"Society Really Does Not Like People With Psychosis": A Thematic Analysis of the Stigma and Self-Stigma Experiences of Young People At-Risk for Psychosis

Objective: Stigma and self-stigma reduce self-esteem and increase hopelessness and suicidality. While psychotic disorders are widely recognized as the most stigmatizing of all mental health disorders, there is a dearth of research investigating how stigma and self-stigma are experienced by young people at ultra-high risk (UHR) for psychosis. These experiences warrant investigation given the unique position of this population, as while they do not have a psychotic disorder, they may be exposed to stigma by virtue of the UHR label and/or symptoms. Methods: Twelve young people at UHR aged 14-25 years were recruited to participate in either an individual interview or focus group. Transcripts were analyzed using reflexive thematic analysis. Results: Five themes were developed including: (1) being at UHR is an inherently difficult, uncertain experience; (2) stigma is pervasive; (3) stigma becomes internalized; (4) stigma and self-stigma are painful; and (5) defending against stigma (containing three subthemes of (a) hiding one's UHR status; (b) rebutting stigma; and (c) educating self and others). Results indicated that young people at UHR for psychosis experience pervasive stigma that leads them to seek ways to protect themselves and their loved ones from stigma. Conclusions and Implications for Practice: Our findings affirm exposure to stigma and self-stigma in particular compound the distress experienced by young people at UHR for psychosis. The themes found in this research give further impetus to the need to develop effective interventions to reduce stigma within, and toward, young people at UHR for psychosis.