# Analyzing LLM Reasoning to Uncover Mental Health Stigma

arXiv: https://arxiv.org/abs/2604.25053 · HTML: https://mlsanity.com/paper/2604.25053/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 7 of its 42 references that are in the map.
- First posted on arXiv 27 Apr 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 7 of 7)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [gpt-oss-120b & gpt-oss-20b Model Card](https://mlsanity.com/paper/2508.10925/) (2025)
- [DeepSeek-V3 Technical Report](https://mlsanity.com/paper/2412.19437/) (2024)
- [Measuring Faithfulness in Chain-of-Thought Reasoning](https://mlsanity.com/paper/2307.13702/) (2023)
- [Evaluating and Mitigating Discrimination in Language Model Decisions](https://mlsanity.com/paper/2312.03689/) (2023)
- [Benefits and Harms of Large Language Models in Digital Mental Health](https://mlsanity.com/paper/2311.14693/) (2023)
- [Bias patterns in the application of LLMs for clinical decision support: A comprehensive study](https://mlsanity.com/paper/2404.15149/) (2024)

## Abstract (arXiv)

While large language models (LLMs) are increasingly being explored for mental health applications, recent studies reveal that they can exhibit stigma toward individuals with psychological conditions. Existing evaluations of this stigma primarily rely on multiple-choice questions (MCQs), which fail to capture the biases embedded within the models' underlying logic. In this paper, we analyze the intermediate reasoning steps of LLMs to uncover hidden stigmatizing language and the internal rationales driving it. We leverage clinical expertise to categorize common patterns of stigmatizing language directed at individuals with psychological conditions and use this framework to identify and tag problematic statements in LLM reasoning. Furthermore, we rate the severity of these statements, distinguishing between overt prejudice and more subtle, less immediately harmful biases. To broaden the reasoning domain and capture a wider array of patterns, we also extend an existing mental health stigma benchmark by incorporating additional psychological conditions. Our findings demonstrate that evaluating model reasoning not only exposes substantially more stigma than traditional MCQ-based methods but also helps identify the flaws in the LLMs' logic and their understanding of mental health conditions.