People with schizophrenia experience stigma from others due to their cognitive difficulties

Dr. Lauren Gonzales, Assistant Professor of Clinical Psychiatry, Columbia University Medical Center

Over 80% of people diagnosed with schizophrenia experience difficulties with cognitive health, including thinking-related processes such as attention, problem-solving, and memory. These difficulties often translate into functional challenges that can present barriers to important life areas, such as maintaining relationships with loved ones or obtaining employment.  Cognitive Remediation is an evidence-based psychological therapy developed to target these difficulties. However, while cognitive health and related functioning do improve, stigmatizing attitudes persist, affecting the ability of people with schizophrenia to live productive or meaningful lives.

Stigma is a social process through which negative attitudes, feelings, and behaviours are perpetuated toward members of a marginalized group. Mental illness stigma has long been studied as common and longstanding and includes such stereotypes as that people with mental illnesses are violent, unpredictable, or incompetent. While mental illness stigma has generally decreased over time for some diagnoses, schizophrenia is still considered the most strongly stigmatized. This is probably because people think of it as a progressive, chronic, and unremitting “brain disease”, although we now know that recovery is possible. Many stigmatizing attitudes and stereotypes about schizophrenia assume that diagnosed people cannot function in society or work toward their life goals. These ideas are directly tied to assumptions about cognitive health.

To better understand stigma and cognitive health difficulties in schizophrenia, researchers at Columbia University Irving Medical Center conducted a scoping review of 32 research studies. The main takeaways were that most existing research investigated a specific kind of stigma – internalized stigma of mental illness – while stigma specific to cognitive health is a small but growing research area. A pattern also emerged that when someone believes they are experiencing cognitive difficulties, they are more likely to perceive stigma from others – regardless of their scores on more “objective” performance-based measures of cognition.

Only two papers have examined stigma specific to cognitive health in schizophrenia, and the results are sobering. When asked, 75% of people about to receive cognitive remediation reported perceiving some stigma from others due to cognitive health difficulties. Perceived cognitive health-related stigma was also related to reduced motivation levels (Gonzales et al., 2025), higher ratings of depression, and larger estimates of decline in their cognition before and after illness onset (Gonzales et al., 2024).

Taken together, these research studies emphasize that people with schizophrenia and related disorders experience stigma from others not just due to their diagnosis or psychiatric symptoms but specifically due to their cognitive health difficulties. Further research is warranted to examine how cognitive health stigma in schizophrenia affects quality of life and also whether it should be a treatment target for those undergoing treatment for cognitive health difficulties.

The scoping review is available to read and download at: https://www.sciencedirect.com/science/article/abs/pii/S0920996425003536?via%3Dihub

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