Insight into Illness Can Provide Insight into Recovery

In problem behaviors, insight or awareness of the behaviors is a very important step to changing the behaviors. Some individuals’ awareness and appreciation of the severity of their illness and its impact on their dangerous behaviors (such as taking drugs and attacking others) are compromised. When insight is impaired there is less perceived need for treatment. The vast majority of people who suffer from severe illness such as schizophrenia are neither aggressive nor violent. However, violence towards others by a minority of individuals is a significant public health concern and should be monitored because it could be preventable. The severity of this violence may be influenced by the extent to which individuals with schizophrenia (and other disorders) are aware that they have a serious and chronic illness that influences their thinking and their behaviors. We wanted to find out whether poor insight in schizophrenia is related to violent behavior and to problems with medication treatment adherence. Sixty male psychotic inpatients, legally detained at a forensic unit in New York City, were assessed with interviews, supplemented with information from hospital and official records, family members and the treating clinician. Results indicated that their severity of violent behavior was related to their poor adherence to medications prescribed by their doctors and to poor insight and drug use (Alia-Klein et al., 2007). We are now carrying out similar studies on insight into severity of illness/self-awareness and association with treatment outcome in drug addicted individuals.


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Icahn School of Medicine at Mount Sinai
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