Self-stigma has always intrigued me, both in my clinical work and personal life. While much research has explored different types of mental health stigma—whether public, systemic, or internalized—the most insidious kind often comes from within. As the famous horror quote says, “The call is coming from inside the house.”

The Pain of Internalized Stigma

Shame and guilt—those sharp emotional stings and long-lasting aches—are at the heart of stigma. Internalized stigma doesn’t just affect mental health; it appears across other societal dimensions too: internalized racism, misogyny, antisemitism, ableism, and more. These forms of self-directed prejudice slowly corrode a person’s self-worth, reinforce external stigma, and perpetuate cycles of discrimination across generations.

Interestingly, most psychiatric research on self-stigma has historically focused on conditions like schizophrenia, bipolar disorder, and psychosis, likely due to their more visible social stigma. Yet, despite being widespread and socially « normalized, » major depressive disorder (MDD) and related conditions—PTSD, OCD, anxiety and ADHD have received comparatively less attention in self-stigma studies.

A Global Study: Depression, Self-Stigma, and Empowerment

A recent paper in the Journal of Affective Disorders (Lasalvia et al., 2025) explores self-stigma in individuals diagnosed with MDD, with an emphasis on empowerment—a concept that counters low self-esteem, shame, and hopelessness often seen in depression.

The cross-national study included over 1,000 participants from 34 countries as part of the ASPEN/INDIGO-Depression project. Researchers measured:

• Empowerment using the Boston University Empowerment Scale (BUES).
• Self-esteem with the Rosenberg Self-Esteem Scale (RSES).
• Self-stigma through the Internalized Stigma of Mental Illness (ISMI) scale.

They also examined country-specific results through the United Nations Human Development Index (HDI) to assess cultural and socioeconomic influence.

How Self-Stigma Works

Self-stigma develops in three phases:

1. Awareness of public mental health stereotypes.
2. Belief in these stereotypes.
3. Identification with them personally.

This internal process undermines self-esteem, damages relationships, and disrupts daily functioning. More critically, it creates a vicious feedback loop between depression and negative self-perception, making recovery more difficult.

In contrast, higher self-esteem supports resilience, motivation, and self-care.

The Power of Empowerment

Empowerment is a vital part of recovery. It increases a person’s sense of control—what psychologists call internal locus of control—and is linked with hope, optimism, and active participation in treatment decisions. In psychoanalytic terms, it aligns with what Bion called the psychoanalytic function of the personality—the ability to face emotional truth and integrate it in a constructive way.

What the Study Found

The research found that self-stigma had a direct and indirect negative impact on empowerment, especially through lowered self-esteem. In fact, 42% of participants reported elevated levels of self-stigma.

These patterns were observed across all countries, regardless of their HDI, though higher-development countries showed a stronger impact—perhaps due to more subtle societal pressures. This underlines the universal need to address stigma, both internally and systemically.

Implications for Treatment

The study suggests that tackling self-stigma could significantly improve recovery outcomes for people with depression. This includes using:

• Therapy targeting negative self-beliefs.
• Peer-led interventions.
• Programs designed to boost self-esteem and empowerment.
  

Such efforts may help people engage in treatment more fully and regain their sense of agency and future hope.

Given that depression affects more than mood—impacting motivation, self-worth, decision-making, and physical health—addressing self-stigma is not just important, it’s essential.

A Path to Healing

Recognizing and working through internalized stigma is a demanding emotional process. It requires self-compassion and sometimes professional support. On a broader level, society must also acknowledge and dismantle the external stigmas that shape our internal worlds.