By Jill Pease

It’s one thing to navigate the daily realities of a chronic health condition — fatigue, pain, treatment regimens, lifestyle changes. But some individuals also carry an invisible weight: the belief that they are somehow to blame, a burden to their loved ones or society, or hold less value as people because of their health. These internalized messages don’t just hurt emotionally — they can harm physical health and mental well-being.

Self-stigma among people with chronic health conditions is rooted in negative societal attitudes and social experiences related to their condition. Over time, people may absorb those harmful messages and begin to hold negative beliefs about themselves, resulting in low self-esteem or self-worth, said Rebecca Pearl, Ph.D., an associate professor and director of research in the College of Public Health and Health Professions’ Department of Clinical and Health Psychology.

Rebecca Pearl, Ph.D.

“A major theme that comes up with self-stigma is feeling like a failure, certainly in the realm of body weight and obesity,” Pearl said. “I’ve talked to many individuals who tell me that they are succeeding in their family life, in their social life and in their professional life, but because they have not been able to control their weight, they believe they have less value as a person. Someone just said to me recently, ‘I failed at my body and nothing else I do matters.’ These thoughts can also be true with other health conditions. I’ve heard from a lot of individuals with chronic health conditions that because of the limitations they experience with their health, they feel worthless, or that they can’t contribute as much to society.”

People who struggle with negative self-talk about their health may be more likely to experience depression, anxiety and substance use and they may be less engaged in healthy behaviors, such as physical activity and eating well, she said.

“When people feel shame, isolation and hopelessness they are less likely to go to the doctor, and that’s especially true if they feel some of that blame or shame coming from health care professionals,” Pearl said. “They are less likely to take the medications they’re prescribed and follow their care regimen. Self-stigma really is a barrier to health-promoting behaviors and disease management.”

Research by Pearl and others has found that as damaging as external social messages can be, the harm from self-directed negative thoughts can have an even greater effect on individuals’ mental health and other health outcomes.

“After turning all these messages inward, without even realizing it, people may become their own worst bullies,” Pearl said.

Pearl has developed an evidence-based intervention, grounded in psychological treatments such as cognitive behavioral therapy and other acceptance-based strategies, that is designed to reduce health-related self-stigma, help people cope with the social aspects of their health conditions, improve how they think and feel about themselves, and enhance their quality of life. She is currently conducting a randomized controlled trial to test the efficacy of the intervention in a group treatment format. Her work is supported by a National Institutes of Health High-Risk, High-Reward Research grant, which funds unconventional approaches to major challenges in biomedical and behavioral research.

Pearl’s study includes participants with conditions that may or may not be visible externally, but are known to be associated with different aspects of stigma: cancer, chronic pain, diabetes, HIV, obesity and skin diseases. Pearl believes the group treatment setting can be extremely valuable for helping people feel empowered and validated by peers. Her long-term vision is for health systems across the country to offer this type of psychosocial support group on an ongoing basis for patients with any diagnosis, helping to fill a national need for psychological care.

“This could potentially be a single intervention that addresses self-stigma across health conditions and places stigma at the forefront as a critical factor that needs to be addressed as part of standard care,” Pearl said.