The impact of poor insight on the course of Obsessive-Compulsive Disorder in patients receiving naturalistic treatment

Objective Some patients with Obsessive Compulsive Disorder (OCD) think that their obsessive-compulsive beliefs are true. These patients have OCD with poor or absent insight, a clinical profile that poses a challenge to the clinician. The purpose of this study is to characterize the clinical profile of poor insight OCD and study the impact of poor insight on the two year course of OCD. Method Data were analysed of 253 adult patients with OCD, participating in the prospective naturalistic Netherlands Obsessive Compulsive Disorder Association (NOCDA) Study. Insight was measured using a standardized instrument, the Overvalued Ideas Scale. Results Good, fair, poor and absent insight occurred at every severity level of OCD. Poor insight was associated with higher OCD symptom severity, more chronicity, more comorbidity and predicted poor outcome at two-year follow-up, independently of treatment, severity of OCD- and depressive symptoms, age of onset, comorbidity and chronicity of OCD. Conclusions More severe and more complex symptoms characterize OCD with poor insight. Poor insight occurs at every severity level of OCD and appears to be an independent phenomenon which predicts poor outcome in OCD. Future work should determine whether improving insight causes better outcome in OCD.