Comparison of clinical characteristics in good and poor insight obsessive-compulsive disorder

Beginning with DSM-III-R, the condition of an intact insight towards obsessive-compulsive symptoms, which was essential for the classical definition of obsessivecompulsive neurosis, has been removed, permitting inclusion of cases with poor insight. A total of 94 cases who met DSM-III-R criteria for obsessive-compulsive disorder were included in this study. The Structured Clinical Interview for DSM-III-R (SCID-P), YaleBrown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression (HRSD), Hamilton Rating Scale for Anxiety (HRSA), and State-Trait Anxiety Inventory (STAI) were administered to each patient. Two subgroups determined by DSM-IV item "poor insight" were compared for demographic variables and the scores obtained on the scales. Scores on the Y-BOCS, HRSA, HRSD and STAI-state were significantly higher in the poor insight group. Current and past major depression were also more frequent. Among personality disorders (PDs), avoidant PD was more common in the good insight group and borderline and narcissistic PDs were more common in the poor insight group. HRSA, HRSD, and STAI-state scores had weak to moderate but significant correlations with insight as defined by the item 11 of Y-BOCS. Findings are discussed in view of previous reports.