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Journal of Trauma & Dissociation
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wjtd20
Comparing Social Stigma of Dissociative Identity
Disorder, Schizophrenia, and Depressive Disorders
Bennett A. A. Reisinger & David H. Gleaves
To cite this article: Bennett A. A. Reisinger & David H. Gleaves (2023) Comparing Social Stigma
of Dissociative Identity Disorder, Schizophrenia, and Depressive Disorders, Journal of Trauma &
Dissociation, 24:2, 171-184, DOI: 10.1080/15299732.2022.2119459
To link to this article: https://doi.org/10.1080/15299732.2022.2119459
Published online: 04 Sep 2022.
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JOURNAL OF TRAUMA & DISSOCIATION
2023, VOL. 24, NO. 2, 171–184
https://doi.org/10.1080/15299732.2022.2119459
Comparing Social Stigma of Dissociative Identity Disorder,
Schizophrenia, and Depressive Disorders
Bennett A. A. Reisinger BPsych (Hons) and David H. Gleaves PhD
University of South Australia, Justice & Society, Adelaide, South Australia, Australia
ABSTRACT
ARTICLE HISTORY
The aim of the current study was to explore how the social
stigmatization of dissociative identity disorder (DID) compared
to that of schizophrenia and depressive disorders. Using
a between-subjects experimental design, a total of 139 partici
pants (126 usable data [39 men, 84 women, 3 other]) from the
general population were randomly assigned to either a DID,
schizophrenia, or depressive disorders experimental condition
and responded to an adapted version of the Prejudice Toward
People With Mental Illness (PPMI) Scale. Results suggested that,
overall, depressive disorders were stigmatized against the least,
schizophrenia was stigmatized against the most, and DID was
intermediate, with its PPMI score being closer to schizophrenia
than that of depressive disorders. We also found the same
pattern for most of the subscales of the PPMI. At least relative
to other well-known disorders, there is negative stigma asso
ciated with having DID.
Received 15 December 2021
Accepted 6 June 2022
KEYWORDS
Dissociative identity disorder
(DID); schizophrenia;
depressive disorders; stigma;
prejudice toward people
with mental illness scale
(PPMI)
In addition to the challenges typically associated with having a psychological
disorder, individuals with such disorders are often subjected to negative
judgments and stigmatization (Rossler, 2016). With an estimated 10.7% of
individuals globally living with psychological disorders, the impact of stigma is
felt by a large population (Ritchie & Roser, 2018). High levels of stigma against
psychological disorders have been found consistently since the 1950s (Levy
et al., 2014).
The modern term “stigma” derives from the Latin word of the same name,
which represented a mark, dot or puncture, which was cut or burned into the
skin of criminals, slaves and traitors so they could be visually identified as
individuals with blemished and polluted morals who were to be avoided in
public places (Rossler, 2016). Ultimately, stigma represents any unfavorable
views of an individual as a result of distinguishing characteristics or traits that
are thought to be undesirable, a process that is instrumental in the restriction
of an individual’s ability to live or develop their potential (Coleman, 1986).
There are multiple forms of stigma (see, Grappone, 2017 for a review); how
ever, in this study we will focus on social stigma, which occurs when a person
CONTACT David H. Gleaves
david.gleaves@unisa.edu.au
C1-07 Magill Campus, Magill, SA 5072, Australia
© 2022 Taylor & Francis
University of South Australia, St Bernards Rd, Room
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B. A. A. REISINGER AND D. H. GLEAVES
endorses negative prejudices and stereotypes against a group of individuals,
resulting in intolerance and discrimination (Corrigan & Watson, 2002).
Social stigma can originate from several social domains, including employ
ment, housing, and health care, all of which present different challenges to
individuals living with psychological disorders (Levy et al., 2014). All of these
instances of social stigma make it extremely difficult for individuals with
psychological disorders to live comfortable and fulfilling lives. It is therefore
vital to further investigate social stigma and to update and review current
societal perceptions of psychological disorders. One factor that may affect the
amount of social stigma experienced is the specific psychological disorder with
which an individual is diagnosed. Exploring the social stigma of psychological
disorders in context and comparing the levels of social stigma between differ
ent psychological disorders is important to better understand stigma’s pre
valence and impact.
