Korean J Schizophr Res.  2019 Oct;22(2):56-65. 10.16946/kjsr.2019.22.2.56.

The Insight Paradox among Outpatients with Schizophrenia

  • 1Department of Psychiatry, College of Medicine, Dong-A University, Busan, Korea. kimck@dau.ac.kr


The primary objective was to test the phenomenon known as the insight paradox, which refers to the association between higher levels of insight and lower self-esteem, higher hopelessness, and a higher perception of social prejudice among patients with schizophrenia.
A total of 216 outpatients with schizophrenia according to the DSM-IV diagnostic criteria were recruited. All participants were receiving ongoing outpatient treatment and were in a stable phase of the disorder. The participants were divided into a good-insight (N=109) and a poor-insight (N=107) group by the direct interview and the mean score of questionnaire. The parameters used for analysis and comparison were demographic variables (age, gender, education), clinical variables (age at onset, number of hospitalizations), self-esteem, hopelessness, self-stigma, and quality of life.
Compared with the poor-insight group, the good-insight group was found to have a lower number of hospitalizations, lower self-esteem, higher hopelessness, lower quality of life, and a higher level of internalized stigma.
The insight can cause the negative consequences in patients with schizophrenia. Therefore, clinicians should pay attention to the negative aspects of insight for improving the quality of life in the treatment of patients with schizophrenia.


Hopelessness; Insight; Insight paradox; Internalized stigma; Quality of life; Schizophrenia; Self-esteem
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