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Failures of metacognition and lack of insight in neuropsychiatric disorders.
Open accessAbstract
Lack of insight or unawareness of illness are the hallmarks of many psychiatric disorders, especially schizophrenia (SCZ) and other psychoses and could be conceived of as a failure in metacognition. Research in this area in the mental health field h as burgeoned with the development and widespread use of standard assessment instruments and the mapping out of the clinical and neuropsychological correlates of insight and its loss. There has been a growing appreciation of the multi-faceted nature of the concept and of the different 'objects' of insight, such as the general awareness that one is ill, to more specific metacognitive awareness of individual symptoms, impairments and performance. This in turn has led to the notion that insight may show modularity and may fractionate across different domains and disorders, supported by work that directly compares metacognition of memory deficits and illness awareness in patients with SCZ, Alzheimer's disease and brain injury. The focus of this paper will be on the varieties of metacognitive failure in psychiatry, particularly the psychoses. We explore cognitive models based on self-reflectiveness and their possible social and neurological bases, including data from structural and functional MRI. The medial frontal cortex appears to play an important role in self-appraisal in health and disease.
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“Deficits in metacognitive knowledge and awareness moreover are believed to lead to cognitive distortions (e.g., jumping to conclusions, attributional biases, theory of mind deficits) (60), dysfunctional beliefs and expectancies (associated with a low self-esteem and negative symptoms) (10, 95) and a lack of cognitive insight into those cognitive biases (96).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [96]
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“On the other hand, evidence from human neuropsychology that first- and second-order behavioural performances are dissociable suggests that at least some degree of separate representation will be required to account for second-order behaviours [ 6 , 9 , 14 ].”
From Metacognition: computation, biology and function (2012) · cites this paper as [14]
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“Together, their work suggests fractionation between different types of insight, such that insight into one aspect of pathology does not necessarily predict insight into another.”
From Metacognition: computation, biology and function (2012) · cites this paper as [14]
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The Psychology of Learning and Motivation
(2021) · The Psychology of learning and motivation/The psychology of learning and motivation · doi:10.1016/s0079-7421(21)x0002-3 · Cited by 5,082
Self-referential processing in our brain—A meta-analysis of imaging studies on the self
Northoff, G., Heinzel, A., de Greck, M., Bermpohl, F., Dobrowolny, H., & Panksepp, J. (2006) · NeuroImage · doi:10.1016/j.neuroimage.2005.12.002 · Cited by 2,792
Metamemory: A Theoretical Framework and New Findings
Nelson, T. O. (1990) · Psychology of Learning and Motivation · doi:10.1016/s0079-7421(08)60053-5 · Cited by 2,583
David, A. S. (1990) · The British Journal of Psychiatry · doi:10.1192/bjp.156.6.798 · Cited by 1,183
Behavioural Assessment of the Dysexecutive Syndrome
(2004) · Methodology Of Frontal And Executive Function · doi:10.4324/9780203344187-15 · Cited by 1,149
Assessment of insight in psychosis
AMADOR, X. F., Strauss, D. H., Yale, S. A., FLAUM, M. M., Endicott, J., & Gorman, J. M. (1993) · American Journal of Psychiatry · doi:10.1176/ajp.150.6.873 · Cited by 1,100
Rivermead Behavioural Memory Test
la Cour, P., & GALLAGHER, K. (1990) · Nordisk Psykologi · doi:10.1080/00291463.1990.10636996 · Cited by 992
Awareness of Illness in Schizophrenia and Schizoaffective and Mood Disorders
AMADOR, X. F. (1994) · Archives of General Psychiatry · doi:10.1001/archpsyc.1994.03950100074007 · Cited by 898
A new instrument for measuring insight: the Beck Cognitive Insight Scale
Beck, A. T. (2003) · Schizophrenia Research · doi:10.1016/s0920-9964(03)00189-0 · Cited by 871
Relating Introspective Accuracy to Individual Differences in Brain Structure
Fleming, S. M., Weil, R. S., Nagy, Z., Dolan, R. J., & Rees, G. (2010) · Science · doi:10.1126/science.1191883 · Cited by 809
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The metabolic basis of cognitive insight in psychosis: A positron emission tomography study
Caletti, E., Marotta, G., Vecchio, G. D., Paoli, R. A., Cigliobianco, M., Prunas, C., Zugno, E., Bottinelli, F., Brambilla, P., & Altamura, A. C. (2017) · PLoS ONE · doi:10.1371/journal.pone.0175803 · Cited by 14
Moeller, S. J., Kundu, P., Bachi, K., Maloney, T., Malaker, P., Parvaz, M. A., Alia-Klein, N., London, E. D., & Goldstein, R. Z. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.107930 · Cited by 14
“Here, we developed a new fMRI task to examine the rACC/vmPFC as underlying selfawareness of the need to change behavior, one component of clinical insight (David et al., 2012), among participants with active CUD.”
