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Schizophrenia Bulletin Advance Access published online on August 7, 2006
Schizophrenia Bulletin, doi:10.1093/schbul/sbl016
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© The Author 2006. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Article

Toward Understanding the Insight Paradox: Internalized Stigma Moderates the Association Between Insight and Social Functioning, Hope, and Self-esteem Among People with Schizophrenia Spectrum Disorders

Paul H. Lysaker 1 *, David Roe 2, and Philip T. Yanos 3
1 Day Hospital 116H, 1481 West 10th Street, Roudebush VA Medical Center, Indianapolis, IN 46202; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202
2 Department of Psychiatric Rehabilitation and Behavioral Health Care, University of Medicine and Dentistry of New Jersey, Scotch Plains, NJ
3 Department of Psychiatry, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ; Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ

* To whom correspondence should be addressed.
Paul H. Lysaker, E-mail: plysaker{at}iupui.edu


  Abstract

Research has paradoxically linked awareness of illness to both better function outcomes and lesser hope and self-esteem. One possible explanation for these findings is that acceptance of having schizophrenia may impact outcomes differently depending on the meanings the person attaches to this acceptance, particularly whether he or she accepts stigmatizing beliefs about mental illness. To explore this possibility we performed a cluster analysis of 75 persons with schizophrenia spectrum disorders based on single measures of insight using the Positive and Negative Syndrome Scale, internalized stigma using the Internalized Stigma of Mental Illness Scale, and compared groups on concurrent assessments of hope and self-esteem. Three groups were produced by the cluster analyses: low in sight/mild stigma (n = 23), high insight/minimal stigma (n = 25), and high insight/moderate stigma (n = 27). As predicted, analysis of variance-comparing groups revealed that the high insight/moderate stigma group had significantly the lowest levels of hope on the Beck Hopelessness Scale and self-esteem using the Multidimensional Self-esteem Inventory. As predicted, the high insight/minimal stigma group also had significantly less impaired social function than the other groups. Implications for assisting persons to come to cope with awareness of illness and stigma are discussed.

Keywords: schizophrenia; stigma; quality of life; insight; hope; social function; narrative.
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