[Personality in psychosis: clinically relevant? Links with clinical insight and symptom distress]

Little is known about the relationship of Five-Factor Model (FFM) personality and therapeutically relevant variables in psychosis.

To examine the relationship between personality traits and both clinical insight and distress due to (subclinical) positive symptoms.

Cross-sectional and longitudinal data from the Genetic Risk and Outcome of Psychosis (GROUP) study were analyzed. Associations between patients’ personality traits and clinical insight was examined using multiple regression. Logistic regression was used to assess the relationship between personality and symptom-related distress in patients, their siblings, and controls. All analyses controlled for symptom levels.

Greater self-reported insight was associated with higher agreeableness, higher neuroticism, lower extraversion, and greater severity of depressive symptoms. Researcher-rated insight was only related to symptom severity, as were changes in insight over time for both forms of insight. Higher openness was associated with a weaker relationship between the frequency of (subclinical) positive symptoms and symptom-related distress in both patients and siblings.

FFM personality traits are associated with both clinical insight and positive symptom distress, independently of symptom severity. In clinical practice, personality and symptoms are difficult to distinguish. This supports the use of integrated, personalized treatment approaches.