Insight In Obsessive-compulsive Disorder Research Articles

A study of clinical correlates and predictors of insight in obsessive compulsive disorder

Background: Obsessive compulsive disorder (OCD) is a clinically heterogeneous psychiatric disorder in terms of symptom content and insight. Aim: To study the various factors associated with insight in OCD. Materials and Methods: A cross-sectional hospital-based study was conducted among 40 patients with OCD who were evaluated on Yale-Brown Obsessive-Compulsive Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Brown Assessment of Beliefs Scale, Meta-Cognitions Questionnaire, WHOQOL-BREF, and Sheehan Disability Scale. Statistical analysis was done using SPSS version 22. Results: Metacognition, severity of OCD, and associated disability were the significant predictors for insight in patients with OCD. Conclusion: Factors associated with insight in OCD can enhance our understanding in the management of OCD.

Unraveling the Neural Substrates of Insight in Obsessive-Compulsive Disorder

Unraveling the Neural Substrates of Insight in Obsessive-Compulsive Disorder

Poor Insight in Obsessive-Compulsive Disorder as a Multifaceted Phenomenon: Evidence From Brain Activation During Symptom Provocation

BackgroundPoor insight in obsessive-compulsive disorder (OCD) is associated with higher symptom severity, more comorbidities, and worse response to treatment. This study aimed to elucidate underlying mechanisms of poor insight in OCD by exploring its neurobiological correlates. MethodsUsing a symptom provocation task during functional magnetic resonance imaging, we compared brain activation of patients with poor insight (n = 19; 14 female, 5 male), good/fair insight (n = 63; 31 female, 32 male), and healthy control participants (n = 42; 22 female, 20 male) using a Bayesian region-of-interest and a general linear model whole-brain approach. Insight was assessed using the Overvalued Ideas Scale. ResultsCompared with patients with good/fair insight and healthy control participants, patients with OCD and poor insight showed widespread lower task-related activation in frontal areas (subgenual anterior cingulate cortex, ventromedial prefrontal cortex, dorsolateral prefrontal cortex, ventrolateral prefrontal cortex, supplementary motor area, precentral gyrus), parietal areas (posterior parietal cortex, precuneus), and the middle temporal gyrus and insula. Results were not driven by interindividual differences in OCD symptom severity, medication usage, age of disorder onset, or state distress levels. ConclusionsDuring symptom provocation, patients with OCD and poor insight show altered activation in brain circuits that are involved in emotional processing, sensory processing, and cognitive control. Future research should focus on longitudinal correlates of insight and/or use tasks that probe emotional and sensory processing and cognitive control.

Insight in obsessive-compulsive disorder: conception, clinical characteristics, neuroimaging, and treatment.

Obsessive-compulsive disorder (OCD) is a chronic disabling disease with often unsatisfactory therapeutic outcomes. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has broadened the diagnostic criteria for OCD, acknowledging that some OCD patients may lack insight into their symptoms. Previous studies have demonstrated that insight can impact therapeutic efficacy and prognosis, underscoring its importance in the treatment of mental disorders, including OCD. In recent years, there has been a growing interest in understanding the influence of insight on mental disorders, leading to advancements in related research. However, to the best of our knowledge, there is dearth of comprehensive reviews on the topic of insight in OCD. In this review article, we aim to fill this gap by providing a concise overview of the concept of insight and its multifaceted role in clinical characteristics, neuroimaging mechanisms, and treatment for OCD.

Insight in Obsessive-Compulsive Disorder: Relationship With Sociodemographic and Clinical Characteristics.

