The negative factor of stigma

METHODS

A clinical case was used as the starting point for a bibliographic review, focusing on scientific studies addressing stigma in healthcare and the impact of professional training programs. Evidence consistently shows that clinicians who receive structured training tend to exhibit lower levels of stigmatizing attitudes.

CLINICAL CASE

A 70‑year‑old woman was admitted to the Neurology Department of Hospital Donostia due to a progressive decline characterized by worsening weakness, bilateral calf myalgias, shoulder‑girdle involvement, and neuropathic pain in the left thigh, with a fifteen‑day evolution at the time of admission.

Her medical history revealed no prior conditions related to neurological disease, and she had no psychiatric antecedents. Baseline functioning was optimal: she was autonomous, socially active, and maintained full functional capacity.

CURRENT ILLNESS

An extensive battery of complementary tests was performed, none of which identified structural lesions or significant abnormalities. Over the subsequent three months, the patient experienced a marked clinical deterioration, with progressive loss of mobility and functional abilities, ultimately requiring admission to the intensive care unit.

The absence of an etiological diagnosis, combined with the difficulty some clinicians had in interpreting the patient’s emotional expression—perceived by some as disproportionate—constituted a turning point in the diagnostic process. The working diagnosis was shifted toward a functional neurological disorder, and management was redirected to Psychiatry and Rehabilitation. Immunoglobulin therapy and morphine were discontinued.

Psychiatric evaluation did not reveal a depressive disorder, maladaptive personality traits, or dysfunctional relational patterns. No recent psychosocial stressors were identified. The patient’s anxiety was considered an understandable reaction to uncertainty. Antidepressant and anxiolytic treatment was initiated to address this reactive anxious‑depressive presentation.

Given the severity and atypical nature of the case, multidisciplinary clinical committees were convened. Some members expressed suspicion of a primary psychiatric disorder, further complicating the diagnostic pathway.

RESOLUTION

Ultimately, electromyography and brachial plexus nerve conduction studies revealed a multifocal motor and sensory multineuritis, providing a clear organic explanation for the tetraparesis. Magnetic resonance imaging of the brachial and lumbar plexus confirmed radiculitis and miositis.

Following the initiation of targeted autoimmune therapy, the patient experienced a rapid and significant recovery. Psychotropic medications were gradually withdrawn without the emergence of neuropsychiatric symptoms.

DISCUSSION

Rare diseases pose a significant challenge due to diagnostic difficulties. Stigmatization negatively affects care, evaluation, and comprehensive treatment. It is a form of discrimination based on prejudice and stereotypes [1].

Healthcare professionals must remain aware of their own biases so they do not guide clinical decisions. Psychiatric consultation should not be used erratically. The literature shows that stigma within healthcare settings can negatively influence diagnostic accuracy, therapeutic adherence, and continuity of care [2].

Stigma operates at multiple levels shaping clinical interactions and influencing the interpretation of symptoms, particularly in complex or diagnostically uncertain cases [3]. In rare diseases, diagnostic uncertainty may amplify cognitive biases and lead to premature psychogenic attributions, increasing the risk of clinical error [4].

They must combat stigma through training strategies: direct and indirect contact, education, critical reflection, clinical simulation, language training, structured interventions, and continuous education. Evidence indicates that structured anti‑stigma training programs improve professional empathy, reduce discriminatory attitudes, and promote more equitable care [5].

References

1. Ahad AA, Sanchez-Gonzalez M, Junquera P. Understanding and addressing mental health stigma across cultures for improving psychiatric care: a narrative review. Cureus. 2023;15(5):e39549.
2. Nyblade L, Stockton MA, Giger K, Bond V, Ekstrand ML, McLean R, et al. Stigma in health facilities: why it matters and how we can change it. BMC Med. 2019;17:25.
3. Logie CH, Nyblade L. Recognizing and responding to stigma-related barriers in health care. Nat Rev Dis Primers. 2024;10:70.
4. Price T, McGowan V, Cooper C, Scott S. Exploring the impact of stigma on the health of inclusion health groups: a qualitative scoping review and critical analysis. BMC Public Health. 2026;26:24.
5. Stangl AL, Earnshaw V, Logie CH, et al. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy. BMC Med. 2019;17:31.