Academic journal article The Israel Journal of Psychiatry and Related Sciences

Insight and Alexithymia in Hospitalized Psychiatric Patients

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Insight and Alexithymia in Hospitalized Psychiatric Patients

Article excerpt

Abstract: The relationship of insight to the personality dimension of alexithymia was investigated in 91 psychiatric inpatients. Insight as a global construct and three subscales: the capacity to recognize that one has a psychiatric disorder, one needs treatment, and to label one's emotional illness as pathological were empirically measured via the Birchwood Scale for Insight. Alexithymia and its three subfactors were assessed by the 26-item Toronto Alexithymia Scale. Two of the alexithymia subfactors did correlate with reduced global insight and less acceptance of the need for therapy. Insight also correlated positively with the magnitude of depressed mood. In a regression model, depressed mood best predicted global insight. Other clinical variables, such as clinical severity upon admission, change in clinical status or diagnosis, did not predict insight levels. In summary, insight is a multidimensional phenomenon that does not simply correlate with alexithymia as a global construct but does correlate with alexithymic subfactor of diminished fantasy life.


In 1934, Sir Aubrey Lewis noted: "Insight is not a word of plain and single meaning" (1). Psychoanalytic writers have frequently utilized the term as a form of verstehen, or understanding, to connote the patient's awareness of unconscious conflicts that result in neurotic symptoms (2).

Hollander and Ford consider insight a form of education that occurs when a patient recognizes repeated affects, symptoms or behaviors and connects them with an unconscious conflict (3). Strupp notes that insight is an essential factor promoting change in psychotherapy. Such insight is gained via recognition of transference phenomena in the psychotherapy (4).

Although phenomenologists such as Jaspers and later psychopathologists such as Conrad considered lack of awareness in schizophrenia an important aspect of the disease, only recently have contemporary psychiatrists renewed empirical investigations into insight as an important element in psychiatric disorders (5). Insight is not a unitary construct, but consists of multiple dimensions such as the ability of individuals to recognize themselves as sick, to agree that treatment is necessary, and to accept psychopathological phenomena as morbid (6). Poor insight has been linked to nonadherence to treatment, severity of psychopathology, and cerebral atrophy (7, 8). Neurologists utilize the construct to denote an individual's inattention to a gross motor or sensory defect.

Concurrently, the personality trait of alexithymia, which denotes an individual's inability to experience and identify specific feeling states, an externally-oriented analytic style and a diminished capacity to daydream, is considered a personality dimension related to poor psychological mindedness (9). Taylor has suggested that alexithymic individuals may be less able to utilize insight oriented dynamic psychotherapy (10). The relationship between the two phenomena has not, to date, been investigated. This present study examines the relationship between insight and alexithymic characteristics in a group of patients hospitalized in a general hospital psychiatric unit. It is hypothesized that patients with greater alexithymic characteristics will have less insight.


Over a six-month period, 91 patients hospitalized in a 34-bed acute care psychiatric unit, in a 656-bed teaching hospital, were studied. Patients were excluded if they were sufficiently psychotic to be unable to complete the inventories or were below 18 years of age. The initial evaluation was determined within 36 hours of admission, while the discharge clinical status was determined in the 24-hour period prior to actual discharge.

Demographic data, including gender, age and educational level, were obtained. A DSM-IV diagnosis was ascertained for each patient (11). In addition, the following measures were utilized:

The Toronto Alexithymia Scale (TAS) ascertained the degree of alexithymia of each subject (12). …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.