Insight is considered a multidimensional concept and, in the context of obsessive-compulsive disorder (OCD), impairment in insight has been widely reported to be associated with severity and other clinical and sociodemographic variables. However, the studies concerning insight in OCD have produced heterogenous data as a result of the scales used to measure insight. To overcome this heterogeneity, the study presented here used 4 different widely used and validated insight scales. The objective was to evaluate various aspects of insight using these scales to identify the relationships between different aspects of insight and clinical and sociodemographic variables to assess which scale or scales might possess greater efficiency in clinical practice. For this purpose, a descriptive, observational, and cross-sectional study of 81 patients in treatment in a mental health center was conducted. Patients were evaluated using the Brown Assessment of Beliefs Scale, the Overvalued Ideas Scale, the Scale of Unawareness of Mental Disorders, the Yale-Brown Obsessive Compulsive Scale, the Clinical Global Impressions Scale, the Global Assessment of Functioning Scale, and the Rey-Osterrieth Complex Figure Test. The results reported significant relationships between insight and scores on the Yale-Brown Obsessive Compulsive Scale (Thoughts, Compulsions, and Total scales), Clinical Global Impressions Scale, and the Global Assessment of Functioning Scale, and significant differences with regard to sex, level of education, working status, and course of the disorder. A correlation analysis was conducted to assess the relationships among the 4 insight scales. The results of this analysis suggest that the scales that measure insight in a multidimensional way (Brown Assessment of Beliefs Scale and Overvalued Ideas Scale) provide more information about the severity of the disorder in patients with OCD.

Poor insight in obsessive compulsive disorder (OCD): Associations with empathic concern and emotion recognition

PurposeInsight is currently considered to be responsible for 20% to 40% of the cases of ineffective obsessive-compulsive disorder (OCD) treatment. As 15% to 36% of patients with OCD have reduced insight, we aimed to identify some of the clinical determinants of insight in OCD. ResultsOur sample consisted of 57 OCD patients, of which 34 men (59%) and 23 women (41%). All individuals completed a two-phase interview consisting of a clinical assessment, emotional awareness evaluation and insight measurement, using the Brown Assessment of Beliefs Scale (BABS). The insight score correlated significantly with negative emotion recognition (p < 0.0001) and empathic concern (p = 0.003). Major conclusionsOur results support the hypothesis that insight in OCD is related to emotional awareness, specifically emotion recognition and empathic concern. Future research should investigate the extent to which poor insight and impaired emotional awareness can be modified by psychological or pharmacological therapies and whether this will enhance treatment response.

Executive functions and insight in OCD: a comparative study

BackgroundAround 25 to 30% of patients with obsessive-compulsive disorder (OCD) do not respond to treatment. These patients have the longest duration of disease and the worst prognosis. Following years of research on this topic, insight has emerged as a potential explanation for this therapeutic resistance. Therefore, it has become important to characterize OCD patients with poor insight. Few studies have focused on the neuropsychological and cognitive characteristics of these patients.MethodsTo help fill this gap, we divided 57 patients into two groups, one with good insight and the other with poor insight, assessed their neuropsychological functions—through a Rey’s figure test, a California verbal learning test, a Toulouse–Piéron test and a Wisconsin Card Sorting Test (WCST)—and compared the results with those of a paired control group.ResultsThe statistical analysis, with a significance level of 95%, revealed differences in the executive function tests, and particularly in the WCST (p ≤ 0.001) and trail-making-test (TMT A/B) (p = 0.002).ConclusionsThese differences suggest that the neuropsychological profile of poor-insight patients is different from their good-insight counterparts, emphasize the role played by the executive functions in insight and highlights the need for more accurate neurocognitive research and treatment.

Concordance of assessment of insight by different measures in obsessive-compulsive disorder: An outpatient-based study from India.

Aims:This study aimed to examine the (a) prevalence of various levels of insight among patients with obsessive-compulsive disorder (OCD) and (b) correlation of insight specifier (Diagnostic and Statistical Manual [DSM]-5) and other established measures of insight in OCD.Methods:One hundred and twenty-five outpatients with a diagnosis of OCD were assessed by Brown Assessment of Beliefs Scale (BABS) and DSM-IV's insight specifier. The insight specifier of DSM-5 was determined by item one (“conviction”) of BABS. Dimensional Yale-Brown Obsessive-Compulsive Severity Scale was used to assess the frequency and severity of dimensional obsessive-compulsive (OC) symptoms.Results:The mean age of the participants was 31.2 (±11) years. Seventy-seven (61.6%) of the participants were men. There was a high correlation (r = 0.73) between the insight specifiers of DSM-5 and DSM-IV. Insight categories of DSM-5 had modest correlations with BABS total score and BABS-based insight categories. Significant associations were observed between the level of insight and comorbid psychotic illness, hoarding and symmetry dimensions of OC symptoms, severity of depressive, and OC symptoms. The first two associations were consistent across group comparisons (insight-groups based on DSM-IV and BABS) and correlation (with total BABS score).Conclusions:Majority of the patients with OCD have good insight and application of different tools influence the assessment of insight in OCD. The DSM-5 insight specifier has strong and significant correlation with the DSM-IV's insight classification and categorization of insight by BABS.

