Felt stigma versus enacted stigma in chronic illness
Felt stigma is fear of being judged or treated badly because of an illness, often leading to concealment (hiding it); enacted stigma is discrimination (unfair treatment) actually experienced.
Remember
Hiding an illness out of fear of judgement, when no discrimination has been experienced, is felt stigma; enacted stigma means discrimination that has actually happened.
Memory aid
felt stigma is feared and enacted stigma is experienced
Ask whether the person is afraid of being treated unfairly (felt) or has already met unfair treatment (enacted).
Stigma means being judged, shamed or treated badly because of an illness. Felt stigma is the expectation of this: a person fears what others will think, and that expectation is enough to change behaviour. Enacted stigma is different, because it means discrimination (unfair treatment) that has really been experienced.
The fear can change behaviour. A person with felt stigma may keep a diagnosis from friends or colleagues, avoid social events, or avoid taking medication in front of others. The cost can be delayed support, and felt stigma can reduce social support. When a condition is not visible, hiding it is possible, so the person can choose who knows.
Stigma can also depend on visibility. A discredited condition is one that others can already see or know about. A discreditable one is invisible, so the person can manage who finds out. These terms describe a person's situation, not the fear itself.
Structural stigma is a separate idea: it comes from the rules and practices of institutions (such as health services), not from personal fear. Internalised stigma means a person accepts the negative views as true of themselves, whereas felt stigma is the fear of what others will think, together with a sense of shame.
A clinician can ask what worries the person about telling people. That answer shows whether the behaviour is driven by fear or by actual events.
Key facts
- Felt stigma
- the fear of being judged or treated badly, often leading to concealment.
- Enacted stigma
- discrimination that has actually been experienced.
- Key clue
- hiding an illness out of fear of judgement, without any experienced discrimination, means felt stigma.
- Nothing need have happened
- the expectation is enough to change behaviour in felt stigma.
- Discredited
- others can already see or know about the condition.
- Discreditable
- the condition is invisible, so the person can manage who finds out.
- Structural stigma
- it comes from institutional rules and practices, not from a person's own fear.
Exam traps
- Discredited stigma does not explain hiding an illness out of fear, because it applies when a condition is already visible or known, so there is nothing left to conceal.
- Enacted stigma does not explain hiding a diagnosis out of worry, because it means discrimination that has actually happened, and worry is not an experience of discrimination.
- Structural stigma does not explain worry about how friends or colleagues will react, because it comes from rules and barriers in institutions, not from a person's own fear.
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