BackgroundMethodThe impact of theory of mind and neurocognition on delusionality in anorexia nervosa
Konstantakopoulos, G., Ioannidi, N., Patrikelis, P., & Gonidakis, F. (2020) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2020.1786504 · Cited by 16
The rise and fall of face recognition awareness across the life span.
Degutis, J. M., Yosef, B., Lee, E. A., Saad, E., Arizpe, J. M., Song, J. S., Wilmer, J. B., Germine, L. T., & Esterman, M. S. (2022) · Journal of Experimental Psychology Human Perception & Performance · doi:10.1037/xhp0001069 · Cited by 14
Do Psychosis Patients with Poor Insight Show Implicit Awareness on the Emotional Stroop Task?
Wiffen, B. D. R., O’Connor, J. A., Russo, M., Falcone, M. A., Joseph, C., Kolliakou, A., Forti, M. D., Murray, R. M., & David, A. S. (2013) · Psychopathology · doi:10.1159/000350452 · Cited by 14
Carrigan, N., Barkus, E., Ong, A., & Wei, M. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.06.016 · Cited by 14
Multidimensional Evaluation of Awareness in Prader-Willi Syndrome
Cobo, J., Coronas, R., Pousa, E., Oliva, J.-C., Giménez‐Palop, O., Esteba‐Castillo, S., Novell, R., Palao, D. J., & Caixàs, A. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10092007 · Cited by 14
“The phenomenon of lack of insight in some specific mental illnesses, namely psychotic and bipolar disorders or dementia syndromes and head injury, has been described for decades [17].”
BackgroundMetacognition, cortical thickness, and tauopathy in aging
Zhuang, K., Chen, X., Cassady, K. E., Baker, S. L., & Jagust, W. J. (2022) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2022.06.007 · Cited by 12
“…as previous literature has demonstrated individual differences in brain correlates of metacognition in other neurological and psychiatric disorders (David et al., 2012; Fleming and Dolan, 2012; Quattrini et al., 2019; Alkan et al., 2020), we hypothesize that appraisal discrepancy, measuring…”
Roux, P., Faivre, N., Urbach, M., Aouizerate, B., Brunel, L., Capdevielle, D., Chéreau, I., Dubertret, C., Dubreucq, J., Fond, G. B., et al. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2022.12.037 · Cited by 13
Implicit and explicit self-related processing in relation to insight in patients with schizophrenia
de Vos, A. E., Pijnenborg, G. H. M., Aleman, A., & van der Meer, L. (2015) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2015.1040151 · Cited by 12
Büchmann, C. B., Pedersen, G., Aminoff, S. R., Laskemoen, J. F., Barrett, E. A., Melle, I. S., & Lagerberg, T. V. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.12.072 · Cited by 15
Advice-taking as a bridge between decision neuroscience and mental capacity
van der Plas, E., David, A. S., & Fleming, S. M. (2019) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2019.101504 · Cited by 13
History biases reveal novel dissociations between perceptual and metacognitive decision-making
Benwell, C., Beyer, R., Wallington, F., & Ince, R. A. A. (2023) · Journal of Vision · doi:10.1167/jov.23.5.14 · Cited by 13
“…& Rahnev, 2021), brain stimulation (Rounis, Maniscalco, Rothwell, Passingham, & Lau, 2010; Rahnev, Maniscalco, Luber, Lau, & Lisanby, 2012) and clinical (David et al., 2012; Fleming, Ryu, Golfinos, & Blackmon, 2014; Del Cul, Dehaene, Reyes, Bravo, & Slachevsky, 2009; Hoven et al., 2019) studies.”
