The Burden of Stigma on Health and Well-Being: A Taxonomy of Concealment, Course, Disruptiveness, Aesthetics, Origin, and Peril Across 93 Stigmas

Abstract

Most individuals are stigmatized at some point. However, research often examines stigmas separately, thus underestimating the overall impact of stigma and precluding comparisons across stigmatized identities and conditions. In their classic text, Social Stigma: The Psychology of Marked Relationships, Edward Jones and colleagues laid the groundwork for unifying the study of different stigmas by considering the shared dimensional features of stigmas: aesthetics, concealability, course, disruptiveness, origin, peril. Despite the prominence of this framework, no study has documented the extent to which stigmas differ along these dimensions, and the implications of this variation for health and well-being. We reinvigorated this framework to spur a comprehensive account of stigma's impact by classifying 93 stigmas along these dimensions. With the input of expert and general public raters, we then located these stigmas in a six-dimensional space and created discrete clusters organized around these dimensions. Next, we linked this taxonomy to health and stigma-related mechanisms. This quantitative taxonomy offers parsimonious insights into the relationship among the numerous qualities of numerous stigmas and health.

Stigmatized beliefs: Conspiracy theories, anticipated negative evaluation of the self, and fear of social exclusion

“…In the future, we can also generate more sophisticated hypotheses by fitting conspiracy theories into known dimensions of stigma (Pachankis et al., ). A first relevant dimension of stigma is its concealability.…”

“…According to Goffman (), a stigma is “an attribute that extensively discredits an individual” (p. 3). These attributes, such as skin color (Pinel, Warner, & Chua, ), sexual orientation (Lewis, Derlega, Griffin, & Krowinski, ), physical or mental disabilities (Crandall & Moriarty, ; Rüsch, Angermeyer, & Corrigan, ), or religious (non)belief (Gervais & Najle, ; Nugier et al., ; Pachankis et al., ) may be of various kinds, as a function of the social context (Major, ). A great deal of research has been devoted to the topic of stigma (Link & Phelan, ; Major & O'Brien, ), including the study of its nature (e.g., the different characteristics of stigma such as controllability, concealability, and dangerousness; Frable, ; Major, ; Quinn, ), its origins (Kurzban & Leary, ), and its social‐psychological consequences (Major & O'Brien, ).…”

Legal Remedies to Address Stigma‐Based Health Inequalities in the United States: Challenges and Opportunities

“…Decades of social science research have repeatedly and robustly shown that stigma is pervasive, that it affects a substantial number of people, that it is a source of social inequalities in life chances that are themselves powerful determinants of health (including, but not limited to, education and academic achievement, housing, employment and income, and beneficial social relationships), and that it has a direct, corrosive impact on the health of populations . For these reasons, stigma has been conceptualized as a fundamental cause of population health inequalities …”

“…The lack of existing protections is further emphasized when one considers that the work of Hatzenbuehler and colleagues, whose work we drew on to create Figure , underestimates the full influence of stigma on life chances, because they chose only six stigmatized statuses that had been the focus of quantitative (eg, meta‐analytic) and qualitative reviews. Although the field has not reached consensus on the exact number of stigmatized identities/statuses, recent work by Pachankis et al . identifies as many as 93 stigmatized categories experienced in the general population (eg, criminal record, drug dependency, Muslim, undocumented immigrant, homeless), the vast majority of which are not explicitly recognized in the legal system as protected classes.…”

“…An emphasis on protected classes can also be overly reductive and fail to capture meaningful intersectionality; in order to receive legal protection, one must identify as a woman, or a black person, failing to capture the unique experience of black women, for instance . In fact, a recent systematic analysis of 93 stigmas in the general population showed that, on average, each individual reported approximately six stigmas, highlighting the important point that intersectional stigmatized identities may be the norm rather than the exception.…”