Although there is little research on the public perceptions of dissociative
identity disorder (DID), it is likely that through inaccurate media portrayals
and skepticism from academics, practitioners and the general public, a large
amount of social stigma surrounds this disorder. For decades, many health
professionals have dismissed the disorder, suggesting individuals are per
suaded to present symptoms by a psychotherapist, or are simply faking
symptoms based on depictions from media (Gleaves, 1996). Although there
is now substantial evidence that suggests these factors are not the cause of DID
(Brand et al., 2016), these notions have had a powerful impact on the way the
disorder is perceived. Myths and misinformation are known to cause higher
social stigma of psychological disorders, with evidence suggesting that knowl
edge about psychological disorders is negatively correlated with stigma toward
individuals with said disorders (Penn & Couture, 2002). Given the conflicting
information presented by health professionals and the misleading and inaccu
rate portrayals in media, it is likely that the general public has a sense of
confusion and mistrust regarding DID, which can, in turn, create fear and
spark intense social stigmatization (Penn & Couture, 2002). Given the pre
valence of factors that incite this stigma, it is imperative that we investigate
social stigma from the general public toward DID. As a comparison, we chose
two other disorders with predictably high and low levels of social stigma.
Schizophrenia is considered by many to be a highly stigmatized psycholo
gical disorder (Rossler, 2016). This disorder elicits responses of fear through
being associated with violence and unpredictability (Henderson et al., 2013).
Conversely, although stigma is still evident toward depressive disorders, it is
found to be at significantly lower levels compared to other investigated
psychological disorders (Werner & Segel-Karpas, 2020). Throughout this
study, we chose a class of disorders (depressive disorders) rather than
a single disorder as one of our comparison groups. We considered using the
more general term “depression,” but that is technically not the name of a DSM-
JOURNAL OF TRAUMA & DISSOCIATION
173
5 (American Psychiatric Association [APA], 2013) disorder, and we wanted to
be consistent in terms of referring to disorders. However, we were also
concerned that using the term “major depressive disorder” and/or “persistent
depressive disorder” might confuse some participants who were unaware of
the technical terms. Thus, we settled on “depressive disorders” with an expla
nation of what the term meant. Parcesepe and Cabassa (2013) conducted
a meta-analysis investigating social stigma of psychological disorders and
found the extent to which individuals with schizophrenia are considered
dangerous was more than that of individuals with depressive disorders.
Given the findings of previous literature, we predicted that there would be
comparatively lower levels of stigma associated with depressive disorders
when compared to both DID and schizophrenia, whereas schizophrenia
would be subject to the highest levels of stigma.
Although it is widely understood that DID is highly controversial and
associated with skepticism, there is very limited literature exploring the social
stigmatization of this psychological disorder. It is therefore important to
investigate this area and understand how individuals with DID are perceived
by the general population. Because both schizophrenia and depressive disor
ders are widely investigated within social stigma literature, and there is an
understanding of their respective levels of stigmatization when compared to
each other, it was useful to compare the social stigmatization of these psycho
logical disorders with that of DID in order to better understand how DID is
perceived. The aim of the current study was thus to explore how the social
stigmatization of DID compared to that of schizophrenia, a disorder known to
face high levels of social stigma, and depressive disorders, disorders that
experience comparatively lower levels of social stigma.
Method
Participants
To be eligible to participate in this study, participants were required to be 18 years
or older, live in Australia, and be proficient in the English language. For their
participation, they were eligible to receive one of five $60 gift cards. A total of 139
individuals met these inclusion criteria and participated in the study. However,
because of missing data, the final sample comprised 126 participants, of which 39
(30.95%) reported being male, 84 (66.67%) reported being female and 3 (2.38%)
reported being other. Ages ranged from 18 to 72 (M = 36.69, SD = 15.71). Of the
participants, 106 (84.1%) identified as having one ethnicity, 19 (15.1%) identified
as having two ethnicities and one (0.8%) identified as having three ethnicities. Of
the participants who identified as one ethnicity, 86.8% reported being Australian,
3.8% North-West European, 3.8% South-East Asian, 1.9% New Zealander, and
1.9% Southern and Eastern European. Of the people who endorsed two
174
B. A. A. REISINGER AND D. H. GLEAVES
ethnicities, the vast majority (89%) identified their ethnicity as Australian plus
another ethnicity, as did the participant who endorsed three.
Materials and measures
The prejudice toward people with mental illness (PPMI; Kenny et al., 2018) scale
The PPMI scale is a 28-item questionnaire that measures four factors of social
stigma regarding psychological disorders. The four-factor structure comprises
fear/avoidance (a belief that individuals with psychological disorders are
dangerous and therefore must be avoided), unpredictability (a belief that the
behavior of individuals with psychological disorders is unpredictable), author
itarianism (a belief that individuals with psychological disorders must be
controlled), and malevolence (a belief that individuals with psychological
disorders are inferior to the general population and they should not be
sympathized with). Each item is rated from “very strongly disagree” (coded
as −4) to “very strongly agree” (coded as +4), with the middle answer signify
ing unsure or neutral (coded as 0). Half of the items are reverse scored. The
average is then calculated, thus presenting a final social stigma score (PPMI
score) between −4 (least stigma) and +4 (most stigma). Each social stigma
factor also has a final score between −4 and +4.
