EMOTIONAL ABUSE AND GENERAL DISTRESS IN INDIVIDUALS WITH MULTIPLE SCLEROSIS: THE MEDIATION ROLE OF INTERNALIZED SHAME AND CHRONIC ILLNESS STIGMA

Background: Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system, causing a wide range of physical and cognitive symptoms, including movement difficulties, fatigue, and cognitive impairments. Research shows that individuals with MS experience higher levels of trauma than the general population. A specific form of trauma, such as Childhood Emotional Abuse (CEA), can lead to anxiety, depression, and stress. It can also foster maladaptive beliefs, like a sense of unworthiness and wrongdoing, which contribute to the development of shame. Additionally, CEA can make individuals more vulnerable to Chronic Illness Stigma due to feelings of inadequacy associated with past abuse. Research has found that emotional abuse can impair emotional regulation, making individuals more susceptible to Internalized Shame and Chronic Illness Stigma, which in turn can worsen their ability to cope with MS, leading to increased General Distress. Objective: This study aimed to assess whether Internalized Shame and Illness Stigma mediate the relationship between Emotional Abuse and General Distress. Method: A sample of 171 individuals with MS, aged 19 to 65 years (M = 34.04; SD = 10.01), were recruited via social media and completed an online survey. Structural equation modeling (SEM) with latent variables was used to test a model where Emotional Abuse was the predictor, Internalized Shame and Chronic Illness Stigma were mediators, and General Distress was the outcome. Results: The model showed good fit indices: χ²(49) = 89.81, p < .001; CFI = .97, RMSEA = .07 (90% CI = .05–.09), SRMR = .08. Significant paths were found from Emotional Abuse to Internalized Shame (β = .42) and Chronic Illness Stigma (β = .32). Significant paths were also found from Internalized Shame (β = .83) and Chronic Illness Stigma (β = .14) to General Distress. A non-significant path was found from Emotional Abuse to General Distress (β = .03). However, statistically significant indirect effects of Emotional Abuse on General Distress via Internalized Shame (β = .34) and Chronic Illness Stigma (β = .05) were detected. Conclusions: The results indicate that Internalized Shame and Chronic Illness Stigma mediate the relationship between Emotional Abuse and General Distress. Individuals who experience feelings of inadequacy and self-isolation are less likely to seek emotional support or help with daily tasks, which may contribute to distress. These findings highlight the importance of addressing Internalized Shame and Illness Stigma in treatment to improve distressing states in individuals with MS.