Social anxiety and self-stigma in schizophrenia: associations with self-compassion and self-esteem

Self-stigma in the context of serious mental illness is defined as the internalization of stigmatizing attitudes into one's identity.  Studies have shown that about one third of people diagnosed with serious mental illness, such as schizophrenia, have high levels of self-stigma which is associated with diverse negative self-perceptions. Although studies have established the association between self-esteem, self-compassion, and self-stigma among people with schizophrenia, the role of social anxiety – including withdrawal behaviors – in predicting self-stigma and its implications has been less addressed.  The reported study exaimned the associations between self-compassion, self-esteem, social anxiety, and self-stigma among people with schizophrenia. The baseline data of 56 adults with schizophrenia who were enrolled in a Metacognitive Reflection and Insight Therapy trial were used. Participants filled out self-report questionnaires measuring self-compassion, self-esteem, social anxiety, and self-stigma. Self-esteem and self-compassion were negatively correlated with self-stigma and social anxiety. Self-compassion was not found to contribute beyond self-esteem to the prediction of self-stigma. Importantly, self-esteem and social anxiety were found to mediate the effects of self-compassion on self-stigma. Thus, it seems that social variables, in addition to self-variables, may lead to the formation of self-stigma among people with schizophrenia. Given the significance of the mediation model  and the role that social anxiety might have in the formation of self-stigma, it seems important for therapies aimed at reducing self-stigma to include therapeutic elements related to coping with social anxiety, in addition to addressing elements of self-esteem and self-compassion.