Kenny et al. (2018) examined the psychometric properties of the PPMI scores
in three different studies with samples of psychology undergraduate students
and the general public, finding Cronbach’s alphas in each study between .91 and
.93. Additionally, the PPMI total scores were reported to have a 2-week testretest reliability of r = .73. Three experts in the field of psychological disorder
stigma and prejudice also rated the items for fidelity to the operational defini
tions and constructs. The PPMI total scores were also highly positively corre
lated with the Community Attitudes toward the Mentally Ill scale (r= .78).
For this study, with the permission of the original authors (B. Bizumic,
personal communication, May 8, 2020), we adapted the PPMI questions to
refer specifically to the three psychological disorders being examined in this
study. For example, in place of the original question “I am not scared of people
with mental illness,” the question on the DID adapted version read “I am not
scared of people who have dissociative identity disorder.” More examples of
questions from the adapted version of the PPMI can be found in Table 1.
Gunningham and Bizumic (2018) previously adapted the PPMI in a similar
way to create two new scales; the Prejudice Toward People with Schizophrenia
(PPS) and Prejudice Toward People with Depression (PPD) scales.
Design and procedure
This study was reviewed and approved by the appropriate human research
ethics committee. We utilized a between-subjects experimental design with
JOURNAL OF TRAUMA & DISSOCIATION
175
Table 1. Examples of questions from the adapted versions of the PPMI.
PPMI Version
PPMI Question
PPMI Question 4
Original PPMI
I am not scared of people with mental illness
DID Adapted Version
I am not scared of people who have dissociative identity disorder.
Schizophrenia Adapted Version
I am not scared of people who have schizophrenia.
Depressive Disorders Adapted Version I am not scared of people who have a depressive disorder.
PPMI Question 23
Original PPMI
People who develop mental illness are genetically inferior to other people
DID Adapted Version
People who develop dissociative identity disorder are genetically inferior
to other people.
Schizophrenia Adapted Version
People who develop schizophrenia are genetically inferior to other
people.
Depressive Disorders Adapted Version People who develop a depressive disorder are genetically inferior to other
people.
participants being randomly assigned to one of three experimental conditions:
DID, schizophrenia, or depressive disorders. We chose this design over
a within-subjects approach in order to reduce participant burden and elim
inate possible order effects.
The study was advertised to participants via recruitment flyers which were
displayed on university campus notice boards, and also posted on social media
by the research team. Other than word of mouth, these recruitment flyers were
the only direct method of participant recruitment. The recruitment flyer briefly
explained the purpose of the study (to compare and predict attitudes toward
various mental disorders), who was eligible to participate (individuals 18 years
or older, proficient in English, and residing in Australia), what participants were
required to do (complete an anonymous questionnaire online) and how long it
would take (approximately 10 minutes), what they would receive for completing
the study (go into a draw to receive a $60 gift card), as well as the ethics protocol
number and the contact details of the primary researcher. The flyer also
contained instructions on how to participate as well as a QR code and URL
link. To participate, participants utilized this URL link which directed them to
the study questionnaire which was facilitated via SurveyMonkey (http://www.
surveymonkey.com). When online, participants were presented with an infor
mation sheet and then provided informed consent to continue with the ques
tionnaire. The survey system automatically randomly assigned participants to
one of the three experimental conditions. After participants answered brief
demographic questions, they were presented with a definition of the psycholo
gical disorder to which they had been randomly assigned. These definitions are
presented in Table 2. All participants then went on to complete their experi
mental condition’s adapted version of the PPMI with reference to either DID,
schizophrenia, or depressive disorders. After completing the questionnaire,
participants were presented with a closing statement, providing mental health
resources as well as the researchers’ contact details. Finally, participants were
given the option to select a new URL link which allowed them to enter the draw
176
B. A. A. REISINGER AND D. H. GLEAVES
Table 2. Definition of the psychological disorders that were presented to participants.
Disorder
DID
Schizophrenia
Depressive
Disorders
Definition
Dissociative identity disorder is characterized by the experience of two or more distinctive
personality states, with each state potentially presenting different behaviors, memories,
perceptions, and motor functioning.
Schizophrenia is characterized by the experience of delusions (a belief or altered reality that is
persistently held despite evidence or agreement to the contrary), hallucinations (a
perception of having seen, heard, touched, tasted or smelled something that wasn’t actually
there), disorganized speech and behavior, and negative symptoms such as diminished
emotional expression.
Although there are a range of depressive disorders, they are generally characterized by
consistent and frequent depressed mood, and diminished interest in most activities
to win one of the available gift cards while maintaining the anonymity of their
survey responses. This link and subsequent participant information were man
aged by an independent party not linked to the present study.