A comparative study of psychopathology and functioning in patients of obsessive–compulsive disorder with good and poor insight from a tertiary care center in North India

BACKGROUND: Degree of insight in Obsessive Compulsive Disorder (OCD) varies with different symptom dimensions of OCD and not much of studies are done in this area. There is need to study insight in more detail in patients of OCD along with psychopathology and functioning. AIMS: To study and compare Psychopathology and Functioning in Patients of Obsessive Compulsive Disorder with Good and Poor Insight. METHOD: This is a cross sectional study and 94 patients fulfilling diagnostic criteria for OCD on the basis of the ICD10-DCR were assessed on Yale- Brown obsessive compulsive scale (Y-BOCS), Dimensional Yale- Brown obsessive compulsive scale (DY-BOCS), Brown Assessment of Belief Scale (BABS) and Social and Occupational Functioning Assessment Scale (SOFAS). RESULTS: A total of 94 patients of OCD were assessed and 76 (81 %) patient had good insight (BABS CONCLUSION: Majority of patient with predominant symptoms as aggression, sexual and religious obsessions belonged to good insight group. Patients with poor insight had higher severity of illness, longer duration of illness and duration of untreated illness.

Mindfulness predicts insight in obsessive-compulsive disorder over and above OC symptoms: An experience-sampling study

Insight in obsessive-compulsive disorder (OCD) is assumed to fluctuate over time. However, temporal variations of insight and its correlates in OCD have never been empirically studied. We used ecological momentary assessment (EMA) to analyze the temporal variation of insight into the unreasonableness of the threat-related core belief (1), into the senselessness of compulsions to prevent this belief from occurring (2), and into the belief, itself, as being due to OCD (3). Furthermore, we analyzed whether worry, self-punishment and mindfulness are associated with these aspects of insight. A total of 50 OCD patients underwent EMA 10 times a day over 6 consecutive days. Data were analyzed using multilevel modelling. Results revealed that multiple time-points within individuals accounted for up to 51.4% of insight variance, indicating a substantial fluctuation of insight over time. Root mean square successive difference (rMSSD) scores indicated significantly higher fluctuation patterns in the doubt/checking dimension as compared to taboo thoughts throughout all aspects of insight. As hypothesized, self-punishment and mindfulness significantly predicted insight into the unreasonableness of the threat-related belief and the senselessness of compulsions to prevent this belief from occurring. Mindfulness demonstrated the greatest predictive value and remained significant after controlling for OC symptoms. Contrary to expectation, worry, as it was measured in our study, was not associated with insight. Besides providing evidence for insight fluctuation, our results indicate that mindfulness-based strategies might be beneficial for increasing insight in OCD.

Utilizing Exposure and Response Prevention to Address Poor Insight in Obsessive-Compulsive Disorder.

Studies indicate that approximately 9%-30% of adults diagnosed with obsessive-compulsive disorder have poor insight into their symptoms. That is, they fail to recognize the excessiveness or irrationality of the obsessive thoughts or their compulsive behaviors. Poor insight in OCD is associated with more severe symptoms, earlier age of illness onset, longer illness duration, and higher rates of comorbid depression. Moreover, some studies have also reported that patients with poor insight are less likely than are those with good or fair insight to respond to first-line treatments such as exposure and response prevention (ERP). Despite the clinical relevance of poor insight, very little research has focused on how to enhance therapy with strategies specifically used to target it. In this report, we use a case study to demonstrate how different techniques can be emphasized or integrated with standard ERP to improve treatment outcomes for this subset of patients.

