Insight Varies Over Time

It has been proposed that several steps of insight have to be traversed before insight can be expected to predict treatment adherence.

For example, unawareness of symptoms might be more directly associated with neuropsychologic deficits, and the labeling of symptoms as mental illness might be associated with reasoning biases (e.g., external attribution, jumping to conclusions), whereas not accepting the diagnosis of mental disorder or its implications might be closely linked to attitudes toward treatment.

This figure depicts a theoretical hierarchical course of insight components over time and the way in which they are likely to differ in origin and implications.

To complicate the matter of assessment further, it cannot necessarily be assumed that patients are being open about their level of insight. Clinical observations show that some patients tend to verbally express insight to be left alone by doctors or therapists. In these cases, we can hardly expect insight to produce the same changes in behavior as in a person with ‘‘real’’ insight.

Reference:
Lincoln TM, Lüllmann E, Rief W. Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophr Bull. 2007; 33(6): 1324-1342.