Results
Missing data analyses
The data were entered into version 26 of IBM SPSS Statistics. First, listwise
deletion was used to remove the data of participants who were missing more
than 10% of the questions; participants who were missing more than 10% of
the questions were generally missing the whole questionnaire. With the
remaining data, after performing Little’s MCAR test, χ2 (107,
N = 126) = 115.82, p= .264, to assess if the data were missing completely at
random, we used the expectation maximization method (Graham, 2009) to
impute values for the remaining missing data.
Preliminary analyses
We conducted a randomization check using age and gender to ensure participant
randomization between the three experimental conditions. Participants identify
ing as “other” gender were excluded from analyses involving gender because
there were too few participants. The distribution of gender was statistically
equivalent across the three groups, χ2 (2, N = 123) = 2.30, p = .317, and there
was also not a statistically significant effect for age, F(2,123) = 1.30, p = .277.
There was also no significant interaction between experimental condition and
gender predicting age, F(2,117) = 0.19, p = .830. Thus, at least with regards to
those two variables, the randomization process appears to have worked.
Score reliability analysis
When we conducted a score reliability analysis, it suggested that the scores on
the total PPMI and all the PPMI subscales had acceptable internal consistency
JOURNAL OF TRAUMA & DISSOCIATION
177
Table 3. Internal consistency scores for the PPMI and PPMI subscale scores.
Experimental Condition’s α
Scales
PPMI (total)
Fear/Avoidance Subscale
Unpredictability Subscale
Authoritarianism Subscale
Malevolence Subscale
Total α
.91
.88
.78
.84
.74
DID
.88
.85
.81
.81
.79
Schizophrenia
.91
.89
.74
.84
.70
Depressive Disorders
.89
.81
.77
.86
.73
(α ≥ .70) according to Nunnally’s (1978) thresholds. Cronbach’s alphas are
presented in Table 3.
PPMI and PPMI subscale score comparisons
We used a two-way analysis of variance (ANOVA) to examine the effects of
experimental condition (which disorder) and gender on participants’ PPMI
scores. We also initially tested age as a covariate, but it was not a statistically
significant predictor of PPMI scores, so we eliminated it from the analysis. In
the ANOVA, when comparing PPMI total scores, there was a statistically
significant main effect for experimental condition F(2,117) = 13.12, p< .001
η2 = .18; however, there was no significant main effect for gender, F
(1,117) = 0.68, p= .412, η2 = .01, nor was there a statistically significant twoway interaction between experimental condition and gender, F(2,117) = 0.90,
p= .411, η2 = .02.
Because there was no statistically significant main effect for gender or
a significant two-way interaction between experimental condition and gender,
“other” gender participants were included in all subsequent analyses, but
gender was not included in these models. Means, standard deviations and
post-hoc comparisons of PPMI scores and PPMI subscale scores of the DID,
schizophrenia, and depressive disorders groups are presented in Table 4.
Tukey post-hoc pairwise comparisons suggested that the DID and schizo
phrenia groups’ PPMI scores were significantly different from those of the
depressive disorders group, but not from each other. The schizophrenia group
had the higher total PPMI scores followed by the DID group, with the
depressive disorders group having the lowest total PPMI scores. Cohen’s
d effect sizes (Cohen, 1992) for the total PPMI scores are presented in Table 5.
Subsequent one-way ANOVAs were conducted to examine the four
PPMI subscales. There was a significant main effect of experimental condi
tion for each of the four PPMI subscale scores (See, Table 4). Tukey posthoc tests indicated that, as with the total PPMI scores, the DID and
schizophrenia groups’ PPMI scores on the fear/avoidance and unpredict
ability subscales were significantly different from those of the depressive
disorders group, but not from each other. On the authoritarianism and
178
B. A. A. REISINGER AND D. H. GLEAVES
Table 4. Comparisons of PPMI and PPMI subscale score means of the DID, schizophrenia, and
depressive disorders experimental conditions.
Experimental Condition
PPMI Scales
PPMI Total Scores
Mean
Std. Dev.
Fear/Avoidance
Mean
Std. Dev.
Unpredictability
Mean
Std. Dev.
Authoritarianism
Mean
Std. Dev.
Malevolence
Mean
Std. Dev.
DID n = 49
Schizophrenia n = 41
Depressive Disorders n = 36
F (2,123)
η2
−1.27a
0.74
−0.94a
0.88
−1.80b
0.83
10.77**
.15
−1.24a
1.08
−0.64a
1.39
−2.00b
1.21
11.88**
.16
0.37a
0.92
0.42a
0.82
−0.24b
1.18
5.46*
.08
−1.79ab
1.23
−1.33a
1.29
−2.06b
1.21
3.49*
.05
−2.16ab
0.95
−1.95a
0.80
−2.55b
0.87
4.50*
.07
Higher PPMI scores represent higher levels of social stigma.
