Internalized Stigma of Mental Illness Scale (ISMI)
Also known as: ISMI
The Internalized Stigma of Mental Illness Scale (ISMI) is a 29-item self-report measure assessing the extent to which individuals with serious mental illness have internalized societal stigma—that is, adopted negative beliefs and stereotypes about themselves and their condition. Developed by Ritsher, Otilingam, and Grajales in 2003, the ISMI captures five dimensions of internalized stigma: alienation, stereotype endorsement, perceived discrimination, social withdrawal, and stigma resistance. The ISMI is widely used in mental health research and clinical practice to assess stigma burden and inform stigma-reduction interventions.
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When to use it
The ISMI is recommended for research on internalized stigma as a moderator or mediator of recovery outcomes, help-seeking, and quality of life. Clinically, it is useful for screening individuals who may benefit from stigma-reduction interventions (cognitive-behavioral therapy for shame, peer support groups, advocacy training). The ISMI can inform individual treatment planning, identifying which stigma domains warrant targeted intervention. It is particularly valuable in recovery-oriented services, where reducing internalized stigma is an explicit treatment goal.
Strengths & limitations
- Multidimensional structure capturing five distinct stigma domains with good internal consistency (Cronbach's α 0.71–0.87 for subscales).
- Conceptually grounded in consumer experiences and validated across diverse populations.
- Strong test–retest reliability (r=0.82–0.90), supporting longitudinal use.
- Responsive to change; ISMI scores decrease following stigma-reduction interventions.
- Includes a Stigma Resistance subscale, capturing protective factors and agency.
- Widely translated and validated internationally (>15 languages).
- Limited discriminant validity between Alienation and Social Withdrawal subscales; some factor analytic studies suggest a four-factor rather than five-factor structure.
- No universal clinical cutoffs; interpretation is context-dependent.
- May be sensitive to social desirability bias, particularly the Stigma Resistance subscale.
- Requires intact cognitive functioning and literacy; less suitable for individuals with significant cognitive impairment or acute psychosis.
- Reverse-scored items can be confusing if respondents are not carefully instructed.
Frequently asked
What are the seven reverse-scored items on the ISMI?
The reverse-scored items vary slightly by published version, but typically include items such as 'People with mental illness are just as intelligent as anyone else' and 'I can contribute to society despite my mental illness.' For each reverse-scored item, recode: 1→4, 2→3, 3→2, 4→1. Always consult the original publication or measure manual for the exact list specific to your ISMI version.
Does a high Stigma Resistance score mean the person has low internalized stigma?
Not necessarily. Stigma Resistance reflects protective coping strategies and the belief that one can overcome or resist stigma, but it can coexist with high stigma burden (high Alienation, high Stereotype Endorsement). A person may simultaneously feel isolated and hold negative self-stereotypes while also believing they can personally resist these beliefs. Stigma Resistance is a protective factor, not an inverse measure of stigma.
How does the ISMI differ from the Link Stigma Scale?
The ISMI measures internalized stigma—personal adoption of negative beliefs. The Link Stigma Scale (perceived devaluation–discrimination) measures perceived external stigma—the belief that others stigmatize you. The two are related but distinct constructs. Using both instruments provides a comprehensive picture of both internalized and perceived stigma.
Can the ISMI be used to track changes from stigma-reduction interventions?
Yes. The ISMI is sensitive to change and is commonly used as an outcome measure in stigma-reduction research. Typical interventions (peer support, group therapy, advocacy training) lead to reductions in total ISMI scores and specific subscales. Meaningful change is often seen over 8–12 weeks of regular intervention, with larger changes over months to years.
Sources
- Ritsher, J. B., Otilingam, P. G., & Grajales, M. (2003). Internalized stigma of mental illness: Psychometric properties of a new measure. Psychiatry Research, 121(1), 31-49. DOI: 10.1016/j.psychres.2003.08.008 ↗
How to cite this page
ScholarGate. (2026, June 3). Internalized Stigma of Mental Illness Scale (ISMI). ScholarGate. https://scholargate.app/en/psychiatric-rehabilitation/internalized-stigma-mental-illness
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
- Link Stigma ScalePsychiatric Rehabilitation↔ compare
- Mental Health Continuum Short FormPsychiatric Rehabilitation↔ compare
- Recovery Assessment ScalePsychiatric Rehabilitation↔ compare
- Self-Stigma of Seeking Help ScalePsychiatric Rehabilitation↔ compare