Poor insight in obsessive-compulsive disorder: Examining the role of cognitive and metacognitive variables

The purpose of the current study was to examine the cognitive and metacognitive constructs that conceptually relate to poor insight in obsessive-compulsive disorder (OCD). Associations between various dimensions of insight in OCD (e.g., clinical insight, conviction in one's beliefs) and cognitive and metacognitive variables (e.g., cognitive insight, decentering) were examined. Participants with OCD (N = 80) referred for treatment at an outpatient anxiety disorders clinic completed a clinical interview and a computer-administered questionnaire package assessing the variables of interest. Cognitive insight, a type of metacognitive process, was significantly negatively associated with delusional thinking, and cognitive self-consciousness was significantly negatively correlated with delusional thinking regarding a psychiatric source for one's symptoms. Finally, insight decreased during recall of times when OCD symptoms were activated for both the good and poor insight groups, and did not significantly vary as a function of insight group status. Implications, limitations, and directions for future research are discussed.

Associations of cortical thickness, surface area and subcortical volumes with insight in drug-naïve adults with obsessive-compulsive disorder.

Poor insight in obsessive-compulsive disorder (OCD) is associated with several adverse clinical outcomes. However, the neurobiological basis of this insight deficit is not clearly understood. The present study thus aimed to investigate associations of cortical thickness, cortical surface area and subcortical volumes with insight in a sample of drug-naïve adults with OCD. Forty-seven OCD patients and 42 healthy controls (HCs) underwent MRI scanning, depression and anxiety assessments. The Brown Assessment of Beliefs Scale (BABS) measured insight levels and patients were divided into two groups: poor insight (OCD-PI; n = 21), and good insight (OCD-GI; n = 26). Cortical thickness and surface area between groups were compared with whole-brain exploratory vertex-by-vertex analyses, while subcortical volumes were compared on a structure-by-structure basis. Partial correlation analyses were then performed to assess associations between regional cortical and subcortical measures and insight levels. OCD-GI and OCD-PI groups displayed partly shared, but also partly distinct brain structural alterations. Strikingly, OCD-PI showed decreased cortical thickness in the left superior frontal gyrus, left anterior cingulate cortex (ACC) and right inferior parietal gyrus, compared to both OCD-GI and HCs. Average cortical thickness extracted from these areas was further negatively correlated with BABS scores in the OCD-PI patients. Our findings suggest that poor insight in patients with OCD may have a neural substrate involving the left medial frontal and the right inferior parietal cortices.

Obsessive–Compulsive Disorder is Characterized by a Lack of Adaptive Coping Rather than an Excess of Maladaptive Coping

The present study aimed to elucidate the profile of coping in patients with obsessive–compulsive disorder (OCD) in order to discern whether the disorder is characterized by an excess of maladaptive coping skills and/or a lack of adaptive coping skills. Sixty individuals with OCD were compared with 110 individuals with depression and 1050 nonclinical controls on the Maladaptive and Adaptive Coping Styles Questionnaire (MAX). Psychopathology was assessed with the Obsessive–Compulsive Inventory-Revised (OCI-R), the Yale-Brown Obsessive–Compulsive Scale (Y-BOCS), and the Patient Health Questionnaire-9 for depression (PHQ-9). Individuals with OCD and depression displayed more maladaptive coping and avoidance as well as less adaptive coping than nonclinical controls. Importantly, adaptive coping was significantly lower in individuals with OCD than in those with depression at a medium effect size, whereas the clinical groups were indistinguishable on maladaptive coping and avoidance. Lack of adaptive coping was strongly correlated with resistance to symptoms and poor insight in OCD (Y-BOCS), even after controlling for depression. Lack of adaptive coping skills may represent a specific pathogenetic factor in OCD. Longitudinal studies need to clarify whether strengthening adaptive skills during childhood and adolescence may help to prevent the progression from subclinical to manifest OCD.

