Clinical Correlates of Poor Insight in Obsessive-Compulsive Disorder: An Integrative Cross-Sectional Analysis

Background/Objectives: Poor insight is a clinically relevant feature of obsessive-compulsive disorder (OCD), yet its broader clinical correlates remain incompletely understood. We aimed to characterize the clinical correlates of insight in adults with OCD using complementary categorical and dimensional approaches. Methods: In this single-center cross-sectional study, 80 adults with OCD were assessed using the Brown Assessment of Beliefs Scale (BABS) total score and BABS item 6. Insight was examined categorically and dimensionally. FDR-corrected Spearman screening was followed by complementary multivariable models and exploratory graphical-lasso partial-correlation networks and relative-importance analyses. Results: Poor-to-absent insight was present in 20 participants (25.0%). In between-group comparisons, the largest differences involved OCD severity, OCPD trait count, and hoarding. In the fully adjusted model for BABS total, OCD severity was the only independently significant correlate (β = 0.339; 95% CI 0.051-0.628; p = 0.021). Exploratory conditional-network analysis likewise identified OCD severity as the strongest conditional correlate of BABS total (partial r = 0.251). For BABS item 6, older age retained an adjusted association, while higher YMRS scores were associated with the upper cumulative thresholds; these threshold-specific findings were based on small subgroups and should be interpreted as exploratory. Conclusions: Poor-to-absent insight was present in one quarter of this treatment-experienced clinical sample. OCD severity emerged as the most consistent correlate of poorer global insight, whereas BABS item 6 showed a partly different pattern of associations. Categorical and dimensional assessment provided complementary information, but BABS item 6 is part of the BABS total score and the observed differences should not be interpreted as evidence of independent insight constructs. Clinical assessment should therefore consider both the level of insight itself and the broader psychopathological context.