Stigma and Prejudice in Chronic Liver Diseases

Stigmatization is a well-documented problem in some diseases. Liver diseases are considered stigmatized diseases, possibly due to their association with alcoholism and drug abuse. In fact, studies have shown that patients with infection due to hepatitis C and B are frequently stigmatized independently of the method of virus transmission and patients with cirrhosis are frequently stigmatized independently of the cause of their disease, Non-alcoholic fatty liver disease (NAFLD) is the most common hepatic disease worldwide, affecting approximately 24% of the world population, and it is frequently associated with obesity and metabolic syndrome. 69% of patients with NAFLD feel stigmatized [1]. The burden of alcoholic liver disease (ALD)as well as combined metabolic dysfunction and alcohol-associated liver disease grows due to increased alcohol intake, widespread metabolic risk factors, delayed diagnosis, and poor integration between primary care and substance use service [3].

Stigmatization of patients with NAFLD, whether it is caused by obesity or the liver disease per se, is strongly and independently associated with a substantial impairment of their quality of life [4]. The liver disease stigma scale (LDSS) is the first multidimensional scale specifically designed and psychometrically evaluated to measure liver disease related stigma [5]. When someone hears you have fatty liver disease, they may think that you brought it upon yourself. The word “fatty” in there could imply it’s related to food or obesity. The fact that it’s a liver disease could imply it was caused by alcohol – even if it is called “nonalcohol-related.” And then if the name actually says “alcohol” in it, like alcohol-induced fatty liver disease, this can help to believe they’re justified in thinking they caused their illness by drinking. Professionals in the health care system can also have negative feelings towards patients with fatty liver disease since they think that patients brought the condition upon themselves. This is one of the reasons why the medical community changed the name of non-alcoholic fatty liver disease to MASLD. The hope is that people will see past the original name and treat the disease like any other.

If a patient has a condition that others blame on alcohol, street drugs, or overeating, your family, friends, and co-workers may pull away from you. The more they pull away or pass judgment on you, the more you become lonely and isolated. This means less access to social support when you may need it most, this can lead to: malnutrition, insomnia, job loss or not being able to find employment, unstable economic situation, having difficulty staying or having a relationship. To face MASLD stigma: Be kind to yourself, Schedule your worry time, seek support, know your rights and if you feel that you’ve been treated unfairly by your health care provider: Speak up, write down what happened, Switch providers or staff, if possible, Complain [6].