Borderline personality disorder can lead to people acting in alarmingly dysfunctional ways, both to the detriment of their own lives and of those around them. however, the good news is that many sufferers can and do recover. There are many factors that aid such recovery including the love and support of those close to the BPD sufferer, validation of the sufferer’s feelings, a trusting relationship with an effective therapist, and insight into their condition. It is this last factor, insight, that I will briefly examine in this article.

My overriding reason for creating this blog was to gain insight into how my own childhood had adversely affected how I thought, felt, and behaved as an adult and I believe that the insight it has afforded me has helped to alleviate many of my problems and difficulties. This is not surprising as research shows that those who have insight into their mental state have a higher rate of recovery.

But what is meant by insight? It refers to the ability of psychiatric patients to understand and accept that they are suffering from a mental health condition and comprises three main elements. These are: PSYCHICAL, SOMAESTHETIC and EMOTIONAL:

Let’s consider each of these three types of insight in turn:

PSYCHICAL INSIGHT:

If an individual has psychical insight it means that he has the capacity to understand that he is mentally ill. This element is further sub-divided into three sub-elements

CLINICAL INSIGHT:

This refers to the ability to understand that one has a mental illness, to be aware of the symptoms of the illness, and to accept that one is in need of treatment (Beck et al., 2004).

COGNITIVE INSIGHT:

This refers to the ability to criticize one’s own beliefs. (Beck et al., 2004) For example, a clinically depressed person (many BPD sufferers suffer from comorbid clinical depression) may believe that they are ‘evil’ when feeling at their worst though maintains the capacity to understand this belief is not correct when helped to form a more realistic view of him/herself by a cognitive therapist.

METACOGNITIVE INSIGHT:

Metacognition refers to the ability to think about and reflect upon and analyze one’s own thinking processes and metacognitive insight refers to the individual’s ability to understand that his/her thinking processes are subject to distortion due to his/her mental illness.

SOMAESTHETIC INSIGHT:

This refers to the individual’s capacity to understand that his/her physical problems (e.g. in the case of complex posttraumatic stress disorder, which is closely related to BPD, hyperventilation, and muscle armoring or, in the case of a clinically depressed person, psychomotor retardation) are intrinsically related to his/her mental state.

EMOTIONAL INSIGHT:

This refers to the individual’s emotional capacity to be convinced that s/he is suffering from a mental illness (as opposed to going into denial due to the threat to one’s self-esteem, for example).

 

Amador and David, on the other hand, posit that there are five dimensions to insight:

  1. Awareness that one has a mental illness
  2. Awareness of the consequences of that mental illness
  3. Awareness of the symptoms of that mental illness
  4. Attribution of symptoms to a mental illness
  5. Awareness of the effects of medication taken for that mental illness

INSIGHT GROWTH AND PSEUDO INSIGHT:

BPD sufferers who lack insight, especially if suffering from a transient psychotic episode, need to develop insight growth in order to increase their chances of recovery.

Insight growth is not to be confused with pseudo insight whereby a psychiatric patient merely parrots his/her psychiatrist’s insights without understanding or acceptance due to perceived pressure to agree with the psychiatrist’s views.

THERAPY:

Therapies that help an individual develop insight into his/her condition include METACOGNITIVE REFLECTION AND INSIGHT THERAPY and MENTALIZATION-BASED THERAPY.

David Hosier BSc Hons; MSc; PGDE(FAHE).