We are unable to speak to a cause of the differences in perceived alcohol stigma across psychiatric comorbidity profiles using cross-sectional data and broad measures of psychopathology. Etiological perspectives on the interplay of stigma and psychiatric disorders describe that certain sequelae of stigma (e.g. rumination, deficits in emotion regulation) may confer risk for psychiatric disorders (Hatzenbuehler et al. 2008; Hatzenbuehler 2009). While leading theoretical perspectives describe that stigma is a social process that has consequences for stigmatized individuals across a variety of domains (Link and Phelan 2001), there has also been attention to specific psychological processes that may elevate perceived stigma. For example, neuroticism has been positively associated with self-report measures of perceived stigma and discrimination, leading some to note that perceived stigma may in part reflect personality orientations (Major et al. 2002; Borecki et al. 2010). Whether internalizing psychiatric comorbidity could sensitize affected individuals to perceive more stigma remains an open question that would be best addressed with prospective data that employs measures of personality orientations to control for their potential confounding nature.
