Investigation of internalized stigma and its correlates in obsessive compulsive disorder

Introduction: Although stigmatization has mostly been addressed with its effects on individuals diagnosed with schizophrenia, another psychiatric disorder prone to be affected by stigmatizing attitudes and behaviors is obsessive compulsive disorder (OCD). Only a few studies are available in the literature investigating internalized stigma in OCD. Furthermore, no comprehensive studies about this subject have been reported from our country yet. This is the first comprehensive study from our country to investigate the effects of the following factors on internalized stigmatization levels in OCD: the severity and characteristics of the disorder, sociodemographic characteristics, concomitant depression, social relationships, and treatment adherence. Objective: Our study aimed to identify internalized stigmatization levels in OCD, its correlates, and to investigate its effects on social relations and treatment adherence. Method: One hundred OCD patients, who were diagnosed with SCID-5 and treated in the inpatient and outpatient psychiatry clinics of Hafsa Sultan Hospital of Celal Bayar University between the dates April 2019 and January 2020, were included in our study provided that they agreed to participate and met the inclusion criteria. In this study, the Internalized Stigma of Mental Illness Scale (ISMIS), the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Symptom Checklist, the Hamilton Depression Rating Scale (HAM-D), UCLA Loneliness Scale, and the Morisky Medication Adherence Scale were used. The relationship of internalized stigma with sociodemographic features, disease-related features, loneliness levels, and treatment compliance was investigated with the t-test, the Mann-Whitney test, and the Kruskal-Wallis test. For multiple comparisons, post hoc Tukey' B test was used. The Pearson analysis was used for determining correlations of internalized stigmatization scores with other scale scores. In the further stages of our analysis, a regression analysis was applied to identify the variables predicting internalized stigmatization levels. Results: Being brought up in a rural area, unemployment, a low education level, the severity of the disorder, hospitalization history, and loneliness levels were positively correlated with internalized stigmatization. Of the symptom types, only sexual obsessions and related compulsions were associated with stigmatization levels. Insight and treatment adherence were not associated with stigmatization. Conclusion: Effects of internalized stigmatization should be taken into consideration in the follow-up and treatment processes of OCD patients. Mental health workers should provide psychotherapeutic interventions to address these issues when necessary. Keywords: Obsessive compulsive disorder, internalized stigma, loneliness.