Internalized Stigma and Narcissistic Regulation Among Patients With Endogenous Psychoses

Abstract

Introduction. Self-stigma in mentally ill patients is an urgent problem in psychiatry. In literary sources, the impact of personal characteristics of patients with psychosis on the formation of internalized stigma remains insufficiently studied. This study aims to examine the mutual influence of narcissistic self-regulation and self-stigma factors as well as to identify protective characteristics of narcissistic regulation related to the minimization of internalized stigma. Methods. The study sample comprised 81 psychiatric in-patients, 62 of whom had ICD-10 F2 disorders and 19 had ICD-10 F3 disorders. The study used the following assessment tools: (a) the Internalized Stigma of Mental Illness (ISMI) scale and (b) the Index of Self-system Functioning (ISSF). Statistical procedures were as follows: descriptive statistics, analysis of variance (Mann–Whitney U test), and calculation of the effect size with Cohen’s d. Results. In the surveyed sample, the ISSF results indicated significant decrease in narcissistic regulation for all the subscales and the total ISSF score (21.1 ± 4), compared to the normative value for an ideally strong personality (0). The mean self-stigma level of the surveyed patients was low (2.4 ± 0.24); the threshold of 2.5 points was exceeded among 30 patients (37 %), which indicates a highly intense of self-stigma. We compared the features of narcissistic regulation in patients with high and low levels of self-stigma and observed significant relationship between manifestations of internalized stigma and factors of personal strengths. Cohen’s d effect sizes for eight subscales (Self1, Self2, Self3, Self5, Self6, Self7, Self12, Self18) were 1.1–1.8 at p ≤ 0.05, which indicates a significant decrease in narcissistic regulation among patients with a high level of self-stigma. Discussion. The characteristics of the system of narcissistic regulation determine the decrease in personal strengths, which may contribute to social maladjustment and to the formation of internalized stigma. The individualized profiles related to deficiency of adequate defense mechanisms may be valuable in focused psychotherapeutic interventions.

Keywords

• psychosis
• stigma
• internalized stigma
• psychiatry
• protective factors
• personal strengths
• self-system regulation
• narcissistic self-regulation
• endogenous psychoses
• psychotherapeutic intervention