Social Cognition and Interaction Training
Fernandes, J. M., & Roberts, D. L. (2014) · Elsevier eBooks · doi:10.1016/b978-0-12-405172-0.00009-0 · Cited by 12
Şizofreni Hastalarında Öznel İyileşme İle Bilişsel İçgörü Arasındaki İlişkinin Araştırılması
İpçi, K., İncedere, A., Kiras, F., & YILDIZ, M. (2018) · Kocaeli Üniversitesi Sağlık Bilimleri Dergisi · doi:10.30934/kusbed.337808 · Cited by 11
Connecting clinical and experimental investigations of awareness in traumatic brain injury
Dockree, P. M., O’Connell, R. G., & Robertson, I. H. (2015) · Handbook of clinical neurology · doi:10.1016/b978-0-444-63521-1.00032-7 · Cited by 12
The longitudinal course of cognitive insight and mood in bipolar disorder
Camp, L. S. C. V., van den Ameele, S., Sabbe, B., & Oldenburg, J. F. E. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.08.063 · Cited by 11
de Jong, S., Hasson‐Ohayon, I., van Donkersgoed, R. J. M., Timmerman, M. E., van der Gaag, M., Aleman, A., Pijnenborg, G. H. M., & Lysaker, P. H. (2019) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2388 · Cited by 12
The idiosyncratic nature of confidencePreprint
Navajas, J., Hindocha, C., Foda, H., Keramati, M., Latham, P. E., & Bahrami, B. (2017) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/102269 · Cited by 11
Metacognitive biases in anxiety-depression and compulsivity extend across perception and memory
Seow, T. X. F., Fleming, S. M., & Hauser, T. U. (2025) · PLOS mental health. · doi:10.1371/journal.pmen.0000259 · Cited by 17
“In experimental studies, quantifying metacognition provides one route towards studying the processes contributing to distorted insight [2], and consequently has been increasingly examined in clinical populations.”
Link Between Perception of Treatment Need and Craving Reports in Addiction
Lambert, L., Serre, F., Thirioux, B., Jaafari, N., Roux, P., Jauffret‐Roustide, M., Lalanne, L., Daulouède, J., & Auriacombe, M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.790203 · Cited by 10
“Perception of treatment need (PTN) is one of the three subdimensions of clinical insight according to the David model (15, 16).”
Benefits of spontaneous confidence alignment between dyad members
Pescetelli, N., & Yeung, N. (2022) · Collective Intelligence · doi:10.1177/26339137221126915 · Cited by 10
“Metacognitive deficits are known to be important aspects of several psychiatric conditions (David et al., 2012).”
BackgroundConsciousness and Meta-Consciousness During Sleep
Baird, B., Erlacher, D., Czisch, M., Spoormaker, V. I., & Dresler, M. (2019) · Handbook of Behavioral Neuroscience · doi:10.1016/b978-0-12-813743-7.00019-0 · Cited by 10
Regression methods for metacognitive sensitivity
Kristensen, S. B., Sandberg, K., & Bibby, B. M. (2019) · Journal of Mathematical Psychology · doi:10.1016/j.jmp.2019.102297 · Cited by 14
Torres, I. J., Hıdıroğlu, C., Mackala, S. A., Ahn, S., Yatham, L. N., Ozerdem, E., & Michalak, E. E. (2021) · European Psychiatry · doi:10.1192/j.eurpsy.2021.31 · Cited by 12
Metacognitive sensitivity and symptoms of mental disorder: A systematic review and meta-analysis
Hohendorf, M., & Bauer, M. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.991339 · Cited by 15
“Whether the representation is of one’s own cognitive processes or those of others, accurate metacognition promotes adaptive behavior at an individual and interpersonal level (David et al., 2012) and has thus been an avenue for developing treatments of mental disorder (Moritz and Lysaker, 2018).”
BackgroundInformation search under uncertainty across transdiagnostic psychopathology and healthy ageing
Mohr, G., Ince, R. A. A., & Benwell, C. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-03065-w · Cited by 11
“Numerous studies have shown that both clinical [11 – 14] and sub-clinical [13, 15 – 17] psychopathology are associated with selective alterations in metacognition and subjective con fi dence.”
BackgroundCella, M., Bodnar, M. D., Lepage, M., MALLA, A. K., Joober, R., Iyer, S. N., Wykes, T., & Preti, A. (2020) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2020.1722084 · Cited by 10
Wright, A. C., Fowler, D. G., & Greenwood, K. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.112643 · Cited by 10
In schizophrenia, are lack of capacity and lack of insight more usefully understood as anosognosia?
