Insight in adults with obsessive–compulsive disorder

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Abstract

The present study examined the clinical correlates of insight among adults with obsessive–compulsive disorder (OCD). One hundred and thirty treatment-seeking adults with a primary diagnosis of OCD, aged 18 to 68 years (mean 31.4 years) participated. Measures of clinical severity, obsessive–compulsive symptom dimensions, anxiety symptoms, depressive symptoms, and ability to resist and control OCD symptoms were obtained. Results indicated that poor insight was positively related to greater OCD symptom severity and poorer ability to resist and control OCD symptoms; this pattern of associations held when insight was examined continuously and categorically (i.e., high versus low insight). Insight was generally not associated with other clinical characteristics, except for a relationship with mental neutralizing behaviors. Insight did not mediate the relationship between the ability to resist and control OCD symptoms and obsessive–compulsive symptom severity. Overall, this study provides further information into the nature and role of insight in adults with OCD.

Section snippets

Participants

Study enrollment included 130 individuals with OCD (49% female; mean age = 31.8 years [SD = 12.7]; range = 18 to 68 years) who presented to one of two specialty OCD clinics for treatment. All participants were diagnosed with OCD according to DSM-IV-TR criteria by a licensed psychologist. A second clinical psychologist independently confirmed the diagnosis of OCD. The Anxiety Disorder Interview Schedule for the DSM-IV [ADIS-IV; 35] was administered by a trained research assistant to all participants

Aim 1: Associations between Insight and Indices of OCD Severity and OCD Symptom Resistance and/or Control

Spearman’s correlations between the insight item (number 11) on the Y-BOCS and indices of OCD severity are presented in Table 1. As predicted, level of insight was positively and moderately correlated with overall symptom severity across several indices, including the Y-BOCS total score, the CGI-S, and the NIMH-GOCS, such that poorer insight was associated with greater severity on these measures. Additionally, poor insight was associated with worse ability to resist and control OCD symptoms

Discussion

We examined clinical correlates of insight using a large sample of adults with OCD. Approximately 18% of the sample exhibited low insight, which is similar to what others have found [e.g., [6], [8], [16]]. Consistent with others [8], [9], [11], [12], [13], [14], [15], [16], [17], [18] level of insight was positively but moderately correlated with overall symptom severity across several indices including the Y-BOCS total score, the CGI-S, and the NIMH-GOCS, such that poorer insight was

Acknowledgment

We would like to acknowledge Scott Baldwin for his contribution of assistance with statistical analyses and Gary Geffken, Tanya Murphy, and Wayne Goodman for their contributions in data collection.

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