Courtesy stigma in the families of patients with severe mental disorders: an obstacle to the recovery process?

The general concept of stigma finds wide application in the field of psychiatry by indicating prejudice, stereotypes and discrimination towards patients diagnosed with psychiatric illness. Among the different declinations of this concept, we find courtesy stigma: a form of stigma by association experienced by people in close contact with the stigmatised person.Those who are most likely to experience this type of discrimination are the family members of the psychiatric patient, as they are particularly connected to the person with mental health problems. This experience contributes to increasing levels of expressed emotion (EE), i.e. the index of the emotional climate within the family.This study is based on two samples: a group of users with a diagnosis of severe mental disorder from the Department of Psychiatry of the University of Campania “Luigi Vanvitelli” and another group of family caregivers. This study aimed to: a) assess the impact of courtesy stigma on the levels of recovery and EE perceived by the patient; b) assess the relationship between the latter and the recovery process.To this end, the RAS-DS (Recovery Assessment Scale - Domains and Stages) and LEE (Level of Expressed Emotion Scale) scales were administered to patients, whereas caregivers were administered the CPMI (Stigma scale for Caregivers of People with Mental Illness) scale.Data processing revealed that high levels of courtesy stigma reported by caregivers not only hinder the patients’ recovery process, but also contribute to increasing EE levels according to the patients. Furthermore, as the EE levels perceived by the patients increase, the recovery levels decrease.