How Does This Differ from Delusions?
Insight was the original feature distinguishing OCD from psychosis. OCD therefore must be carefully differentiated from psychotic disorders. Some individuals with OCD have poor insight or even delusional OCD beliefs. However, they have obsessions and compulsions (distinguishing their condition from delusional disorder) and do not have other features of schizophrenia or schizoaffective disorder (e.g., hallucinations or formal thought disorder).
How to Assess insight?
Insight exists along a continuum from excellent to extremely poor. The Brown Assessment of Beliefs Scale (BABS) allows the clinician to examine the degree of insight. It is particularly useful for OCD but can also be used for other OC family conditions including Body Dysmorphic Disorder (BDD) and Hypochondriasis. The BABS is a 7-item clinician administered interview. Scores for each item range from 0 (non-delusional) to 4 (delusional).
why Care about insight?
15-36% of OCD patients have little or no insight. Lack of insight is correlated with more severe OCD symptoms, and difficulties with treatment compliance. OCD patients with poor insight are more likely to have depression and may have increased rates of schizotypal personal disorder.
Poor insight has been associated with obsessions focusing on responsibility for harm, religious concerns, and somatic issues. Patients with Hypochondriasis and BDD generally show poorer insight than people with OCD.