The relationship between theory of mind and insight in obsessive-compulsive disorder

Background: It is known that obsessive-compulsive disorder (OCD) patients with poor insight display more severe neuropsychological impairments than other patients with OCD. There are limited studies of OCD and theory of mind (ToM).Aim: To investigate ToM skills in patients with OCD and the relationship between insight and ToM skills by comparing OCD patients with good and poor insight.Methods: Eighty patients with OCD and 80 healthy controls completed the structured clinical interview for DSM-IV axis I disorders, the Yale Brown Obsessive-Compulsive Scale, the Beck Anxiety and Beck Depression Inventories, and the Brown Assessment of Beliefs Scale. To assess ToM skills, first- and second-order false-belief tests, a hinting test, a faux pas test, a reading the mind in the eyes test, and a double-bluff test were administered.Results: Patients with OCD had poorer ToM abilities than healthy controls. All ToM scores were significantly lower in the poor insight group than in the good insight group (p < .001). A significant negative correlation was found between the BABS-total scores and all the ToM test mean scores (p < .05).Conclusions: The finding of significantly lower ToM skills in OCD with poor insight than in OCD with good insight may contribute to the idea of OCD with poor insight being a subtype with different clinical and neuropsychological characteristics.

Personality organization in patients with obsessive-compulsive disorder and its relationship with functionality

Objectives: The aim of this study is to investigate the level of personality organization in obsessive-compulsive disorder (OCD), to determine the effect of personality organization dimensions on functioning, and to show the rela-tion with insight important in DSM-5. Methods: One hundred patients with OCD diagnosed according to DSM-5 were included in the study. Yale Brown Obsessive-Compulsive Disorder Questionnaire (Y-BOCS), Personality Organization Diagnosis Form (PODF) and Global Assessment of Functioning (GAF) scales were administered to all participants. Correlation analysis was performed to test the relationship between total insight score and the PO dimensions with global functionality level in patients with OCD. Hierarchical linear regression models were conducted. After controlling other variables, the predictability of PODF components on global functionality was assessed. Results: In the neurotic personality spectrum of individuals with OCD 24%, 62% were in the spectrum of borderline personality organization, and 14% were in the spectrum of psychotic personality organization. Corre-lation analyses showed that the total GAF and Y-BOCS insight scores were positively correlated with the total score on the PODF mature defenses and the total PODF identity score, but negatively correlated with the total score from the PODF primitive defenses and the total PODF reality testing score. In the hierarchical regression model in which functionality was a dependent variable, the Y-BOCS insight score, the total score from PODF primitive defenses, and the total PODF reality testing score were inverse predictors of global functioning, and the total PODF score from mature defenses predicted global functioning in a linear direction. Discussion: It was concluded that dimen-sions of the PODF (with the exception of identity dimension) could be used to predict functionality, even if it was a confounding factor with insight. The variable of insight in OCD was a concept that differs from the reality-testing dimension. Assessing the level of personality organization in patients with OCD will help to create areas that can be remediated in the design of functionality and treatment plans.

Abnormal small-world brain functional networks in obsessive-compulsive disorder patients with poor insight

BackgroundThere are limited data on neurobiological correlates of poor insight in obsessive-compulsive disorder (OCD). This study explored whether specific changes occur in small-world network (SWN) properties in the brain functional network of OCD patients with poor insight. MethodResting-state electroencephalograms (EEGs) were recorded for 12 medication-free OCD patients with poor insight, 50 medication-free OCD patients with good insight, and 36 healthy controls. ResultsBoth of the OCD groups exhibited topological alterations in the brain functional network characterized by abnormal small-world parameters at the beta band. However, the alterations at the theta band only existed in the OCD patients with poor insight. LimitationsA relatively small sample size. Subjects were naïve to medications and those with Axis I comorbidity were excluded, perhaps limiting generalizability. ConclusionsDisrupted functional integrity at the beta bands of the brain functional network may be related to OCD, while disrupted functional integrity at the theta band may be associated with poor insight in OCD patients, thus this study might provide novel insight into our understanding of the pathophysiology of OCD.