** p< .001
* p< .05
Means with same superscript are not statistically significant at p< .05 level.
Table 5. Cohen’s d values of PPMI and PPMI subscale score compar
isons between the DID, schizophrenia, and depressive disorders experi
mental conditions.
Experimental Conditions
PPMI Total Scores
DID
<
DID
>
Schizophrenia
>
Fear/Avoidance Subscale
DID
<
DID
>
Schizophrenia
>
Unpredictability Subscale
DID
<
DID
>
Schizophrenia
>
Authoritarianism Subscale
DID
<
DID
>
Schizophrenia
>
Malevolence Subscale
DID
<
DID
>
Schizophrenia
>
Cohen’s d
Schizophrenia
Depressive Disorders
Depressive disorders
0.41
0.67
1.01
Schizophrenia
Depressive Disorders
Depressive Disorders
0.48
0.66
1.04
Schizophrenia
Depressive Disorders
Depressive disorders
0.06
0.58
0.65
Schizophrenia
Depressive Disorders
Depressive disorders
0.37
0.22
0.58
Schizophrenia
Depressive Disorders
Depressive disorders
0.24
0.43
0.72
“” (greater than) represents which experimental condition had
the numerically higher PPMI score.
malevolence subscales however, only the PPMI scores of the schizophrenia
and depressive disorders groups differed significantly. Again, in all cases,
the schizophrenia group had the higher PPMI scores followed by the DID
JOURNAL OF TRAUMA & DISSOCIATION
179
group, with the depressive disorders group having the lowest PPMI scores.
Cohen’s d effect sizes (Cohen, 1992) for the PPMI subscale scores are
presented in Table 5.
Discussion
The purpose of this study was to explore how the social stigmatization of DID
compared to that of schizophrenia and depressive disorders. In terms of
overall stigma (PPMI total scores), the levels of stigma toward both schizo
phrenia and DID differed significantly from depressive disorders, but not from
each other. Schizophrenia was the most highly stigmatized disorder, closely
followed by DID, with depressive disorders being the least stigmatized.
To our knowledge, this is the first study to compare social stigma toward
DID with other psychological disorders and provides a preliminary indication
of DID’s relative standing in regard to social stigma levels. When surveying the
general public, Gunningham and Bizumic (2018) found stigma levels that were
similar to the current study, with PPMI scores for schizophrenia also being
significantly higher than scores for depressive disorders.
The results of our study support the vast literature suggesting that schizo
phrenia is one of the most highly stigmatized psychological disorders whereas
depressive disorders are comparatively less stigmatized (Rossler, 2016). As the
difference between social stigma levels toward both DID and schizophrenia
were not statistically significant in our study, our findings suggest that the level
of social stigma toward DID is more similar to other highly stigmatized
psychological disorders, like schizophrenia.
This finding is further illustrated by the Cohen’s d effect sizes, which suggest
that the difference between stigma levels toward schizophrenia and depressive
disorders were not only statistically, but also substantively significant
(d = 1.01), whereas the difference between the stigma levels toward DID and
schizophrenia was smaller (d = 0.41).
Comparisons of the PPMI subscale scores further support these conclu
sions, as stigma levels toward depressive disorders were the lowest, schizo
phrenia was the most highly stigmatized, and DID was the middlemost
stigmatized disorder on each subscale. Additionally, the level of stigma toward
DID was closer to the level of stigma toward schizophrenia on all PPMI
subscales except the Authoritarianism subscale, where it sat closer to that of
depressive disorders. This again suggests that DID is a highly stigmatized
psychological disorder whose levels of stigma were more similar to schizo
phrenia than to depressive disorders on three of the four PPMI subscales.
With the exception of the Authoritarianism subscale, these results and their
respective effect sizes complement the PPMI total scores, in that DID was
consistently closer to schizophrenia and further away from depressive disor
ders when it comes to social stigma levels. Why the pattern was somewhat
180
B. A. A. REISINGER AND D. H. GLEAVES
different for the Authoritarianism subscale is not totally clear. Items on that
subscale refer to the belief that individuals with the disorder should be con
trolled, and one item refers to the belief that such individuals should not be
allowed to have children. It is possible that participants were more likely to
endorse such items related to schizophrenia (relative to DID) because of
a belief that schizophrenia has a genetic origin; however, more research is
needed.