Little, J. (2020) · Australasian Psychiatry · doi:10.1177/1039856220975296 · Cited by 8
Cognitive insight and introspective accuracy in individuals with bipolar disorder: A scoping review
Wels, L., Dalkner, N., Lenger, M., Fellendorf, F. T., Schönthaler, E. M. D., Harvey, P. D., & Reininghaus, E. Z. (2023) · Neuroscience Applied · doi:10.1016/j.nsa.2023.101132 · Cited by 8
“Research in psychiatric disorders concerning CI and IA has mainly focused on individuals with schizophrenia (e.g. David et al., 2012; Kao and Liu, 2010; Lincoln et al., 2007; Mervis et al., 2022; Riggs et al., 2012), yet there are not many studies that investigated this matter in individuals with…”
Hwang, S. S., Ahn, Y. M., & Kim, Y. S. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.11.004 · Cited by 8
Dresler, M., Erlacher, D., Czisch, M., & Spoormaker, V. I. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00052-0 · Cited by 8
Anosognosia in hoarding disorder is predicted by alterations in cognitive and inhibitory control
van Roessel, P., Marzke, C., Varias, A. D., Mukunda, P., Asgari, S., Sanchez, C., Shen, H., Jo, B., Gunaydin, L. A., Williams, L. M., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-25532-4 · Cited by 8
Relationship between cognition and suicidal behavior in recent-onset psychosis
Sastre-Buades, A., Caro‐Cañizares, I., Ochoa, S., Lorente-Rovira, E., Barajas, A., Gutiérrez‐Zotes, A., Sánchez-Alonso, S., López‐Carrilero, R., Grasa, E., Pousa, E., et al. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2022.12.042 · Cited by 9
Data, diagnoses, and interventions addressing the nursing focus “delusion”: A scoping review
Gonçalves, P., Sampaio, F., Sequeira, C., & Silva, M. A. T. D. C. P. E. (2019) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12401 · Cited by 8
Seow, T. X. F., Jelinek, L., Moritz, S., & Hauser, T. U. (2025) · Nature Reviews Psychology · doi:10.1038/s44159-025-00503-4 · Cited by 11
“This term was initially conceptualized to capture the importance of recognizing and accurately attributing one’s mental illness for diagnostic purposes in patients with psychosis 52–54 , and it is currently applied in other diagnoses more widely 12,55–58 .”
Giotakos, O. (2017) · Psychiatriki · doi:10.22365/jpsych.2017.284.332 · Cited by 7
Confidence biases in problem gambling
Friedemann, M., Fox, C. A., Hanlon, A. K., Tighe, D., Yeung, N., & Gillan, C. M. (2024) · Journal of Behavioral Addictions · doi:10.1556/2006.2024.00030 · Cited by 7
Singularity and consciousness: A neuropsychological contribution
de Haan, E. H. F., Scholte, H. S., Pinto, Y., Foschi, N., Polonara, G., & Fabri, M. (2021) · Journal of Neuropsychology · doi:10.1111/jnp.12234 · Cited by 9
Rodolico, A., Cutrufelli, P., Brondino, N., Caponnetto, P., Catania, G., Concerto, C., Fusar‐Poli, L., Mineo, L., Sturiale, S., Signorelli, M. S., et al. (2023) · Brain Sciences · doi:10.3390/brainsci13111557 · Cited by 7
“Deficits in metacognitive skills [61], alongside specific aspects of anosognosia such as deficits in self-monitoring related to frontal lobe dysfunction [62] and impaired awareness of illness associated with fronto-temporo-parietal asymmetry [63] have been identified in psychotic patients.”
BackgroundFan, L., Bass, E., Klein, H., Springfield, C. R., Vanneste, S., & Pinkham, A. E. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf014 · Cited by 6
Lambert, L., Serre, F., Thirioux, B., Jaafari, N., & Auriacombe, M. (2022) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2022.109391 · Cited by 6
Self-reflection in illness and health: literal and metaphorical?
David, A. S. (2017) · Humanities and Social Sciences Communications · doi:10.1057/palcomms.2017.91 · Cited by 6
Mueller, S. M. (2014) · International Neuropsychiatric Disease Journal · doi:10.9734/indj/2014/8102 · Cited by 6
Cognitive insight, neurocognition and life skills in patients with schizophrenia
Expósito, M. S., & Castaño, E. F. (2018) · Psicothema · doi:10.7334/psicothema2018.12 · Cited by 6
“…fl exibility and memory and the negative symptomatology to be defi ned as statistically signifi cant predictors, allowing us to explain a large percentage of the variance in self-certainty (David et al., 2012, Orfei et al., 2010, Pedrelli et. al., 2004) and in life skills (Giusti et al., 2013).”
