(PS3-D77) Examining Clinical Insight and Symptom Types in Obsessive-compulsive Disorder

Objective: Poor clinical insight, the degree to which one is unable to recognize the unreasonableness of one’s obsessions and compulsions (APA, 1994), has been linked to poor response to pharmacological treatment (Cherian et al. 2012) and psychotherapy (Himle et al. 2006) and to higher symptom severity (Bellino et al. 2005), in individuals with obsessive-compulsive disorder (OCD). Although extant research highlights the importance of clinical insight in OCD treatment outcome and severity, there is conflicting research on the OCD symptom types that are most influenced by poor insight (Fontenelle et al. 2010; de Avila et al. 2019; Turksoy et al. 2002). Thus, in this study, we examined the relationship between clinical insight and primary symptom type for adults with OCD. Additionally, we will investigate the longitudinal relationship between insight and OCD symptom severity.

 Method:  Participants were 242 adults (M_age = 40.1, SD = 12.8) with OCD enrolled in the Brown Longitudinal Obsessive Compulsive Study (BLOCS; see Pinto et al., 2006 for a detailed description). Participants completed the Yale-Brown Obsessive Compulsive Scale and Symptom Checklist (YBOCS; Goodman et al., 1989), Hamilton Rating Scale for Depression (HDRS; Hamilton, 1960), and the Brown Assessment of Beliefs Scale (BABS; Eisen et al., 1998). The BABS was used to measure the degree of insight into participants’ primary obsession(s). These primary obsessions were then categorized based on the a priori symptom categories of the YBOCS: aggression, contamination, hoarding, overresponsibility for harm, religious, sexual, somatic, and symmetry. Preliminary analyses were conducted to investigate the differences in insight according to primary symptom type. Planned analyses also include multivariate models to investigate the relationship between OCD symptom severity and insight, as insight changes over time.

Results: Preliminary results from a one-way ANOVA found a statistically significant, moderate effect of symptom dimension on insight, F (8, 233) = 3.53, p < .001, ω² = .278. The model explained 7.73% of the variance on insight. Bonferroni post-hoc tests revealed that having primary symptoms related to contamination resulted in statistically significantly poorer insight than having primary symptoms related to aggression (p < .01) or overresponsibility for harm (p = .03).  

 
Conclusion: While there is some contention about the relationship between OCD symptom subtype and insight, our preliminary results echo Cherian et al. (2012)’s report of a strong association between contamination and low levels of insight. These results could be beneficial for clinicians as they may adjust their treatment goals to accommodate for poor insight. Future directions could include interventions that would assess whether addressing insight for certain symptom types would benefit treatment outcomes.