{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:13:35Z","timestamp":1790381615158,"version":"4.1.0"},"reference-count":31,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Centro San Juan de Dios, Orden Hospitalaria Hermanos San Juan de Dios"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Stigma and discrimination remain significant challenges to the quality of life and social integration of individuals with chronic mental disorders, particularly schizophrenia, one of the most stigmatized conditions. The paradox of insight, in which greater awareness of illness correlates with poorer psychosocial outcomes in the presence of high internalized stigma, provides a critical framework for understanding these challenges. This study examined the moderation between insight and internalized stigma and its influence on psychosocial outcomes in 83 male participants diagnosed with psychotic spectrum disorders. Using K-means clustering, three distinct profiles emerged: (1) good insight and minimal stigma, (2) poor insight and mild stigma, and (3) good insight and severe stigma. These profiles showed significant differences in depression, quality of life, and global functioning. Findings confirmed that internalized stigma moderates the relationship between insight and psychosocial well-being, exacerbating the negative influence of insight on quality of life and psychological health when stigma levels are high. The results emphasize the need for psychoeducational interventions to normalize experiences of psychosis, family and community engagement to reduce stigma, and cognitive-behavioral therapies to address stigma-related beliefs. These strategies are essential for improving psychosocial well-being and supporting recovery in this population.<\/jats:p>","DOI":"10.3390\/bs15040410","type":"journal-article","created":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T13:48:20Z","timestamp":1742824100000},"page":"410","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The Psychosocial Impact of Insight Paradox and Internalized Stigma in Chronic Psychotic Disorders"],"prefix":"10.3390","volume":"15","author":[{"given":"Juan Jes\u00fas","family":"Mu\u00f1os Garc\u00eda","sequence":"first","affiliation":[{"name":"Centro de San Juan de Dios, Orden Hospitalaria San Juan de Dios, 28350 Ciempozuelos, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9273-8982","authenticated-orcid":false,"given":"Ricardo M.","family":"Hodann-Caudevilla","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Hospitalarias Zaragoza, Hermanas Hospitalarias, 50190 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Garc\u00eda Casta\u00f1o","sequence":"additional","affiliation":[{"name":"Hospital Infanta Sof\u00eda, 28702 San Sebasti\u00e1n de los Reyes, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8480-743X","authenticated-orcid":false,"given":"Sergio","family":"Aguilera Garrido","sequence":"additional","affiliation":[{"name":"Centro de Salud Mental Parla, 28981 Parla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Dur\u00e1n Tischhauser","sequence":"additional","affiliation":[{"name":"Centro de Salud Mental Rivas-Vaciamadrid, 28529 Rivas-Vaciamadrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1lvaro","family":"Pico Rada","sequence":"additional","affiliation":[{"name":"Centro de San Juan de Dios, Orden Hospitalaria San Juan de Dios, 28350 Ciempozuelos, Spain"},{"name":"Cl\u00ednica Nuestra Se\u00f1ora de la Paz, Orden Hospitalaria San Juan de Dios, 28033 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7009-4642","authenticated-orcid":false,"given":"Rafael","family":"Salom","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Nuestra Se\u00f1ora de la Paz, Orden Hospitalaria San Juan de Dios, 28033 Madrid, Spain"},{"name":"Faculty of Psychology, Valencian International University (VIU), 46002 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"key":"ref_1","first-page":"244","article-title":"Adaptation into Spanish of the internalised stigma of mental illness scale to assess personal stigma","volume":"11","year":"2018","journal-title":"Revista de Psiquiatr\u00eda y Salud Mental"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1037\/h0080427","article-title":"Subjective experience in schizophrenia: Factors influencing self-esteem, satisfaction with life, and subjective distress","volume":"69","author":"Bradshaw","year":"1999","journal-title":"American Journal of Orthopsychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.schres.2018.01.014","article-title":"Unraveling the insight paradox: One-year longitudinal study on the relationships between insight, self-stigma, and life satisfaction among people with schizophrenia spectrum disorders","volume":"197","author":"Chio","year":"2018","journal-title":"Schizophrenia Research"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.euroneuro.2015.04.003","article-title":"Treatment adherence in schizophrenia: A patient-level meta-analysis of combined CATIE and EUFEST studies","volume":"25","author":"Czobor","year":"2015","journal-title":"European Neuropsychopharmacology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.comppsych.2012.07.011","article-title":"Meaning in life, insight and self-stigma among people with severe mental illness","volume":"54","author":"Feingold","year":"2013","journal-title":"Comprehensive Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jad.2024.07.011","article-title":"Synthesising 30 years of clinical experience and scientific insight on affective temperaments in psychiatric disorders: State of the art","volume":"362","author":"Favaretto","year":"2024","journal-title":"Journal of Affective Disorders"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.psychres.2018.09.021","article-title":"Adherence, insight and disability in paranoid schizophrenia","volume":"270","author":"Ovejero","year":"2018","journal-title":"Psychiatry Research"},{"key":"ref_8","first-page":"59","article-title":"El estigma de la enfermedad mental. Estudio comparativo transversal del estigma social, el internalizado y la autoestima","volume":"33","author":"Castellanos","year":"2022","journal-title":"Cl\u00ednica y Salud"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1097\/NMD.0000000000001475","article-title":"Psychopathology and poor clinical insight in psychotic patients: Does the diagnosis matter?","volume":"210","author":"Moradi","year":"2022","journal-title":"The Journal of Nervous and Mental Disease"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1177\/0020764013490263","article-title":"Stigma and discrimination against people with schizophrenia related to medical services","volume":"60","author":"Harangozo","year":"2014","journal-title":"International Journal of Social Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.psychres.2012.07.038","article-title":"Insight into mental illness and self-stigma: The mediating role of shame proneness","volume":"200","author":"Vahab","year":"2012","journal-title":"Psychiatry Research"},{"key":"ref_12","unstructured":"Hern\u00e1ndez-Guanir, P. (2010). Moldes. Test de estrategias cognitivo-emocionales. Manual, Tea Ediciones S.A."