(PS2-5) An Investigation of Internalized Stigma in Anxiety and Related Disorders

In Western communities, anxiety disorders constitute the largest group of mental disorders and lead to substantial burden and disability. Although effective treatments like cognitive behavioural therapy (CBT) exist for anxiety disorders, factors like stigma can impact the uptake and effectiveness of these treatments. Stigma refers to stereotypes and prejudices about mental illness. Internalized stigma (IS) is where individuals accept and apply these prejudices to themselves. While the literature on IS and mental illness has been growing over the last 25 years, there is limited information on IS in those with anxiety and related disorders. For example, is the level of IS consistent across different anxiety and related disorders? What clinical variables might predict the level of IS in individuals? The purpose of this study was to investigate IS in a treatment seeking population with anxiety and related disorders. Specifically, principal diagnosis, symptom severity, the number of diagnoses, and the presence of certain comorbidities (Substance Use Disorders and Personality Disorders) were investigated as predictors of IS. Participants were outpatients of a tertiary care anxiety disorders clinic in a public hospital in Hamilton, Ontario, Canada. The sample included 202 adults (mean age: 33.9 years; females: 148) with a principal diagnosis of an anxiety or related disorder (Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Obsessive-Compulsive Disorder (OCD), Posttraumatic Stress Disorder (PTSD), Panic Disorder/Agoraphobia). IS was assessed using the Internalized Stigma of Mental Illness 10-item scale (ISMI-10). Symptom severity was assessed using self-report measures for respective principal diagnoses, including the Penn State Worry Questionnaire–Past Week, Social Phobia Inventory, Yale Brown Obsessive-Compulsive Scale, PTSD Checklist for DSM-5, and the Panic Disorder Severity Scale-Self Report. R (version 4.2.3 GUI 1.79 High Sierra build) was used to create a multiple linear regression model to estimate relationships between ISMI-10 scores and the various independent variables, and then further analyzed with an analysis of variance and a comparison of marginal means. Principal diagnosis (F(4, 188) = 7.04, p < 0.001) was a significant predictor of IS. Individuals with a principal diagnosis of SAD reported higher IS than those with GAD (β = -0.69, SE = 0.18, p = 0.004) and OCD (β = -0.90, SE = 0.20, p < 0.001), while those with a principal diagnosis of PTSD reported higher IS than those with OCD (β = -0.76, SE = 0.21, p = 0.004). Greater symptom severity (β = 0.97, SE = 0.25, p < 0.001) and greater total number of diagnoses (β = 0.19, SE = 0.07, p = 0.005) were also associated with higher IS. The presence of a comorbid Personality Disorder was seen approaching significance (F(2, 188) = 2.77, p = 0.06), with those with Obsessive-Compulsive Personality Disorder reporting less IS than individuals without a Personality Disorder (β = -0.76, SE = 0.33, p = 0.06). These results may guide clinicians to assess IS in patients with SAD, higher symptom severity, and higher total number of diagnoses, while also being mindful of comorbid personality disorders to ensure that IS is not impacting treatments like CBT.