Dimensional correlates of poor insight in obsessive–compulsive disorder

Abstract

Background Cross-sectional studies have associated poor insight in patients with obsessive-compulsive disorder (OCD) with increased OCD symptom severity, earlier age of comorbid depression, and treatment response. The goal of this current study was to examine the relationship between dimensions of OCD symp tomatology and insight in a large clinical cohort of Brazilian patients with OCD. We expect poor insight to be associated with total symptom severity as well as with hoarding symptoms severity. Methods 824 outpatients underwent a detailed clinical assessment for OCD, including the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), the Dimensional Yale–Brown Obsessive–Compulsive Scale (D-YBOCS), the Brown Assessment of Beliefs Scale (BABS), a socio-demographic questionnaire, and the Stuctured Clinical Interview for axis I DSM-IV disorders (SCID-P). Tobit regression models were used to examine the association between level of insight and clinical variables of interest. Results Increased severity of current and worst-ever hoarding symptoms was associated with poor insight in OCD after controlling for current OCD severity, age and gender. Poor insight was also correlated with increased current OCD symptom severity. Conclusion Hoarding and overall OCD severity explained were significantly but weakly associated with level of insight in OCD patients. Further studies should examine insight as a moderator and mediator of treatment response in OCD in both behavioral therapy and pharmacological trials. Behavioral techniques aimed at enhancing insight may be potentially beneficial in OCD, especially among patients with hoarding.

‘Impulsive compulsivity’ in obsessive-compulsive disorder: A phenotypic marker of patients with poor clinical outcome

“…Conversely, there appears to be some consensus regarding the association of impulsivity with hoarding and symmetry symptoms; however differences in findings across studies could be a result of the measure used, as well as sample sizes. There is also reliable evidence for the relationship of hoarding to poor insight (Jakubovski et al, 2011) and poor treatment response (Kishore et al, 2004) along with a suggestion that it might represent a distinct clinical entity (Pertusa et al, 2008;Phillips et al, 2010;Saxena, 2008). Our finding that hoarding is associated with impulsivity in OCD emphasizes the need for clinical and research focus on this dimension.…”

Obsessive-Compulsive Disorder: Diagnosis, Epidemiology, Etiology, and Treatment

“…(5) It has been recognized for some time that the degree of insight may vary during a single episode and across episodes (6), yet the etiology underlying these variations is unclear. Although research findings are mixed, poor insight has been associated with earlier age of onset (7,8), longer illness duration (7,8), greater severity of symptoms (9)(10)(11)(12), and an increased comorbidity with major depression (8,12).…”

Obsessive Compulsive Disorder with Poor Insight

“…[18] Bu araştırmada belirti boyutları Boyutsal YBOCS Ölçeğiyle kontaminasyon-yıkama, saldırganlık, cinsel-dini, simetri-düzenleme-sayma, istifleme ve çeşitli belirtiler boyutu olarak belirlenmiştir. Önceki araştırmaların sonuçlarına dayanarak, istiflemenin içgörü azlığıyla ilişkili bulunacağı öngörülmüştür.…”