Are self-reports valid for schizophrenia patients with poor insight? Relationship of unawareness of illness to psychological self-report instruments

This investigation aimed to determine whether impaired insight influences the validity of self-report test scores in schizophrenia and schizoaffective disorder. 274 outpatients enrolled in work rehabilitation completed the Beck Depression Inventory (BDI), Eysenck Personality Questionnaire (EPQ), Bell Object Relations and Reality Testing Inventory (BORRTI), and NEO-Five Factor Inventory (NEO-FFI). Self-report scores were compared to clinician's ratings on comparable personality and symptom dimensions on the Positive and Negative Syndrome Scale (PANSS), the Work Behavior Inventory (WBI), and the Quality of Life Scale (QLS). The influence of insight was determined using the Scale for Unawareness of Mental Disorder (SUMD). In the first analysis, clinician SUMD ratings of patient insight were associated with self-report accuracy. In a second analysis, patients were categorized into good and poor insight groups based on SUMD ratings and compared on self-report and clinician report variables. Results suggest that poor insight patients accurately report less Neuroticism and Agreeableness, and more Psychoticism than good insight patients, but individuals with poor insight wish to present themselves as more extraverted than they actually are, and they are likely to be more certain of their perceptions than they should be. It appears that self-report measures may be valid for most personality and symptom domains.