness) has been shown to undermine adherence to empirically-sound treatment programs as well as derail the pursuit of rehabilitation goals. The personal reaction to stigma is a fairly complex experience however, best understood as a paradox. Some people with mental illness respond to psychiatric stereotypes with diminished self-esteem and self-efficacy. Others, however, are energized by stereotypes and respond with righteous anger. A third group seems to be relatively indifferent to the experience altogether. We propose two studies in this exploratory/developmental grant application to better understand self-stigma and our model of paradox. In STUDY 1, we develop and evaluate a measure of self-stigma in people with serious psychiatric disability. Test items reflect the three components of self-stigma: awareness of the stereotype, application of the stereotype to one's self (stereotype self-concurrence), and having self-concurrence lead to diminished self-esteem and self-efficacy (self-concurrence esteem decrement). We use Link's (1987; et al., 2001) Devaluation-Discrimination Measure as the scale to assess stereotype awareness and add corresponding items that evaluate stereotype self-concurrence and self-concurrence esteem decrement. In a preliminary stage of development, fifty research participants with serious mental illness will complete the test twice; subsequent item analysis will yield a more psychometrically sound measure. In the second stage, a sample of 70 other participants with serious mental illness will be administered the revised version of the scale along with measures of self-esteem, self-efficacy, depression, social cue perception, disease awareness, and thought disorder. In STUDY 2, effects of perceived legitimacy and in-group identification on self-stigma will be assessed. Seventy adults with serious mental illness will be administered the Measure of Self-Stigma in Mental Illness. They will also complete measures of the perceived legitimacy of mental illness stereotypes and in-group identification with people labeled mentally ill. A measure of righteous anger will also be collected. Findings from the proposed research will provide a necessary first step in designing strategies for helping people cope with self-stigma.