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Relationships between internalized stigma, stigma coping strategies, and functioning in remitted individuals with

Bochra Nourhène Saguem¹, Cyrine Bey¹, Sami Ouanes²

¹Faculty of Medicine Ibn El Jazzar of Sousse, Research Laboratory LR12ES04, Department of Psychiatry, Farhat Hached Hospital, University of Sousse.

Psychiatric Rehabilitation Journal

|May 11, 2026

Abstract

Objective:

This study aimed to assess internalized stigma and stigma coping strategies in Tunisian remitted individuals with bipolar disorder and to examine the role of potential mediators in the relationships between internalized stigma, stigma coping, and functioning.

Methods:

A cross-sectional study was conducted on Tunisian individuals with bipolar disorder in remission. Internalized stigma and stigma coping strategies were assessed through the Internalized Stigma of Mental Illness Scale, Perceived Discrimination and Devaluation Scale, and Stigma Coping Orientation Scale. Participants' functioning, cognitive insight, self-esteem, and perceived social support were also evaluated. Multiple mediation analyses were performed.

Results:

The study sample comprised 110 participants among whom 25.5% were experiencing internalized stigma. Alienation, social withdrawal, and reporting experiences of discrimination were the most elevated domains measured by the Internalized Stigma of Mental Illness Scale. Participants experiencing clinically significant internalized stigma were more likely to rely on avoidant coping strategies and less likely to engage in more active coping strategies. Perceived devaluation and discrimination significantly mediated the relationship between internalized stigma and functioning. Stigma coping strategies and cognitive insight did not significantly mediate this relationship. Cognitive insight, self-esteem, or perceived social support did not exhibit a significant effect on the relationship between internalized stigma and coping strategies.

Conclusions And Implications For Practice:

Internalized stigma experienced by individuals with bipolar disorder negatively impacts functioning through a heightened perception of discrimination and devaluation. Internalized stigma also exerts a direct and potent effect in shaping the stigma coping strategies that will be adopted by remitted individuals with bipolar disorder. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

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