Self-Compassion Reduces Stigma in Chronic Physical Illness

Many of us learn as children to diminish others in our beliefs or actions. This may be driven by low self-esteem, childhood trauma, being bullied, a lack of empathy or feelings of rejection or exclusion. At times such diminishing may simply result from modeling the behavior of our caretakers or those in one’s community.

These experiences support stigma and stigmatizing others in a negative way because of a particular characteristic. Such stigma and stigmatizing have long been associated with both physical disability and certain physical illnesses. The impact of such stigmatizing is the shaming of individuals that can lead to internalized stigma that fosters shame–leading to feeling "less than," inadequate and a desire to hide or isolate.

Stigma has adaptive roots: it may have arisen from fear that any illness would slow up the movement of the pack–thus making it more vulnerable to potential harm. We may experience fear or anxiety about catching the illness. An illness or disability of another person may challenge our sense of having control in our lives. These same feelings may lead to moralizing about illness.

History provides a variety of examples in the stigmatization of leprosy, tuberculosis, cancer and more recently, HIV+ and AIDS. Stigmatizing and internalized stigma can have detrimental effects regarding accurate diagnosis, seeking and maintaining treatment and a sense of isolation that contributes to anxiety and/or depression.

Additionally, these attitudes may undermine our capacity for compassion, evoking it in reaction to breast cancer but not for lung cancer caused by smoking. It may similarly be at play for those who can be compassionate for the child who is born with HIV+ but not for the parent with the virus. This is consistent with an earlier study concluding that diseases perceived to be severe or under self-control were more likely to lead to social rejection (Crandall & Moriarity, 1995).

An overview of stigma and physical illness

A comprehensive meta-analysis of 64 studies of disease-related stigma, stigmatizers, causes and consequences was performed by researchers in Iran (Akbari, Mohammadi & Hosseini, 2023). It reviewed studies on patients suffering from mental illness, AIDS, leprosy, cancer, autism, obesity, intestinal disorders, epilepsy, Down’s syndrome and coronavirus.

They identified conflict in society, lack of knowledge, specific characteristics of the disease and the contagious quality of the disease as the main contributors to stigma. These led to stigmatization by groups such as significant others, generalized others, institutional others and the media. Most significantly, they found that patients experiencing stigma faced, psychological, physical and social complications and they engaged in concealment, which is a potential threat to society and to themselves.

Man reacting with internalized stigma

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Stigma and lung cancer

In recent years there has been an increase in studying such stigma and how it is impacted by the healing inherent in exercises of self-compassion. For example, one study involved 108 individuals with lung cancer who completed measures of lung cancer stigma, self-compassion, depressive symptoms and physical symptom bother, over a 12-week period (Williamson, Garon, Shapiro, et. al., 2022).

Higher internalized stigma, constrained disclosure and perceived subtle discrimination were strongly associated with depressive symptoms. Constrained disclosure and perceived subtle discrimination were associated with higher cancer related stress and higher physical symptom bother at study entry. Higher self-compassion strongly moderated the relationship between perceived subtle discrimination and psychological health outcomes.

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Stigma and HIV

In one study 90 gay men completed an online assessment of HIV-stigma, IH (internalized homophobia), self-compassion, depression, anxiety, and positive and negative affect (Skinta, Fekete, & Williams, 2018). More HIV stigma was indirectly related to more depressive symptoms and anxiety through higher internalized homophobia. Self-compassion was identified as a moderator of the IH such that this effect was highest with low self-compassion, but not for those with high self-compassion.

Stigma and acne

In another study, 600 adults with acne symptoms completed a web-based inventory regarding Facebook use, self-compassion, skin appearance comparisons and internalized stigmatization (Adkins, Overton, Moses, et. al., 2023). It found that self-compassion was negatively correlated with appearance comparisons and feelings of stigmatization.

Stigma and Parkinson’s disease

One team of researchers explored stigma, self-compassion and psychological distress among individuals with Parkinson’s disease (Eccles, Sowter, Spokes, et. al., 2023). Participants were 130 people with Parkinson’s who completed questionnaires assessing self-compassion, stigma, and depression, anxiety, and stress. Lower self-compassion correlated with greater distress, both of which were viewed as related to the internalization of stigma.

Stigma and Hepatitis B virus

A recent study evaluated the role of self-compassion in the relationship between self-stigma and psychological distress in people with Hepatitis B (Wang, Li & Zhou, 2024). It involved 133 participants diagnosed with hepatitis B virus who responded to inventories regarding self-stigma, self-compassion and symptoms of psychological distress such as depression, anxiety and stress. It found that self-compassion mediated the impact of stigma and stress. More specifically, uncompassionate self-responding influenced the effects of stigma on psychological distress, while compassionate self-responding helped mitigate the negative effects of the uncompassionate self-responding.

Stigma and epilepsy

Two hundred patients diagnosed with epilepsy were assessed to determine the impact of self-compassion on the relationship between psychological distress and perceived stigma on their mental well-being (Alabi, Musbau, Wojujutari, et. al., (2023). Participants completed assessments of self-compassion, psychological distress, the perceived stigma of epilepsy and mental well-being. The results showed self-compassion to be associated with mental well-being and that it may play an important role in the relationship between perceived stigma and mental well-being among individuals living with epilepsy.

Cultivating self-compassion to reduce internalized stigma

The above studies highlight the positive impact that self-compassion plays with regard to reducing self-stigma. Accordingly, their results support the cultivation of self-compassion as an essential part of the treatment plan for patients dealing with such chronic illness. This was further supported by a mega-analysis that explored the relationship between self-compassion and physical health and health promoting behavior in a sample of 29,588 individuals soured from 94 peer reviewed articles (Phillips & Hine, 2019). Self-compassion was associated with most health domains, with the strongest effects on global physical health, functional immunity, composite health behavior, sleep and danger avoidance.

Recent studies have sought to identify the specific components of self-compassion that most powerfully impact psychological health related to physical illness. One study highlighted the importance of mindfulness in helping to reduce self-judgment and feelings of isolation that can foster depressive symptoms (Matos-Pina, Oliveira & Ferreira, 2023).

Self-compassion entails evoking an observing self that can respond to one’s own behavior and suffering with the same caretaking repertoire that one might apply to a friend, a loved one or intimate partner. This is a task that requires cultivation grounded in patience and commitment. It is a task that should become part of the treatment plan for anyone with chronic physical illness–especially with accompanying internalized stigma.