The results of each subscale further strengthen findings from previous
literature. Henderson et al. (2013) found that individuals with psychotic
disorders (e.g., schizophrenia) are more likely to be perceived as violent and
unpredictable relative to people with other psychological disorders. This find
ing is mirrored in the current study, with the highest levels of social stigma
throughout the study being reported against schizophrenia on the unpredict
ability subscale. Hodgins (2008) noted that, although disproportionate to the
actual rates of violent individuals with psychological disorders, fear from the
public is prevalent. This public fear toward individuals with psychological
disorders is related to the desire to distance oneself socially from these
individuals (Durand-Zaleski et al., 2012), and is also evident in the current
study in that the fear/avoidance subscale had the second-highest level of
stigma for all disorders, supporting this concept of a fear/avoidance mentality
within the general public.
Although there were multiple different methods of participant recruitment,
a limitation of this study may have resulted from utilizing convenience
sampling through study flyers displayed at a university campus that provides
tertiary education largely in the disciplines of psychology, social work, and
human services. We aimed to investigate social stigma levels against psycho
logical disorders of the general public, but this sample may have had an
unrepresentative proportion of individuals with greater knowledge of psycho
logical disorders and a preexisting drive to understand and support individuals
with psychological disorders. When using their adapted PPMI scales (PPS and
PPD), Gunningham and Bizumic (2018) used a more successful method of
participant recruitment which yielded a more demographically diverse sample.
However, although their sample may have been more representative of the
general population, their mean PPMI scores for schizophrenia and depressive
disorders were similar to those in the current study.
We also did not measure the relationship between many demographic or
individual difference variables and stigma. Gender and age were not statisti
cally significant predictors of stigma scores, but future research might attempt
to study other predictors (e.g., other attitudes and beliefs). Given the skepti
cism toward DID sometimes seen among many health professionals, it would
also be useful to study stigma among various types of professionals and
perhaps at various stages in their careers.
JOURNAL OF TRAUMA & DISSOCIATION
181
Additionally, we did not measure participants’ knowledge of the disorders
being studied, and a potential lack of knowledge may have affected the results.
Although a basic definition for each disorder was provided, this limitation may
be significant when investigating the social stigma toward specific disorders,
especially DID and schizophrenia, which are often misunderstood or confused
with one another (Renard et al., 2017). This issue may be circumvented by
utilizing a psychological disorder literacy questionnaire and incorporating the
subsequent data into participant screening criteria, or as a confounding vari
able within any statistical analyses. This extra screening criterion was not
implemented in the current study in order to minimize the length of the
questionnaire and reduce the overall participant burden.
As with many self-report measures, even though the questionnaire was
anonymous and the exact purpose of the study was vague, the results may
have been affected by a social desirability bias. Participants may have been
unwilling to admit their prejudice and stereotyping of individuals with psy
chological disorders, and therefore may have responded in a way that they
believed was more socially desirable or acceptable, rather than reflecting their
true attitudes toward psychological disorders. A measure of social desirability
could be used to address this limitation, but, as with measuring knowledge of
disorders, this was not incorporated in the current study to reduce participant
burden.
Finally, the generalizability of our results may be limited by self-selection
and the demographic features of our sample. Participants were those who
chose to respond to the flyers and may have had different attitudes toward
mental disorders than did individuals who did not choose to participate.
However, the flyers only referred to the study being about attitudes toward
mental disorders and did not mention specific disorders; thus is no reason to
believe that our participants would have had particularly positive or negative
attitudes toward any of the three disorders that we studied. Furthermore, most
of our participants identified as non-Aboriginal Australian in ethnicity, so the
generalizability of our findings to other ethnicities and cultures is unknown
and could be a focus of future research. It was positive, however, that we had
a reasonable age range and that the participants were not limited to under
graduate university students, as often is the case with psychological research.
Despite these limitations, this study also has strengths in that, to our
knowledge, this is the first study to compare the social stigmatization of
DID with other psychological disorders. Utilizing an experimental design
allowed us to measure and compare social stigma levels toward different
psychological disorders, while also developing a replicable standardized
procedure that can be useful in future research. By investigating the use
and reliability of scores from our own modified version of a preexisting
psychological disorder stigma scale (the PPMI; Kenny et al., 2018), we
provided additional evidence supporting the use of the PPMI for specific
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B. A. A. REISINGER AND D. H. GLEAVES
psychological disorders rather than psychological disorders as a whole.
According to Nunnally’s (1978) thresholds, when replacing “mental illness”
in the original version of the PPMI with the name of the specific disorder
being investigated, scores on the adapted PPMI and respective PPMI sub
scales had acceptable internal consistency (minimum α ≥ .70) within this
study’s sample. Although there may be potential for the successful applica
tion of this scale in measuring the social stigma levels toward specific
psychological disorders, future adaptations of the PPMI in this manner
should be done with caution and researchers must check their own data
for score reliability. This measure is beneficial, as it is important to have
a universal and standardized method of investigating social stigma toward
psychological disorders. Future research should continue to investigate and
collect reliability and validity data on disorder-specific adapted versions of
the original PPMI.