Mograbi, D. C., Brown, R. G., Brand, A., & Morris, R. G. (2014) · Temas em Psicologia · doi:10.9788/tp2014.3-04 · Cited by 6
On the contribution of unconscious processes to implicit anosognosia
Saj̈, A., Vocat, R., & Vuilleumier, P. O. (2013) · Cognitive Neuroscience · doi:10.1080/17588928.2013.854760 · Cited by 6
Functional implications and course
Harvey, P. D. (2013) · Cambridge University Press eBooks · doi:10.1017/cbo9781139003872.006 · Cited by 6
Dimensions of insight in eating disorders: clinical and psychological predictors
Gawron, L., Garrido, I., Amaro-Carriba, M. A., Hernández-Molina, M., Carceller‐Sindreu, M., Carmona, C., Portella, M. J., & Pousa, E. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116566 · Cited by 5
“…relevant and is considered to be a potential treatment target in many mental disorders such as bipolar disorder (Depp et al., 2014), schizophrenia (Mintz et al., 2003), obsessive-compulsive disorder (Markov ´ a, Jaafari and Berrios, 2009) and neuropsychiatric disorders (David et al., 2012).”
Removing Compliance: Interpersonal and Social Factors Affecting Insight Assessments
Curk, P., Gurbai, S., & Freyenhagen, F. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.560039 · Cited by 5
“(24) healthy controls were more swayed by the benefits of admitting to mental illness than participants with a diagnosis.”
BackgroundResultInfluentialAssociations between Cortical Thickness and Metamemory in Alzheimer’s Disease
Duran, T., Woo, E., Svaldi, D. O., Risacher, S. L., Stage, E., Sanjay, A. B., Nho, K. T., West, J. D., Phillips, M. L., Goukasian, N., et al. (2022) · Brain Imaging and Behavior · doi:10.1007/s11682-021-00627-0 · Cited by 5
“Previous research shows that impaired metacognition is observed in various neurological and psychiatric disorders (David et al., 2012; Koren et al., 2006; SchmitterEdgecombe & Woo, 2004; Wilson et al., 2016).”
BackgroundBrunet-Gouet, É., Urbach, M., Ramos, V., Ehrminger, M., Aouizerate, B., Brunel, L., Capdevielle, D., Chéreau, I., Dubertret, C., Dubreucq, J., et al. (2019) · Clinical Rehabilitation · doi:10.1177/0269215519888784 · Cited by 5
Palmer-Cooper, E. C., & David, A. S. (2013) · Cognitive Neuroscience · doi:10.1080/17588928.2013.854759 · Cited by 5
Approaches to Medication Administration in Patients With Lack of Insight
Okobi, O. E., Agazie, O., Ayisire, O. E., Babalola, F., Dick, A. I., Akinsola, Z., Adeosun, A. A., Owolabi, O. J., Ajayi, T. O., & Odueke, A. Y. (2022) · Cureus · doi:10.7759/cureus.27143 · Cited by 6
“It has been recognized that the pathophysiological causes of lack of insight in schizophrenia have a neuropsychological basis associated with anomalies in the frontal and temporal lobes of the brain [5, 7, 9-10, 12-14].”
BackgroundInfluentialKonstantakopoulos, G., Trova, A., Tzavellas, E., Stefanatou, P., David, A. S., & Paparrigopoulos, T. J. (2023) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2023.109917 · Cited by 4
“Several different components of insight have been examined, including the ability to recognize that one has a mental illness, the capacity to relabel symptoms as pathological, awareness of illness’ consequences, and engagement with treatment (David et al., 2012, Konstantakopoulos et al., 2013).”
Cognitive functioning and awareness of illness in schizophrenia: a review and meta-analysis
Nair, A., Aleman, A., & David, A. S. (2013) · Cambridge University Press eBooks · doi:10.1017/cbo9781139003872.010 · Cited by 4
Recent Neurobiological Insights into the Concept of Insight in Psychosis
Mythri, S. V., & Sanjay, Y. (2016) · Indian Journal of Psychological Medicine · doi:10.4103/0253-7176.183077 · Cited by 4
“Research with this scale has shown a correlation between reduced cognitive insight on at least one subscale of BCIS and increased severity of delusions.[21] However, some studies did not show such a correlation.”
