Poor insight and self-disorders in schizophrenia: an empirical study

Poor insight is a core feature of schizophrenia and empirical studies have demonstrated associations with important symptom domains, cognitive functions, and clinical outcomes. While recent explanatory accounts mostly focus on neuro-, social-, or meta-cognitive deficits, a complementary model from phenomenological psychopathology suggests that impaired insight in schizophrenia is tied to fundamental alterations to the structure of subjectivity, viz. self-disorders affecting the conditions for self-reflection, that usually precede psychotic experiences and persist temporally beyond state-psychopathology. In line with this account, we hypothesized that self-disorders would be associated with impaired insight independently of shared associations with other forms of psychopathology and general intelligence. A sample of 67 patients with a diagnosis of schizophrenia or non-affective psychosis in non-acute phase of illness underwent comprehensive psychopathological examination including the Examination of Anomalous Self-Experiences (EASE) for assessment of self-disorders and the Positive and Negative Syndrome Scale (PANSS). PANSS item G12 was used as measure of insight. The group with impaired insight was characterized by a significantly higher level of self-disorders than the group with good insight, but there were no significant between-group differences regarding positive, negative, or depressive symptoms. In simple linear regression analysis only self-disorders were significantly associated with impaired insight, and multiple linear regression showed similar results. Our findings support the theoretical claim that self-disorders are linked to poor insight in schizophrenia. If corroborated this may have implications for early intervention and treatment.