Paradoxical Self-Stigma and Cannabis Use Disorder – External Attributions in a Case-Vignette Study

Background: Past research on self-stigmatization describes internalization, indifference, and stigma resistance as responses to societal stereotypes. We propose paradoxical stigmatization as another stigma response, characterized by strong belief in the legitimacy of stereotypes and high levels of group identification, and aim to provide psychometric evidence for this new construct. Methods: A web-based vignette study with a sample representative of the adult German population (n = 1,103) and a purposefully oversampled adolescent counterpart (n = 500). Young and old participants rated two case vignettes depicting young and old individuals with cannabis use disorder (CUD) using the Attribution Questionnaire and six newly developed items for paradoxical stigmatization (PS). Psychometric distinctness of PS was examined using split-half cross-validated exploratory and confirmatory factor analyses. Associations between PS and sample characteristics were explored via Pearson correlations and a linear mixed- effects model. Results: PS items formed a coherent, empirically distinct factor from general stigmatizing attributions across all four subsamples (CFI = .92–.97; ω = .90–.94; latent factor intercorrelation r = .57–.68). PS scores were significantly higher for the adolescent vignette, among adult participants. Lifetime cannabis use was associated with lower PS, while craving and others' concerns about one's use predicted higher PS. Conclusions: PS represents a psychometrically distinct dimension of cannabis-related stigma, endorsed more strongly by adults and men, and directed at adolescents with CUD. Among lifetime cannabis users, lower endorsement of PS was found but higher endorsement in individuals with problematic use.