BackgroundResultInfluentialDavid, A. S. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.10.048 · Cited by 4
Chung, J. H., Eun, Y., Ock, S. M., Kim, B.-K., Kim, T.-H., Kim, D., Park, S. J., Im, M.-K., & Kim, S. (2022) · Psychiatry Investigation · doi:10.30773/pi.2022.0165 · Cited by 4
“In fact, previous studies showed that reduced frontal lobe volume caused a failure of metacognition 26 and a lack of insight in neuropsychiatric disorders.”
Mäntylä, T. J. S., Kieseppä, T., Suvisaari, J., & Raij, T. T. (2021) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2021.111347 · Cited by 4
“…directed to one’s mental functioning in general, such as cognitive and emotional processes, is often called metacognition (Fernandez-Duque et al., 2000; Grant et al., 2002), and insight into illness has thus been construed as a form of metacognition (David et al., 2012; Vohs et al., 2016).”
InfluentialReply to: Metacognition, Adaptation, and Mental Health
Seow, T. X. F., Rouault, M., Gillan, C. M., & Fleming, S. M. (2021) · Biological Psychiatry · doi:10.1016/j.biopsych.2021.11.005 · Cited by 4
Kiss, A., Mihura, J. L., Meyer, G. J., Pimentel, R. P. F. D. A., & Kletzka, N. T. (2023) · Psychological Injury and Law · doi:10.1007/s12207-023-09473-5 · Cited by 3
“This effect could result because some of the patients may have self-awareness deficits, failing to recognize the symptoms they exhibit or more readily endorsing symptoms than is indicated (e.g., David et al., 2012).”
BackgroundRoux, P., Faivre, N., Cannavo, A.-S., Brunet-Gouet, É., & Passerieux, C. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10194349 · Cited by 3
“In individuals suffering from severe and persistent psychiatric disorders, metacognition is a multi-faceted construct encompassing the recognition that one is ill, the awareness of one’s own cognitive style and beliefs, and the awareness of one’s own cognitive performance [1].”
BackgroundMetacognition, Accountability and Legal Personhood of AI
Ribeiro, B. A., Coelho, H., Ferreira, A. E., & Branquinho, J. (2023) · Law, governance and technology series · doi:10.1007/978-3-031-41264-6_9 · Cited by 5
Drug use and self-awareness of treatment need
Moeller, S. J., Goodwin, R. D., Sullivan, R. M., & Verdejo‐García, A. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815298-0.00026-5 · Cited by 3
Construction and Validation of the Inventory of Addiction Awareness (ICE-A)
Valdés, N., Díaz, R., Quevedo, Y., Arriagada, L., Andrés Borzutzky, H., & Schilkrut, R. (2019) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-019-00137-7 · Cited by 3
“…regarded as a continuum ranging from complete denial of the disease, when people underestimate the multiple everyday consequences of substance use (David et al. 2012; Lincoln et al. 2011), autobiographical memory deficits (Poncin et al. 2015), to the full and conscious acknowledgment that one is…”
BackgroundA Skeptical View on the Physics-Consciousness Explanatory Gap
Martinez‐Saito, M. (2021) · Axiomathes · doi:10.1007/s10516-021-09570-7 · Cited by 3
Remmert, N., Schmidt, K. M. B., Mussel, P., & Eid, M. (2021) · doi:10.31234/osf.io/mujya · Cited by 3
Gussmann, E., Lucae, S., Falkai, P., Padberg, F., Egli, S., & Kopf-Beck, J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1160075 · Cited by 2
“, jumping to conclusions, attributional biases, theory of mind deficits) (60), dysfunctional beliefs and expectancies (associated with a low selfesteem and negative symptoms) (10, 95) and a lack of cognitive insight into those cognitive biases (96).”
BackgroundInstruments for assessing insight in psychosis: A systematic review of psychometric properties
Hazan, H., Tayfur, S. N., Karmani, S., Gibbs-Dean, T., Mourgues, C., & Srihari, V. H. (2025) · Psychological Medicine · doi:10.1017/s0033291725101918 · Cited by 2
“Several valuable studies have advanced the understanding of insight in psychosis through longitudinal and intervention designs (e.g. David, Bedford, Wiffen, & Gilleen, 2012; Rathod, Kingdon, Smith, & Turkington, 2005; Wiffen, Raballo, & David, 2010), culturally diverse cohorts (Saravanan et al.,…”
The self and self-knowledge after frontal lobe neurosurgical lesions
Brown, L. B., Fish, J. E., Mograbi, D. C., Ashkan, K., & Morris, R. G. (2023) · Cortex · doi:10.1016/j.cortex.2023.02.006 · Cited by 2
“, 2007) and less motivation for and compliance with treatment (David et al., 2012).”
