Insight in clinical psychiatry. A new model.

Recent interest in insight in psychiatry has resulted in studies focusing on correlations between insight and variables such as severity of psychopathology, neuropsychological impairments, and magnetic resonance imaging. However, there has been relatively little exploration of the concept of insight itself as a basis of empirical research. This paper examines the concept of insight, differentiating this from the phenomenon of insight, and proposes that insight is a construct that needs to be considered from the perspective of the patient, of the clinician, and of their interaction. A new hierarchical model of insight construction is described, closely linked to symptom formation, and mechanisms are suggested to explain insight structure in relation to the different ways symptoms arise. The relationship between insight and symptom structure and disease suggests that the phenomenon of insight will vary in relation to different diseases. This in turn suggests that insight assessments should be modified according to the individual disease.