Behavior or Diagnosis? Effects of Irritable Patient Behavior and a Schizophrenia Diagnosis on Mental Illness Stigma

Although research demonstrates significant stigma toward individuals with mental illness, the relative importance of observed behavior and a psychiatric diagnosis in eliciting stigma remains poorly understood. Using video vignettes, two experiments (ns = 195 and 749) examined the effect of irritable (vs. calm) behavior and the presence (vs. absence) of a schizophrenia diagnosis on attitudinal, emotional, and behavioral dimensions of stigma toward a fictitious emergency room patient seeking migraine treatment. In line with labeling theory, irritable behavior resulted in greater blameworthy attributions for behavior, greater fear and anger, and less caring emotions. A psychiatric diagnosis increased endorsement of other stigmatizing attributions (e.g., substance use) as a reason for behavior. Behavior and diagnosis both resulted in patients being rated as less warm, competent, and predictable, and more dangerous. These independent variables also interacted to predict desire for social distance. A calm, nondiagnosed patient elicited the lowest desire for distance, an irritable patient with or without a diagnosis elicited equally high desire for distance, and a calm, diagnosed patient elicited moderate desire for distance. Mediational analyses show that dangerousness and fear may mediate the effect of a diagnosis on desire for distance. In all, results suggest both diagnostic labels and behavior result in stigma via different attitudinal and emotional mechanisms, and that individuals with a schizophrenia diagnosis face stigma even if behaving calmly. By enriching understanding of the relative importance of aberrant behavior and a psychiatric diagnosis on multiple dimensions of mental illness stigma, this work has implications for antistigma interventions.