Stigmatization as an environmental risk in schizophrenia: a user perspective.

Stigmatization represents a chronic negative interaction with the environment that most people with a diagnosis of schizophrenia face on a regular basis. Different types of stigma-public stigma, self--stigma, and label avoidance--may each have detrimental effects. In the present article, the possible consequences of stigma on onset, course, and outcome of schizophrenia are reviewed. Stigmatization may be conceptualized as a modifiable environmental risk factor that exerts its influence along a variety of different pathways, not only after the illness has been formally diagnosed but also before, on the basis of subtle behavioral expressions of schizophrenia liability. Integrating stigma-coping strategies in treatment may represent a cost-effective way to reduce the risk of relapse and poor outcome occasioned by chronic exposure to stigma. In addition, significant gains in quality of life may result if all patients with schizophrenia routinely receive information about stigma and are taught to use simple strategies to increase resilience vis-à-vis adverse, stigmatizing environments.