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"106222","DOI":"10.1016\/j.eplepsyres.2019.106222","article-title":"Genetic and clinical features of SCN8A developmental and epileptic encephalopathy","volume":"158","author":"Kim","year":"2019","journal-title":"Epilepsy Research"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.socscimed.2018.07.015","article-title":"Experience of stigma and discrimination in families of persons with schizophrenia in the Czech Republic","volume":"212","author":"Krupchanka","year":"2018","journal-title":"Social Science & Medicine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s00406-017-0829-3","article-title":"The impact of cognitive insight, self-stigma, and medication compliance on the quality of life in patients with schizophrenia","volume":"268","author":"Lien","year":"2018","journal-title":"European Archives of Psychiatry and Clinical Neuroscience"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1080\/08870446.2020.1828413","article-title":"Challenging mental illness stigma in healthcare professionals and students: A systematic review and network meta-analysis","volume":"36","author":"Lien","year":"2021","journal-title":"Psychology & Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s11136-011-9926-3","article-title":"The WHO quality of life (WHOQOL) questionnaire: Spanish development and validation studies","volume":"21","year":"2012","journal-title":"Quality of Life Research"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/wps.20508","article-title":"Insight in schizophrenia spectrum disorders: Relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments","volume":"17","author":"Lysaker","year":"2018","journal-title":"World Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1093\/schbul\/sbl016","article-title":"Toward understanding the insight paradox: Internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders","volume":"33","author":"Lysaker","year":"2007","journal-title":"Schizophrenia Bulletin"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Marek, F., and Oexle, N. (2024). Supportive and non-supportive social experiences following suicide loss: A qualitative study. BMC Public Health, 24, (1).","DOI":"10.1186\/s12889-024-18545-3"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.schres.2015.01.003","article-title":"Is good insight associated with depression among patients with schizophrenia? Systematic review and meta-analysis","volume":"162","author":"Murri","year":"2015","journal-title":"Schizophrenia Research"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/0165-1781(94)90093-0","article-title":"Psychometric properties of the Positive and Negative Syndrome Scale (PANSS) in schizophrenia","volume":"53","author":"Peralta","year":"1994","journal-title":"Psychiatry Research"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1080\/00332747.2022.2161261","article-title":"Integrating loss and processing grief in psychotherapy of psychosis","volume":"86","author":"Ridenour","year":"2023","journal-title":"Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Sampogna, G., Di Vincenzo, M., Giuliani, L., Menculini, G., Mancuso, E., Arsenio, E., Cipolla, S., Della Rocca, B., Martiadis, V., Signorelli, M. S., and Fiorillo, A. (2023). A systematic review on the effectiveness of antipsychotic drugs on the quality of life of patients with schizophrenia. Brain Sciences, 13, (11).","DOI":"10.3390\/brainsci13111577"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S0920-9964(02)00490-5","article-title":"Cross-cultural adaptation and validation of the Spanish version of the Calgary Depression Scale for Schizophrenia","volume":"68","author":"Arranz","year":"2004","journal-title":"Schizophrenia Research"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Gaebel, W., R\u00f6ssler, W., and Sartorius, N. (2017). Structures and types of stigma. The stigma of mental illness\u2014End of the story?, Springer International Publishing.","DOI":"10.1007\/978-3-319-27839-1"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.schres.2020.03.038","article-title":"Relationship of poor insight to neurocognition, social cognition, and psychiatric symptoms in schizophrenia: A meta-analysis","volume":"220","author":"Subotnik","year":"2020","journal-title":"Schizophrenia Research"},{"key":"ref_28","unstructured":"The Jamovi Project (2023, October 20). Jamovi (Version 2.5) [Computer Software], Available online: https:\/\/www.jamovi.org."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"113068","DOI":"10.1016\/j.psychres.2020.113068","article-title":"Schizophrenia stigma in mental health professionals and associated factors: A systematic review","volume":"290","author":"Valery","year":"2020","journal-title":"Psychiatry Research"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Thornicroft, G., and Tansella, M. (1996). The Composite International Diagnostic Interview: An instrument for measuring mental health outcome?. Mental health outcome measures, Springer.","DOI":"10.1007\/978-3-642-80202-7"},{"key":"ref_31","unstructured":"World Health Organization (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines, World Health Organization. Available online: https:\/\/iris.who.int\/handle\/10665\/37958."}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/15\/4\/410\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:58:57Z","timestamp":1760029137000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/15\/4\/410"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,24]]},"references-count":31,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["bs15040410"],"URL":"https:\/\/doi.org\/10.3390\/bs15040410","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,24]]}}}