The effectiveness of the inference based approach to treating obsessive-compulsive disorder with poor insight; a randomized controlled multicentre trial

BackgroundThere is an urgent need for an effective psychological treatment for patients with obsessive compulsive disorder (OCD) with poor insight, since this disorder is associated with severe suffering and a low quality of life. The inference based approach (IBA), a new psychotherapy for OCD specifically targets insight in OCD. In a randomized controlled multicentre trial, the effectiveness of IBA was compared to the effectiveness of CBT for treating patients with OCD with poor insight. In this study, 24 sessions of IBA were tested versus 24 sessions of CBT. Ninety patients with a main diagnosis of OCD with poor insight according to the DSM-IV criteria participated in the study. The primary outcome was reduction of the obsessive-compulsive symptoms.ResultsIn both conditions, a significant OCD symptom reduction was reached, but no condition effects were established. Post hoc, in a small subgroup of patients with the worst insight (n = 23), it was found that the patients treated with the IBA reached a significantly higher OCD symptom reduction than patients treated with CBT [estimated marginal mean = –7.77, t(219.45) = –2.4, P = 0.017]. Of patients treated with IBA, 41.9% were responder and 20.9% completely recovered. Of the patients treated with CBT, 42.6% were responder and 12.8% recovered.ConclusionPatients with OCD with poor insight improve significantly after psychological treatment. The results of this study suggest that both CBT and the IBA are effective treatments for OCD with poor insight. The IBA might be more promising than CBT for patients with more extreme poor insight.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neuroimaging correlates of insight in obsessive compulsive disorder: A fMRI study

Aim of the studyTo study the neural substrates of insight in OCD by comparing patients with good insight, patients with poor insight and matched healthy controls using functional MRI.MethodologySubjects were recruited from among patients attending OCD clinic, adult psychiatry services and psychiatry ward inpatients of National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore. They were further divided into ‘good insight’ (n = 30) and ‘poor insight’ (n = 14) using Brown's assessment of belief's scale. Control subjects (n = 30) were recruited from consenting volunteers. 3 T MRI was used mental rotation task was paradigm used for fMRI and analysis was done by SPM 8.ResultsPoor insight patients and good insight patients comparison revealed differential activation in left superior/medial frontal gyrus (corresponding to the DLPFC). A negative correlation between BABS score and activation of right inferior parietal lobule. Mental rotation task behavioural data results: OCD patients as a group had significantly lower accuracy compared to healthy controls. Poor insight group had significantly decreased accuracy ratio compared to good insight group and healthy controls. A negative correlation was noted between BABS score and accuracy ratio, indicating that poorer the insight, greater the errors during the active task.ConclusionInsight has been important prognostic factor in OCD. Poor insight patients had specific deficits in left medial frontal gyrus and right inferior parietal lobule as compared to good insight patients and healthy controls. Together, these indicate that insight has a strong neurobiological underpinning in OCD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Spontaneous neural activity in the right superior temporal gyrus and left middle temporal gyrus is associated with insight level in obsessive-compulsive disorder

BackgroundInsight into illness is an important issue for psychiatry disorder. Although the existence of a poor insight subtype of obsessive-compulsive disorder (OCD) was recognized in the DSM-IV, and the insight level in OCD was specified further in DSM-V, the neural underpinnings of insight in OCD have been rarely explored. The present study was designed to bridge this research gap by using resting-state functional magnetic resonance imaging (fMRI). MethodsSpontaneous neural activity were examined in 19 OCD patients with good insight (OCD-GI), 18 OCD patients with poor insight (OCD-PI), and 25 healthy controls (HC) by analyzing the amplitude of low-frequency fluctuation (ALFF) in the resting state. Pearson correlation analysis was performed between regional ALFFs and insight levels among OCD patients. ResultsOCD-GI and OCD-PI demonstrated overlapping and distinct brain alterations. Notably, compared with OCD-GI, tOCD-PI had reduced ALFF in left middle temporal gyrus (MTG) and right superior temporal gyrus (STG), as well as increased ALFF in right middle occipital gyrus. Further analysis revealed that ALFF values for the left MTG and right STG were correlated negatively with insight level in patients with OCD. LimitationsRelatively small sample size and not all patients were un-medicated are our major limitations. ConclusionsSpontaneous brain activity in left MTG and right STG may be neural underpinnings of insight in OCD. Our results suggest the great role of human temporal brain regions in understanding insight, and further underscore the importance of considering insight presentation in understanding the clinical heterogeneity of OCD.