Backgroundde Oliveira, I. C., Neto, H. G. R., Nascimento, I., Pinto, V. A. M., Appolinário, J. C., & Cavalcanti, M. T. (2022) · Jornal Brasileiro de Psiquiatria · doi:10.1590/0047-2085000000344 · Cited by 2
Metacognition vulnerabilities in time of crisis: Who to protect from suicidal risk?
Martin, S. S., Oltra, A., & Monte, J. D. (2022) · Brain and Behavior · doi:10.1002/brb3.2794 · Cited by 1
“…in hard-to-treat disorders, such as psychosis, bipolar disorder, and resistant anxiety disorders (David et al., 2012; Jacobi et al., 2006; Moritz et al., 2010a; Moritz et al., 2010b; Myers & Wells, 2005; Tas…”
BackgroundThe relationship of action, affect, and metacognition in functional seizures
Jungilligens, J., Flohr, M.-C., Lange, M., Wellmer, J., & Popkirov, S. (2023) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2023.2287778 · Cited by 3
“Within the field of neuropsychiatric disorders, research interest in meta-cognition has increased in recent years (David et al., 2012; Rouault et al., 2018), based in part on the idea that metacognition provides a lens through which individuals with psychiatric disorders experience, interpret, and…”
BackgroundTorres, I. J., Mackala, S. A., Ahn, S., Michalak, E. E., Chakrabarty, T., Lam, R. W. M., Keramatian, K., & Yatham, L. N. (2024) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617724000559 · Cited by 2
“…in BD may reflect poor insight or awareness into one ’ s own cognitive functioning, which can be conceptualized as a metacognitive failure that results in inaccurate cognitive self-ratings (David et al., 2012; Roux et al., 2021; Torres et al., 2016; Torres et al., 2021; Van Camp et al., 2019).”
Insight in Psychosis: An Integrated Perspective
Mythri, S. V., & Ebenezer, J. A. (2018) · InTech eBooks · doi:10.5772/intechopen.79368 · Cited by 2
Grigsby, T. J., Forster, M., & Sussman, S. Y. (2018) · Journal of Addictive Diseases · doi:10.1080/10550887.2018.1557991 · Cited by 24
Compliance and insight as factors of recovery in patients with schizophrenia spectrum disorders
Karpenko, O. (2022) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202212201241 · Cited by 2
Boness, C. L. (2021) · MOspace Institutional Repository (University of Missouri) · doi:10.32469/10355/90983 · Cited by 2
Fekete, Z., Vass, E., Farkas-Pócs, M., Balajthy, R., & Szabó, I. K. (2022) · Current Psychology · doi:10.1007/s12144-022-02794-9 · Cited by 1
Zakrzewski, J. J., Twamley, E. W., Thomas, M. L., & Ayers, C. R. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.10.065 · Cited by 1
“Contemporary research exploring the neurobiological underpinnings of anosognosia, especially in psychosis and dementia, has emphasized the role of executive functioning and error-monitoring in disordered awareness (Agnew and Morris, 1998; Aleman et al., 2006; David et al., 2012; Klein et al., 2013).”
İnce, E., Hoşgelen, E. I., & Bora, E. (2026) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acag046 · Cited by 1
Towards an integrative neuroscience of metacognition
Fleming, S. M. (2026) · Nature reviews. Neuroscience · doi:10.1038/s41583-026-01081-x · Cited by 3
“and often manifest impaired clinical and cognitive insight into the abnormal nature of their experiences 143 .”
Confiance, métacognition et perception
Massoni, S. (2017) · L Actualité économique · doi:10.7202/1039885ar · Cited by 1
“Des études par microsimulation ou sur des patients souffrant de liaisons cérébrales précises sont nécessaires (par exemple, David et al., 2012, sur la métacognition de patients schizophréniques ou Fleming et al., 2014, sur des patients souffrant de lésions cérébrales).”
