The impact of illness identity on recovery from severe mental illness: A test of the model

Objective: The Illness Identity model posits that self-stigma reduces hope and self-esteem among persons with severe mental illnesses, impacting a range of outcomes. The “insight paradox” anticipates that the negative effects of self-stigma are amplified by insight. This study tested these predictions using both cluster and path analyses. Method: A total of 117 participants meeting the criteria for schizophrenia-spectrum disorders completed measures of self-stigma, self-esteem, hopelessness, insight, social functioning, coping, and symptoms. Results: Cluster analysis supported the insight paradox; persons with low self-stigma/high insight had fewer psychiatric symptoms and better interpersonal functioning than persons with high self-stigma/low insight. Path analysis did not support the insight paradox, but indicated that self-stigma and insight impact different outcomes. Discussion: Findings suggest that support for the predictions of the Illness Identity model and insight paradox are supported may depend on analytic method. Conclusions: Finding suggest that the benefits of self-stigma reduction may be constrained by insight.