Level of Insight in Patients With Obsessive–Compulsive Disorder: An Exploratory Comparative Study Between Patients With “Good Insight” and “Poor Insight”

Abstract

Introduction: Insight may be defined as the ability to perceive and evaluate external reality and to separate it from its subjective aspects. It also refers to the ability to self-assess difficulties and personal qualities. Insight may be a predictor of success in the treatment of obsessive–compulsive disorder (OCD), so that individuals with poor insight tend to become refractory to treatment. The objective of this study is to investigate factors associated with poor insight in individuals with OCD. Methods: This cross-sectional exploratory study used the Brown Belief Assessment Scale as a parameter for the creation of the comparison groups: individuals who obtained null scores (zero) composed the group with preserved or good insight ( n = 148), and those with scores above the 75% percentile composed the group with poor insight ( n = 124); those with intermediate scores were excluded. Sociodemographic characteristics and clinical and psychopathological aspects, intrinsic and extrinsic to the typical symptoms of OCD, were compared in a univariate analysis. A logistic regression was used to determine which factors associated with critical judgment remained significant. Results: Individuals in the poor insight group differed from those with good insight in regard to: more prevalent use of neuroleptics ( p = 0.05); higher untreated time interval ( p < 0.001); higher total Yale–Brown obsessive–compulsive scale score and the obsessions and compulsions factors (all factors with p < 0.001); higher dimensional Yale–Brown obsessive–compulsive scale total and dimensional scores ( p from 0.04 to 0.001); higher prevalence of contamination/cleaning ( p = 0.006) and hoarding ( p < 0.001) symptoms dimensions; more prevalent sensory phenomena ( p = 0.023); higher levels of depression ( p = 0.007); and more prevalent comorbidity with bipolar affective disorder ( p = 0.05) and post-traumatic stress disorder (PTSD) ( p = 0.04). After analyzing the logistic regression, we conclude that the most important factors associated with poor insight are: the presence of any sensory phenomena (OR: 2.24), use of neuroleptics (OR: 1.66), and hoarding symptoms (OR: 1.15). Conclusion: The variability of insight in patients with OCD seems to be an important psychopathological characteristic in the differentiation of possible subtypes of OCD, since the poor insight is associated with sensory phenomena and greater use of neuroleptics, which makes it possible to conjecture the role of dopaminergic neurocircuits in the neurobiology of this disorder. In addition, there is also an association with the symptoms of hoarding content, admittedly one of the symptomatic contents with less response to...

Clinical Correlates of Treatment Adherence and Insight in Patients with Schizophrenia

“…Therefore, the present study supported the approval that insight level is a predictive factor on treatment adherence, and closely associated with the severity of clinical symptoms [32]. Many previous studies reported that OCD patients with poor insight show poor treatment adherence, more resistant symptoms, and more severe clinical symptoms [33]. Furthermore, duration of OCD was found to be related with lower insight level in several studies, and the insight level was also negatively correlated with the duration of the disorder in the present study [34].…”

Executive functions and insight in OCD: a comparative study

“…Agoraphobia, a fairly frequent disorder, was also statistically insignificant, with only four cases in the whole sample-two in the good-insight group and two in the control group. Although many authors claim that patients with poor insight display more comorbidities, recent studies have also failed to identify statistically relevant values of agoraphobia in OCD groups with good and poor insight [72], which suggests, for now, that the comorbidity of OCD with agoraphobia is not a research priority. As for depression, the percentage of patients suffering from this condition was higher in the poor-insight group (with p = 0.029, which coincides with the cut-off value, and a low effect size (0.25)).…”

Dissociable source-monitoring impairments in obsessive–compulsive disorder and schizophrenia

“…Traditionally, the obsessional thoughts in OCD have been distinguished from the delusions and hallucinations in SCZ because of their lack of perceptual qualities and the high level of patients' insight. However, numerous studies have recently reconsidered this dichotomy by showing that patients with OCD have a wide range of insight levels [6,[48][49][50][51] and frequently described their obsessional thoughts as perceptual irritations [52][53][54][55]. Moreover, patients with SCZ with diagnosed hearing hallucinations often describe them as less loud than real voices or without perceptual qualities but merely as strange thoughts [56].…”