Finally, through this research, there is now further evidence that psycholo
gical disorders are stigmatized at different levels. Additionally, the current
study presents research into the social stigmatization of DID which we believe
has not been previously done. This research has important implications for
understanding which disorders require more immediate interventions to
reduce social stigma. By allowing mental health organizations to understand
which psychological disorders are subjected to the highest levels of social
stigma, and which of the four factors of social stigma are responsible for
higher levels of stigma, targeted campaigns can be developed, specifically
aimed at reducing stigma where it is needed.
Conclusion
The findings of this study provide valuable insights into the social stigmatiza
tion of DID. It is essential that levels of social stigma against disorders are
understood in order to reduce this burden on those living with psychological
disorders. Although this study has given important insights into stigma against
DID, schizophrenia and depressive disorders, it is imperative that this line of
research is continued. Increased research in the field of social stigma against
psychological disorders may help to strengthen the current study’s findings
and provide a better understanding of the levels of social stigma against
specific disorders.
Disclosure statement
No potential conflict of interest was reported by the author(s).
JOURNAL OF TRAUMA & DISSOCIATION
183
Funding
The author(s) reported there is no funding associated with the work featured in this article.
ORCID
David H. Gleaves PhD
http://orcid.org/0000-0003-0954-5739
Data availability statement
The data that support the findings of this study are available from the corresponding author,
upon reasonable request.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Author. https://doi.org/10.1176/appi.books.9780890425596
Brand, B. L., Sar, V., Stavropoulos, P., Kruger, C., Korzekwa, M., Martinez-Taboas, A., &
Middleton, W. (2016). Separating fact from fiction: An empirical examination of six myths
about dissociative identity disorder. Harvard Review of Psychiatry, 24(4), 257–270. https://
doi.org/10.1097/HRP.0000000000000100
Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159. https://doi.org/10.
1037/0033-2909.112.1.155
Coleman, L. (1986). Stigma: An enigma demystified. In S. Ainlay, G. Becker, & L. Coleman
(Eds.), The dilemma of difference: A multidisciplinary view of stigma (pp. 211–232). Plenum
Press. https://doi.org/10.1007/978-1-4684-7568-5_11
Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with
mental illness. World Psychiatry: Official Journal of the World Psychiatric Association (WPA),
1(1), 16–20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/
Durand-Zaleski, I., Scott, J., Rouillon, F., & Leboyer, M. (2012). A first national survey of
knowledge, attitudes and behaviours towards schizophrenia, bipolar disorders and autism in
France. BMC Psychiatry, 12(128), 1–8. https://doi.org/10.1186/1471-244X-12-128
Gleaves, D. H. (1996). The sociocognitive model of dissociative identity disorder:
A reexamination of the evidence. Psychological Bulletin, 120(1), 42–59. https://doi.org/10.
1037/0033-2909.120.1.42
Graham, J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review
of Psychology, 60(1), 549–576. https://doi.org/10.1146/annurev.psych.58.110405.085530
Grappone, G. (2017, Spring). Overcoming stigma. National Alliance on Mental Illness
Advocate. https://www.namikenosha.org/uploads/4/9/0/6/49066629/overcoming_stigma.
pdf
Gunningham, B., & Bizumic, B. (2018). Attitudes towards people with mental illness, schizo
phrenia and depression: Measurement, structure, and antecedents [Unpublished manu
script]. Research School of Psychology, Australian National University.
Henderson, C., Evans-Lacko, S., & Thornicroft, G. (2013). Mental illness stigma, help seeking,
and public health programs. American Journal of Public Health, 103(5), 777–780. https://doi.
org/10.2105/AJPH.2012.301056
Hodgins, S. (2008). Violent behaviour among people with schizophrenia: A framework for
investigations of causes, and effective treatment, and prevention. Philosophical Transactions
184
B. A. A. REISINGER AND D. H. GLEAVES
of the Royal Society B: Biological Sciences, 363(1503), 2505–2518. https://doi.org/10.1098/
rstb.2008.0034
Kenny, A., Bizumic, B., & Griffiths, K. M. (2018). The Prejudice towards People with Mental
Illness (PPMI) scale: Structure and validity. BMC Psychiatry, 18(1), 293. https://doi.org/10.
1186/s12888-018-1871-z
Levy, B., Celen-Demirtas, S., Surguladze, T., & Sweeney, K. K. (2014). Stigma and discrimina
tion: A Socio-cultural etiology of mental illness. The Humanistic Psychologist, 42(2),
199–214. https://doi.org/10.1080/08873267.2014.893513
Nunnally, J. C. (1978). Psychometric theory (2nd ed.). McGraw-Hill.
