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.

Background: Psychotic spectrum disorders are associated with persistent impairments in psychosocial functioning that are not fully explained by symptom severity, particularly in individuals with chronic courses and prolonged hospitalization. Beyond psychopathological symptoms, relatively stable cognitive-emotional styles may influence long-term adaptation, subjective recovery, and quality of life in severe mental disorders. To examine the psychometric properties of the MOLDES questionnaire in a clinical sample of patients with psychotic spectrum disorders receiving long-term psychiatric care. Methods: A cross-sectional observational study was conducted in a sample of 83 clinically stable male patients with psychotic spectrum disorders hospitalized in a long-term psychiatric care unit. Internal consistency of the global MOLDES score and its three dimensions (Vital Spontaneity, Adjustment, and Optimization) was assessed using Cronbach’s alpha. Convergent and discriminant validity were explored through Spearman’s correlations with psychotic symptom severity, depressive symptoms, internalized stigma, and quality of life. Results: The global MOLDES score and its dimensions showed acceptable internal consistency, with Cronbach’s alpha values ranging from 0.70 to 0.77. No significant associations were observed between MOLDES dimensions and psychotic or depressive symptom severity, supporting discriminant validity. In contrast, Vital Spontaneity and Adjustment were negatively correlated with internalized stigma, while the Optimization dimension showed a positive association with quality of life. Conclusions: These findings provide preliminary evidence supporting the reliability and validity of the MOLDES questionnaire in patients with chronic psychotic disorders. The instrument appears to capture adaptive cognitive-emotional styles that are largely independent of symptom severity and meaningfully related to relevant psychosocial outcomes, suggesting its potential usefulness as a complementary assessment tool in long-term psychiatric care and rehabilitation-oriented settings.

In the global context of mental health, a concerning reality persists stigma and discrimination towards individuals with chronic mental disorders pose significant challenges affecting their quality of life and social integration. This study focuses on schizophrenia, one of the most stigmatized disorders, specifically exploring the phenomenon of insight and its interaction with internalized stigma. Previous findings are replicated and extended, involving a sample of 83 men diagnosed with psychotic spectrum disorders. K-means cluster analysis and ANOVA were used to identify subgroups based on levels of insight and stigma. This revealed significant differences between subgroups in psychosocial variables such as depression, quality of life, and global patient functioning. The results confirm an "insight paradox," where greater insight may be associated with poorer psychosocial outcomes in the presence of significant internalized stigma. These findings underscore the need for clinical interventions aimed at reducing stigma and enhancing the psychosocial well-being of individuals with psychotic spectrum disorders.