BackgroundMetacognitive insight into cognitive performance in Huntington’s disease gene carriers
Hewitt, S., White, A. J., Mason, S., & Barker, R. A. (2022) · BMJ Neurology Open · doi:10.1136/bmjno-2022-000268 · Cited by 1
Gutierrez, G., de Jalón, E. G., Aranguren, L., Corrales, A., Gil‐Berrozpe, G. J., Sánchez-Torres, A. M., Librero, J., Peralta, V., & Cuesta, M. J. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116261 · Cited by 1
Psychedelic-assisted therapy, metacognition, and the problem of integration: a tri-phasic approach
Dowie, T.-I. (2025) · Philosophical Psychology · doi:10.1080/09515089.2025.2508411 · Cited by 3
“More clinically oriented research has shown that lapses in metacognitive control and monitoring are directly associated with mental illness and psychological distress (David et al., 2012; Lysaker et al., 2018, 2020; MacBeth et al., 2016).”
Figueroa, R. A., León, T., & Sorensen, R. (2016) · Summa Psicológica · doi:10.18774/448x.2016.13.304 · Cited by 1
Clark, S. (2022) · Digital Archive @ GSU · doi:10.57709/10052447 · Cited by 1
Suominen, P. (2020) · SSRN Electronic Journal · doi:10.2139/ssrn.3721233 · Cited by 2
Palmer-Cooper, E. C. (2015) · ePrints Soton (University of Southampton)
Goupil, L. (2015) · theses.fr (ABES) · doi:10.70675/428bec58z5847z41acz905fzc51410a051e2
O’Connor, J. A., Wiffen, B., Forti, M. D., Joseph, C., Kolliakou, A., Bonaccorso, S., Murray, R. M., David, A., & Ferraro, L. (2013) · Nova Science Publishers (Nova Science Publishers, Inc.)
The Pragmatics of Confidence in Perceptual and Value-based Choice
Folke, N. E. T. (2017) · Apollo (University of Cambridge) · doi:10.17863/cam.22112
Prefrontal Control of the Tactile Sense
Gogulski, J. (2018) · Työväentutkimus Vuosikirja
Novel regression methods for metacognitionPreprint
Kristensen, S. B., Sandberg, K., & Bibby, B. M. (2018) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/423947
“Metacognition is a recurrent concept in many psychological fi elds of study (Metcalfe & Shimamura, 1996), and metacognitive disability is a characteristic of clinical diagnoses such as schizophrenia, Alzheimer’s and certain injuries of the brain (David, Bedford, Wi ff en, & Gilleen, 2012).”
BackgroundKarel, M., & Lund, D. B. (2015) · CRC Press eBooks · doi:10.1201/b18139-11
Rys, W. (2020) · Arrow@dit (Dublin Institute of Technology)
Houben, F., Ghysels, R., Mennen, D., Bosmans, R., Nuyts, E., & Spooren, A. I. F. (2020) · Brain Injury · doi:10.1080/02699052.2020.1802658
Metadata
- Authors
- David, A. S., Bedford, N., Wiffen, B., & Gilleen, J.
- Affiliations
- King's College London (GB)
- Section of Cognitive Neuropsychology, Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
- Venue
- Philosophical Transactions of the Royal Society B Biological Sciences
- Publisher
- The Royal Society
- Published
- 2012-05-19
- Volume
- 367
- Issue
- 1594
- Pages
- 1379-1390
- ISSN
- 0962-8436 (ISSN-L)
- 1471-2970
- PMC
- PMC3318769
- OpenAlex
- W2133743374
- Cited by
- 227
- References
- 110
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 11 · 2023: 18 · 2022: 22 · 2021: 22 · 2020: 11 · 2019: 18 · 2018: 15 · 2017: 21 · 2016: 18 · 2015: 15 · 2014: 17 · 2013: 16 · 2012: 6
- FWCI
- 12.34
- Type
- journal article
- Language
- en
- Update notices
- correction (2014-01-19)
- Open access
- bronze
- doi.org
- Locations
- Philosophical Transactions of the Royal Society B Biological Sciences (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0510-10129)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- metacognition, insight, anosognosia, schizophrenia, psychosis, neuropsychiatric disorders, disease awareness, self-reflection, medial frontal cortex, self-assessment, memory impairment, Alzheimer's disease, brain injury, functional MRI, structural MRI
- MeSH terms
- Cognition Disorders, Frontal Lobe, Humans, Models, Neurological
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