The paradoxical role of insight in mental illness: The experience of stigma and shame in schizophrenia, mood disorders, and anxiety disorders

Abstract

This study examined the factor structure of the Hungarian version of the Birchwood Insight Scale (BIS) and analyzed its association with socio-demographics, diagnosis, internalized stigma, and shame using confirmatory factor analysis (CFA) with covariates. Mentally ill patients (N = 200) completed self-report questionnaires. CFA supported a two-factor structure. While previous hospitalizations and diagnosis were associated with insight, insight predicted higher internalized stigma and shame. Efforts to increase insight should be matter of importance in the wider spectrum of mental diagnoses. However, such efforts should be conducted with special care as further research is needed to understand the impact of insight on wellbeing.

Psychopathology and Poor Clinical Insight in Psychotic Patients

“…In the BID group, by contrast, a lack of depression appears to contribute to poor insight. This link was observed in previous research (Buchman-Wildbaum et al, 2020; Cobo et al, 2020; Lysaker et al, 2003) and could be explained with the concept of “insight paradox” (Belvederi Murri et al, 2016; Murri et al, 2015). Insight paradox refers to the idea that unawareness of painful realities may protect persons from stigma and other demoralizing phenomenon commonly found in psychotic disorders.…”

“…The unique predicting role of cognitive symptoms on clinical insight in the schizophrenia group, and to a lesser extent in the BID group, suggests that we should take into account cognitive factors to better understand the roots of poor clinical insight and develop diagnosis-specific prevention or intervention frameworks. Although the positive effect of cognitive intervention models, such as psychoeducation therapy, that emphasize increasing patients’ knowledge regarding mental disorders is evident (Lincoln et al, 2007), patients do not necessarily benefit from this knowledge to overcome the debilitating experience of psychosis in daily life (Buchman-Wildbaum et al, 2020; Kemp and David, 1995). Alternatively, Metacognitive Reflection and Insight Therapy (Lysaker and Klion, 2017) targets metacognition, promotes the ability to be aware of the abnormal internal experiences related to mental illness, and assists patients in responding to these experiences in an adaptive and personally meaningful manner (Lysaker and Dimaggio, 2014).…”

Loneliness and Major Depressive Disorder in the Elderly with a History of Suicidal Ideation or Attempt: A Comment on “Therapist-Guided Internet-Based Treatments for Loneliness” by Käll et al.

“…Despite notable differences between internet-based cognitive behavioral therapy and interpersonal therapy, both had medium-to-large within-group effect sizes 4 months post-intervention. This encouraging finding indicates that clinical management of loneliness in addition to treatment for depression and anxiety is a possible avenue to prevent elderly suicide, as we demonstrated in our study that loneliness and mood disorder insight [2] were proximal to state suicidality among the elderly.…”

Approaches to Medication Administration in Patients With Lack of Insight

“…For instance, the Baker Act Regulation of Florida is a medicolegal-related regulation that permits the treating physician to detain and examine individuals who exhibit mental illness and are dangerous to themselves or others, including the risk of self-neglect and physical injury [19][20]. In other circumstances, medical professionals and associated caregiving services may keep a patient against their will after receiving permission from the relevant court [18][19][20][21][22][23][24]. After the assessment and work-up are finished, if the loss of insight is confirmed with other symptoms like impaired decision-making capacity, the necessity for hospitalization or other emergency psychiatric problems, the most expedient form of effective pharmacotherapy may be used.…”