There are several interacting levels of stigma: social, structural, and internalised. Social (public) stigma occurs within a large group, such as members of the general public, who collectively adopt stereotypes about the victims of stigma. Structural stigma refers to the institutional rules, policies, and procedures that restrict the rights and opportunities of particular groups of people. Internalised stigma occurs within an individual, such that a person’s attitude may reinforce a negative self-perception of mental disorders, resulting in reduced sense of self-worth, anticipation of social rejection and often a desire for social distance.

Stigma can be an important barrier to seek out proper treatment. Interventions to reduce stigma include mass media programs, contact with patients either in person, by video or imaginary, education programs, family interventions, and symptom simulation.

What is the evidence regarding stigma toward bipolar disorder?

Moderate to low quality evidence suggests medium to high levels of internalised stigma in patients, and lower levels of internalised stigma in family members and caregivers of people with bipolar disorder. Moderate to high quality evidence indicates medium to strong relationships between more internalised stigma and more symptom severity, less hope, less self-esteem, less empowerment, less self-efficacy, less quality of life, less social support and less treatment adherence.

Moderate to low quality evidence found public attitudes towards bipolar disorder are generally more positive than public attitudes towards schizophrenia, but less positive than public attitudes towards depression. Moderate to high quality evidence indicates a medium-sized effect of reduced social stigma towards people with a mental illness, including bipolar disorder, following intergroup contact. Intergroup contact was particularly useful for improving attitudes, prejudice, and intentions in people without a mental illness towards people with a mental illness. Moderate to low quality evidence found mass media interventions may reduce prejudice, but not discrimination, of people with a mental disorders.

November 2021

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Internalised stigma occurs within an individual, such that a person’s attitude may reinforce a negative self-perception of mental disorders, resulting in reduced sense of self-worth, anticipation of social rejection, and a desire for social distance. Stigma can be an important barrier for people with bipolar disorder to seek out proper treatment. Also see the related topic on stigma under the course and outcomes category.

What is the evidence for therapies for internalised stigma?

Moderate to high quality evidence suggests a small effect of reduced internalised stigma with targeted interventions comprising psychoeducation and peer-led group discussion.

November 2021

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