ernalized Stigma of Mental Illness Inventory (ISMI)

We are going to use the term "mental illness" in the rest of this questionnaire, but please think of it as
whatever you feel is the best term for it.

For each question, please mark whether you strongly disagree (1), disagree (2), agree (3), or strongly agree (4).

Strongly Disagree Agree Strongly

disagree agree

1. I feel out of place in the world because I have a mental illness. 1 2 3 4

2. Mentally ill people tend to be violent. 1 2 3 4

3. People discriminate against me because I have a mental illness. 1 2 3 4

4. I avoid getting close to people who don’t have a mental illness to

1 2 3 4
avoid rejection.

5. I am embarrassed or ashamed that I have a mental illness. 1 2 3 4

6. Mentally ill people shouldn’t get married. 1 2 3 4

7. People with mental illness make important contributions to

1 2 3 4
society.

8. I feel inferior to others who don’t have a mental illness. 1 2 3 4

9. I don’t socialize as much as I used to because my mental illness

1 2 3 4
might make me look or behave “weird.”

10. People with mental illness cannot live a good, rewarding life. 1 2 3 4

11. I don’t talk about myself much because I don’t want to burden
1 2 3 4
others with my mental illness.

12. Negative stereotypes about mental illness keep me isolated

1 2 3 4
from the “normal” world.

13. Being around people who don’t have a mental illness makes me
1 2 3 4
feel out of place or inadequate.

14. I feel comfortable being seen in public with an obviously

1 2 3 4
mentally ill person.

15. People often patronize me, or treat me like a child, just because
1 2 3 4
I have a mental illness.

16. I am disappointed in myself for having a mental illness. 1 2 3 4

17. Having a mental illness has spoiled my life. 1 2 3 4

18. People can tell that I have a mental illness by the way I look. 1 2 3 4
 Strongly Disagree Agree Strongly
disagree agree

19. Because I have a mental illness, I need others to make most

1 2 3 4
decisions for me.

20. I stay away from social situations in order to protect my family or

1 2 3 4
friends from embarrassment.

21. People without mental illness could not possibly understand me. 1 2 3 4

22. People ignore me or take me less seriously just because I have

1 2 3 4
a mental illness.

23. I can’t contribute anything to society because I have a mental

1 2 3 4
illness.

24. Living with mental illness has made me a tough survivor. 1 2 3 4

25. Nobody would be interested in getting close to me because I

1 2 3 4
have a mental illness.

26. In general, I am able to live my life the way I want to. 1 2 3 4

27. I can have a good, fulfilling life, despite my mental illness. 1 2 3 4

28. Others think that I can’t achieve much in life because I have a
1 2 3 4
mental illness.

29. Stereotypes about the mentally ill apply to me. 1 2 3 4

 Scoring Key

The ISMI contains 29 items which produce 5 subscale scores and a total score. Each score is calculated
by adding the item scores together and then dividing by the total number of answered items. If any items
are not answered, the total number to be divided by is reduced. The resulting score should range from 1-
4. For example, if someone answers 5 of the 6 Alienation items, the Alienation score is produced by
adding together the 5 answered items and dividing by 5.

Alienation (6 items)

1. I feel out of place in the world because I have a mental illness

5. I am embarrassed or ashamed that I have a mental illness

8. I feel inferior to others who don’t have a mental illness

16. I am disappointed in myself for having a mental illness

17. Having a mental illness has spoiled my life

21. People without mental illness could not possibly understand me

Stereotype Endorsement (7 items)

2. Mentally ill people tend to be violent

6. Mentally ill people shouldn’t get married

10. People with mental illness cannot live a good, rewarding life

18. People can tell that I have a mental illness by the way I look

19. Because I have a mental illness, I need others to make most decisions for me

23. I can’t contribute anything to society because I have a mental illness

29. Stereotypes about the mentally ill apply to me

Discrimination Experience (5 items)

3. People discriminate against me because I have a mental illness

15. People often patronize me, or treat me like a child, just because I have a mental illness

22. People ignore me or take me less seriously just because I have a mental illness

25. Nobody would be interested in getting close to me because I have a mental illness
 28. Others think that I can’t achieve much in life because I have a mental illness

Social Withdrawal (6 items)

4. I avoid getting close to people who don’t have a mental illness to avoid rejection

9. I don’t socialize as much as I used to because my mental illness might make me look or behave “weird”

11. I don’t talk about myself much because I don’t want to burden others with my mental illness

12. Negative stereotypes about mental illness keep me isolated from the “normal” world

13. Being around people who don’t have a mental illness makes me feel out of place or inadequate

20. I stay away from social situations in order to protect my family or friends from embarrassment

Stigma Resistance (5 items – reverse code before including in total score)

7. People with mental illness make important contributions to society

14. I feel comfortable being seen in public with an obviously mentally ill person

24. Living with mental illness has made me a tough survivor

26. In general, I am able to live my life the way I want to

27. I can have a good, fulfilling life, despite my mental illness

As they are shown in the questionnaire, higher scores on these questions indicate more resistance to
stigma and therefore less internalized stigma. If you wish to include them in the total score, you must
reverse the scores before doing so. To reverse the scores, subtract them from 5. Thus, a score of 1
becomes a 4 and a score of 4 becomes a 1.

Total Score (29 items)

Add together all the answered items and divide by the total number of answered items. (If the person
answered every question, divide by 29). Make sure to use reverse-coded Stigma Resistance items.

Total Score without Stigma Resistance (24 items)

Same as above, but do not include the Stigma Resistance items. You may choose to interpret these items
separately or to leave them out altogether (Lysaker et al., 2007).
Interpretation of scores

4-category method (following the method used by Lysaker et al., 2007):

1.00-2.00: minimal to no internalized stigma

2.01-2.50: mild internalized stigma

2.51-3.00: moderate internalized stigma

3.01-4.00: severe internalized stigma

2-category method (following the method used by Ritsher & Phelan, 2004).

1.00-2.50: does not report high internalized stigma

2.51-4.00 reports high internalized stigma

References:

Lysaker, P. H., Roe, D., Yanos, P. T. (2007). Toward understanding the insight paradox: Internalized
stigma moderates the association between insight and social functioning, hope, and self-esteem
among people with schizophrenia spectrum disorders. Schizophrenia Bulletin, 33, 192-199.

Ritsher, J. B., Otilingam, P. O., Grajales, M. (2003). Internalized stigma of mental illness: Psychometric
properties of a new measure. Psychiatry Research, 121, 31-49.
http://repositories.cdlib.org/postprints/2005.

Ritsher, J. B., Phelan, J. (2004). Internalized stigma predicts erosion of morale among psychiatric
outpatients. Psychiatry Research, 129, 257-265.