Stigma and Support in Online Sexual Violence Narratives on Reddit

Objectives: To develop a codebook for self-stigma across cognitive, affective, and behavioral domains, and to estimate the prevalence, co-occurrence, and temporal patterns of these indicators in Reddit posts by people who use drugs. Methods: We developed a ten-indicator codebook through consensus-based abductive coding spanning cognitive (self-labeling, pessimism/self-defeatism, deservingness/worthlessness), affective (shame, guilt/self-blame, despair/hopelessness), and behavioral (concealment, anticipated rejection, desire to quit, ambivalence) domains; two coders reached substantial agreement (Cohen's k = 0.72). We then scaled classification with a large language model validated against expert coding (k = 0.73, F1 = 0.80), analyzing 72,115 thread-initiating posts from 1,660 English-language users (2006-2025). Results: 3,838 posts (5.3%) from 1,228 users (74.0%) contained self-stigma; all ten indicators discriminated self-stigma posts (RR 3.6 to 86.2), led by self-labeling (56.0%) and despair/hopelessness (48.5%). Self-stigma was integrated: core and behavioral indicators were strongly associated at the user level (OR = 4.65, 95% CI 3.12-6.94, p < 0.001), and 87.0% of posts with behavioral indicators also contained a core indicator. Contrary to progressive models, behavioral indicators emerged earlier than core ones (desire to quit at median position 0.08 vs. shame at 0.38). Nine of ten indicators were stable across posting trajectories; only pessimism increased (OR = 1.62, 95% CI 1.25-2.10). Conclusion: Among people who use drugs online, self-stigma is an integrated phenomenon in which behavioral indicators rarely appear without internalized ones and often precede them. Most expressions remain stable over time, but pessimism about change deepens, marking a target for early digital intervention and showing that progressive stage models do not map directly onto textual disclosure.

Self-stigma predicts treatment avoidance and disengagement among people who use drugs (PWUD), yet conversational systems aiming to provide support typically treat self-stigma expression as a uniform signal. We present a three-phase, proof-of-concept study of a persona-aware approach to LLM support. Latent Profile Analysis (LPA) on indicator-level features from 1,174 self-stigma expressors on Reddit yields a four-persona typology validated against held-out behavioral and linguistic features. Sequential Bayesian and recurrent neural classifiers recover these personas from limited posting histories, substantially outperforming batch and few-shot LLM baselines (macro-F1 = 0.74 at 30 posts). Evaluation by eight clinical experts across three contemporary LLMs revealed a misalignment: persona-matched responses successfully achieved targeted behavioral shifts, yet raters holistically preferred the generic empathy of the persona-neutral baseline. Our findings suggest that holistic empathy judgments and clinically-aligned response design can pull in opposite directions, and that evaluating LLM-based stigma support requires rubrics capable of decomposing the two.

Reclaimed slur usage is a common and meaningful practice online for many marginalized communities. It serves as a source of solidarity, identity, and shared experience. However, contemporary automated and AI-based moderation tools for online content largely fail to distinguish between reclaimed and hateful uses of slurs, resulting in the suppression of marginalized voices. In this work, we use quantitative and qualitative methods to examine the attitudes of social media users in LGBTQIA+, Black, and women communities around reclaimed slurs targeting our focus groups including the f-word, n-word, and b-word. With social media users from these communities, we collect and analyze an annotated online slur usage corpus. The corpus includes annotators' perceptions of whether an online text containing a slur should be flagged as hate speech, as well as contextual features of the slur usage. Across all communities and annotation questions, we observe low inter-annotator agreement, indicating substantial disagreement among in-group annotators. This is compounded by the fact that, absent clear contextual signals of identity and intent, even in-group members may disagree on how to interpret reclaimed slur usage online. Semi-structured interviews with annotators suggest that differences in lived experience and personal history contribute to this variation as well. We find poor alignment between annotator judgments and automated hate speech assessments produced by Perspective API. We further observe that certain features of a text such as whether the slur usage was derogatory and if the slur was targeted at oneself are more associated with whether annotators report the text as hate speech. Together, these findings highlight the inherent subjectivity and contextual nature of how marginalized communities interpret slurs online.