We sought to investigate whether first-episode and multiple-episode patients differ in their awareness of their illness. A total of 312 multiple-episode and 144 first-episode patients participated, the majority of whom had a schizophrenia spectrum disorder (schizophrenia or schizophreniform disorder). Insight was measured using the Scale for the Assessment of Unawareness of Mental Disorder (SUMD). First-episode patients with a schizophrenia spectrum disorder were less aware of having a mental illness than multiple-episode patients. Our findings suggest that in the time following the first episode of psychosis, patients may become less defensive, and possibly more skilled in using medical terms to describe their illness. We suggest a need for skilled psychoeducation that addresses awareness in patients with psychosis, particularly those who are unaware of their illness.