title: Understanding the importance of "symbolic interaction stigma": How expectations about the reactions of others adds to the burden of mental illness stigma.
abstract: OBJECTIVE
  Important components of stigma include imagining what others might think of a stigmatized status, anticipating what might transpire in an interaction with others, and rehearsing what one might do if something untoward occurs. These imagined relations are here called symbolic interaction stigma and can have an impact even if the internalization of negative stereotypes fails to occur. Concepts and measures that capture symbolic interaction stigma are introduced, and a preliminary assessment of their impact is provided.
  
  
  METHODS
  Four self-report measures of symbolic interaction stigma (perceived devaluation discrimination, anticipation of rejection, stigma consciousness, and concern with staying in) were developed or adapted and administered to a sample of individuals who have experienced mental illness (N = 65). Regression analyses examined whether forms of symbolic interaction stigma were associated with withdrawal, self-esteem, and isolation from relatives independent of measures of internalization of stigma and rejection experiences.
  
  
  RESULTS
  As evidenced by scores on 4 distinct measures, symbolic interaction stigma was relatively common in the sample, somewhat more common than the internalization of stigma. In addition, measures of symbolic interaction stigma were significantly associated with withdrawal, self-esteem, and isolation from relatives even when a measure of the internalization of stigma was statistically controlled.
  
  
  CONCLUSIONS
  The study suggests the potential importance of considering symbolic interaction forms of stigma in understanding and addressing stigma and its consequences. Being aware of symbolic interaction stigma could be useful in enhancing rehabilitation goals if an approach to counteracting the negative effects of these aspects of stigma can be developed.
authors.affiliation: Mailman School of Public Health, Columbia University.
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Link
authors.affiliation: Mailman School of Public Health, Columbia University.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wells
authors.affiliation: Mailman School of Public Health, Columbia University.
authors.forename: Jo C
authors.initials: JC
authors.lastname: Phelan
authors.affiliation: Mailman School of Public Health, Columbia University.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D059031:Anticipation, Psychological; D005260:Female; D006801:Humans; D007092:Imagination; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D008875:Middle Aged; D012929:Psychological Distance; D011618:Psychotic Disorders / Q000523:psychology*; D012044:Regression Analysis; D012559:Schizophrenia; D012565:Schizophrenic Psychology; D012649:Self Concept; D063508:Social Discrimination / Q000523:psychology*; D012934:Social Isolation / Q000523:psychology*; D057545:Social Stigma; D013240:Stereotyping; D011795:Surveys and Questionnaires; D013561:Symbolism; D055815:Young Adult