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Revisiting Poor Insight into Illness in Anorexia Nervosa: True Unawareness or Conscious Disagreement?


Journal of Psychiatric Practice®: March 2014 - Volume 20 - Issue 2 - p 85–93
doi: 10.1097/01.pra.0000445243.00683.30

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. (Journal of Psychiatric Practice 2014;20:85–93)

ARBEL: Haifa University, Haifa, Israel; LATZER and KOREN: Haifa University and Rambam Medical Center, Haifa

This work is based on Reout Arbel’s doctoral dissertation that was conducted at the University of Haifa under the supervision of Danny Koren and Yael Latzer. The dissertation was supported by a doctoral grant from the University of Haifa to Reout Arbel. The authors wish to thank Miri Givon and Hamutal Shalev for their help in data collection and data coding.

The authors declare no conflicts of interest.

Please send correspondence to: Reout Arbel, PhD, The Faculty of Social Welfare and Health Studies, The School of Public Health, Haifa University, Haifa, Israel, 31905.

© 2014 by Lippincott Williams & Wilkins, Inc.