Revisiting poor insight into illness in anorexia nervosa: True unawareness or conscious disagreement?

Background. To investigate and validate a novel approach to distinguishing between two possible sources of poor insight in anorexia nervosa: true unawareness, in which a patient is not aware that other people think there is a problem, and disagreement, in which a patient does recognize that others think there is a problem. Methods. Thirty-nine patients with anorexia nervosa or eating disorder not otherwise specified-anorexia nervosa were given two versions of the Scale of Unawareness of Mental Disorder (SUMD), one in which they were asked about their own opinion and one in which they were asked about their clinicians' opinion. Clinicians also completed the SUMD with their opinion about the patient's illness. Patients and clinicians both also completed a Visual Analog Scale assessing treatment acceptance. Results. About 57% of the overall level of poor insight was explained by disagreement. Prediction of treatment acceptance was significantly improved when poor insight was broken down into true unawareness and disagreement. Conclusions. These data suggest that impaired insight in anorexia nervosa is an additive outcome of true unawareness and disagreement.