Is your inner critic rooted in internalized stigma?

It’s hard enough to feel stigmatized by others when you live with a mental health condition. But when that stigma starts to sound like your inner voice, it can be even more painful. This is called internalized stigma. With internalized stigma, you take on negative beliefs about living with a mental health condition.

Internalized stigma is common, and it affects most people who live with a mental health condition. It’s dangerous because it can get in the way of getting treatment. But living with a mental health condition is nothing to feel ashamed about. Working with a therapist can help you overcome self-stigma and get the care you deserve.

How internalized stigma works

According to research, three types of stigma exist: 

1. Public stigma (negative attitudes and discrimination from others)

2. Structural stigma (systemic or institutional discrimination)

3. Self or internalized stigma (when a person applies these negative beliefs to themselves)

Internalized stigma doesn’t appear out of nowhere. It arises because other forms of stigma, like public stigma, exist.

When constantly surrounded by messaging that something is “bad” or “shameful,” we can come to believe it ourselves. We can be influenced by what we hear in media, at work, and from our loved ones.

Societal stigma has told us that people with mental health conditions are weak and unstable. These negative messages can create misunderstandings of mental health conditions and lead people to believe they shouldn’t receive care and compassion.

None of these messages are true. But many people who live with mental health conditions start to internalize these messages. Unconsciously or consciously, they start to believe these things about themselves.

This can happen even when we logically “know better.” For example, you might be a psychologist who understands that mental health challenges are nothing to be ashamed of. You may even help your clients come to see this but still feel ashamed about disclosing your own diagnoses with friends and family.

Common examples of internalized stigma

People with any mental health condition can experience internalized stigma. It can happen if you live with a long-lasting condition or you start experiencing new symptoms.

Here are some examples to illustrate how internalized stigma might look for someone with the following:

• Attention-deficit hyperactivity disorder (ADHD): You miss a deadline due to symptoms of disorganization. Instead of being honest about living with ADHD, you lie and say you’re under the weather.

• Depression: You don’t have the energy for a big social gathering. So you tell your friends you aren’t feeling well but don’t specify that your symptoms are emotional. You feel that mental health symptoms aren’t enough of an “excuse” to cancel plans.

• Social anxiety disorder (SAD): You turn down invitations to gatherings because you’re afraid of being judged. Later, you feel guilty and tell yourself you’re just being “lazy,” even though that’s not the case.

• Obsessive-compulsive disorder (OCD): You’re experiencing recurrent intrusive thoughts about accidentally harming your loved ones. You’ve learned in therapy that these thoughts have nothing to do with intent or danger. But you still feel deep shame and hide these thoughts from everyone around you.

• Severe mental health symptoms: You’re experiencing some challenges but refuse to take medication. You’ve taken it before, and it’s helped — but you tell your therapist that you “should be able to get through this on your own.”

To clarify, internalized stigma isn’t just about choosing not to disclose your symptoms or diagnosis. You don’t owe anyone your personal health information. If you prefer to keep this private, that’s completely your right and doesn’t necessarily mean you have internalized stigma. 

The important thing to pay attention to is what’s driving your behavior. Consider if it’s shame around your condition or simply a desire for privacy.

The emotional impact of self-stigma

Living with internalized stigma can be emotionally painful. This type of stigma, in particular, can affect your well-being because of how it impacts your self-esteem. Other types of stigma make life difficult. But when you start to internalize that stigma, you can start to experience chronic feelings of worthlessness or shame.

These feelings can create a cycle — especially for mental health conditions like depression that already may come with feelings of worthlessness. The lower your self-esteem gets because of internalized stigma, the worse you may feel. And the more severe your symptoms are, the more you may start to believe these critical inner voices.

The psychological impact of self-stigma is severe. Research shows that the higher the self-stigma, the more severe the mental health symptoms. The impact of self-stigma can be just as damaging as the symptoms of the mental health condition itself. In addition, people with higher levels of internalized stigma may be at higher risk of suicide.* 

One of the biggest impacts of internalized stigma is the way it can keep people from getting the treatment they need and deserve. This happens when shame makes you believe you’re unworthy of help or that therapy “won’t work” for someone like you. Over time, this can stop you from reaching out for care even when your symptoms worsen.

*If you or a loved one is experiencing suicidal thoughts or thoughts about harming themself or others, please call or text 988 on any phone for the Suicide & Crisis lifeline, contact a local crisis line, or head to the emergency room immediately. Any of these resources will ensure that the person in crisis receives support right away. For more information on getting help, go to 988lifeline.org

If experiencing a life-threatening emergency or you need immediate help, please call 911. 

Overcoming internalized prejudices

If your inner critic is telling you that your mental health condition affects your worth, it’s important to deal with internalized stigma as soon as possible.Some strategies to overcome internalized stigma include: 

Build a community

One of the best ways to deal with internalized stigma is to build a community of people you respect who also live with a mental health condition. When you see your role models living openly and fully with their symptoms, it may be easier to realize that mental health doesn’t need to hold you back. Many anti-stigma programs include a peer support component.

Work on your self-esteem

Because of the way that self-stigma affects your self-esteem, it may help to acknowledge your other qualities. Focus on your strengths, relationships, and values. When you start to see yourself as more than your diagnosis, your sense of self-worth can start to grow.

Don’t accept societal stereotypes as true

Internalized stigma happens because, at some point, we accept the messages that society tells us as true and valid. But the fact is that these stereotypes about mental health conditions aren’t true, and we don’t need to believe them about ourselves (or other people). When you hear a disparaging message about mental health conditions, consciously challenge it. Tell yourself: “That belief is outdated, and it doesn’t define who I am.” If you feel comfortable, speaking up when others make negative comments about mental health can help change the narrative. You may feel more empowered, plus those around you can gain insight and make progress toward reducing the stigma.  

Become an advocate

Another way to challenge the societal stigma and prevent internalized stigma is to take part in mental health awareness and advocacy. We’ve come a long way — more people are speaking openly about therapy, and awareness campaigns are reducing stigma every year. Being part of this movement can remind you that you’re not alone and your voice matters.

Work with a therapist

Just like someone with a physical health condition deserves treatment and support, so do you. A therapist can help you overcome internalized stigma by guiding you to recognize your self-critical thoughts and replace them with more compassionate ones.

Clinician’s take

Quieting an inner critic starts with calling out these thoughts as they arise. You can say to that voice ‘I hear you trying to dismiss my needs. I choose to listen to them and get the support I need.’ Over time, this voice gets quieter and you build an internal compass that guides you in a healthy direction.

Ashley Ayala, LMFT

Clinical reviewer