Parcesepe, A. M., & Cabassa, L. J. (2013). Public stigma of mental illness in the United States:
A systematic literature review. Administration and Policy in Mental Health and Mental
Health Services Research, 40(5), 384–399. https://doi.org/10.1007/s10488-012-0430-z
Penn, D. L., & Couture, S. M. (2002). Strategies for reducing stigma toward persons with
mental illness. World Psychiatry: Official Journal of the World Psychiatric Association (WPA),
1(1), 20–21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489812/
Renard, S. B., Huntjens, R. J. C., Lysaker, P. H., Moskowitz, A., Aleman, A., &
Pijnenborg, G. H. M. (2017). Unique and overlapping symptoms in schizophrenia spectrum
and dissociative disorders in relation to models of psychopathology: A systematic review.
Schizophrenia Bulletin, 43(1), 108–121. https://doi.org/10.1093/schbul/sbw063
Ritchie, H., & Roser, M. (2018). Mental health. Our World In Data. https://ourworldindata.org/
mental-health
Rossler, W. (2016, September). The stigma of mental disorders: A millennia-long history of
social exclusion and prejudices. EMBO Reports, 17(9), 1250–1253. https://doi.org/10.15252/
embr.201643041
Werner, P., & Segel-Karpas, D. (2020). Depression-related stigma: Comparing laypersons’
stigmatic attributions towards younger and older persons. Aging & Mental Health, 24(7),
1149–1152. https://doi.org/10.1080/13607863.2019.1584791
Journal Review #1
Ima Student
Holy Family University
COUN 540: Psychopathology and Diagnosis Using the DSM 5
Professor Wayne J. Popowski
Month. Day, Year
Cassidy, C., & Erdal, K. (2020). Assessing and addressing stigma in bipolar disorder: The impact
of cause and treatment information on stigma. Stigma and Health, 5(1), 104–113.
https://doi.org/10.1037/sah0000181
Retrieved from the Holy Family University Library’s Psychinfo database
PURPOSE OF THE STUDY:
Cassidy et al. (2020) seeks to understand the role psycho-education related to bipolar
disorder plays in reducing the stigma towards individuals with bipolar disorder. Stigma is cited
as a leading reason individuals avoid treatment and reject help for bipolar disorder.
Overview:
The psycho-education component of bipolar treatment is studied in an effort to
understand and reduce the negative social stigma that individuals with Bipolar Disorder face.
Cassidy et al. (2020) cites the Surgeon General claim in 1999 that social stigma is the leading
barrier for individuals seeking help with mental illness. Increasing exposure to and knowledge of
the sources and treatments for Bipolar Disorder is believed to reduce the less severe symptoms
associated with it, including suicide attempts according to Kassidy et al. (2005). The reduced
stigma increases the likelihood that individuals with Bipolar Disorder will seek help and have a
support system in place when they need help.
Methodology:
The current study measured participants’ perceptions of individuals with Bipolar
Disorder with a series of self-report surveys and questionnaires related to stigma associated
behaviors, including perceived dangerousness, social distance, and blame related to the mental
illness. These questionnaires and surveys were recorded regarding each participant’s perception
of a case vignette of a person diagnosed with Bipolar Disorder prior to psycho-education. The
questionnaires and surveys were recorded a second time following the psycho-education which
included leading causes, treatments, and outcomes for individuals with Bipolar Disorder.
Findings:
Cassidy et al. (2020) concluded that psycho-education related to the treatability and
possible positive outcomes for individuals with Bipolar Disorder decreased the negative stigma
individuals held. This did not apply for psycho-education that centered around biological factors
that may cause Bipolar Disorder. The resulting reduction in stigma is believed to improve the
treatment experience of individuals with Bipolar Disorder and increase their likelihood of
seeking and remaining in treatment.
Discussion:
The current study provides insight into why individuals avoid seeking help for mental
illness and how professionals in the mental health field can counteract this. The negative social
stigma as it is defined by Cassidy et al. (2020) revolves around the idea that individuals with a
Bipolar Diagnosis are dangerous, irresponsible, and different from others in society. This study
shows that with proper education and familiarization with treatments for Bipolar Disorder, these
perceptions can be changed.
Clinicians must keep this in mind as they practice psychotherapy, continuously providing
psycho-education and resources for individuals with Bipolar Disorder and their communities.
Including these practices reduces the risk individuals with Bipolar Disorder face in terms of
attrition from treatment, time wasted before seeking treatment, and the physical and mental harm
the disorder can manifest. With such important information shared about Bipolar Disorder,
further research is needed to understand if this same principle of widespread psycho-education
can help reduce stigma for individuals with other mental illnesses as they seek help.
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