Insight in schizophrenia: associations with empathy

  • G. H. M. PijnenborgEmail author
  • J. M. Spikman
  • B. F. Jeronimus
  • A. Aleman
Original Paper


Many people with schizophrenia (50–80 %) demonstrate impaired insight, something which has been associated with a poorer outcome. Two types of empathy can be distinguished: affective empathy via shared emotions and cognitive empathy, also referred to as Theory of Mind (ToM). ToM can be subdivided into cognitive ToM (knowledge about beliefs of other people via perspective taking) and affective ToM (knowledge about other people’s emotions via perspective taking). Recent studies show a relationship between Theory of Mind (ToM) and insight. However, the relationship between affective empathy and insight in schizophrenia was not examined previously. This was the aim of the present study. We expected that affective empathy would show a stronger relationship with insight than both cognitive and affective ToM. We assessed forty-six patients with a diagnosis of schizophrenia, and fifty-three healthy controls were assessed with a test battery consisting of tests of social cognition (a self-rating scale for affective empathy, a ToM task assessing both cognitive and affective ToM, and two tests of emotion perception), verbal memory, executive functioning, psychomotor speed, and intelligence. Insight was assessed with item G12 of the PANSS-interview. A regression equation showed that affective empathy made the strongest unique contribution to insight, followed closely by affective ToM. Together, they explained 45 % of the variance in insight. None of the other independent variables made a unique contribution to the prediction of insight. Both affective ToM and affective empathy are associated with insight in schizophrenia. Being able to take empathize with other peoples feeling at both the affective and cognitive level may enhance insight in schizophrenia.


Schizophrenia Psychosis Empathy Theory of mind Insight Awareness of illness 



This project received financial support from the Foundation de Open Ankh, Foundation “Dienstbetoon Gezondheidszorg”, PO Box 142, 3769 ZJ, Soesterberg and ZONMW, PO Box 93 245, 2509 AE, Den Haag. The authors are endebted to Jikkelies Spoelman for her help in collecting the data and to Marije aan t Rot for her helpful comments on the manuscript.

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • G. H. M. Pijnenborg
    • 1
    • 2
    • 5
    Email author
  • J. M. Spikman
    • 4
    • 3
  • B. F. Jeronimus
    • 6
  • A. Aleman
    • 5
    • 3
  1. 1.Department of Psychotic DisordersGGZ-DrentheAssenThe Netherlands
  2. 2.Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
  3. 3.Department of Clinical and Developmental NeuropsychologyUniversity of GroningenGroningenThe Netherlands
  4. 4.Department of NeurologyUniversity Medical Center GroningenGroningenThe Netherlands
  5. 5.Neuroimaging CenterUniversity Medical Center GroningenGroningenThe Netherlands
  6. 6.Interdisciplinary Centre Pathology of Emotion regulation (ICPE), Department of PsychiatryUniversity Medical CenterGroningenThe Netherlands

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