Insight in psychosis: influence of cognitive ability and self-esteem.

BACKGROUND Insight in psychosis has previously been associated with both depression and cognitive ability. Some studies have found a curvilinear relationship between insight and cognitive ability, but the roles of self-esteem and depression have not been taken into account. AIMS To investigate the relationships between insight and IQ, depression, and self-esteem. METHOD Correlations between self-reported and observer-rated insight, and measures of IQ, depression and self-esteem were examined in 67 people with psychosis. RESULTS Better self-reported insight was associated with higher IQ and poorer self-esteem, but not depression. There was some evidence for a curvilinear relationship between IQ and self-reported insight, specifically the ;awareness of illness' dimension, which survived correction for symptom variables. CONCLUSIONS The relationship between insight and IQ might reflect both the basis of insight in intellectual ability and the influence of a psychological mechanism that preserves self-esteem.