Understanding Insight and Its Role in OCD

Understanding Insight and Its Role in OCD OCD Living With OCD Print Understanding Insight and Its Role in OCD By Owen Kelly, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on August 05, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on February 20, 2020 nullplus/Getty Images More in OCD Living With OCD Causes Symptoms and Diagnosis Treatment Types Related Conditions Insight is an important component of understanding obsessive-compulsive disorder (OCD). When someone is unable to recognize or acknowledge that their OCD symptoms are irrational, it presents a major challenge for patients, treatment providers, and  family members. Heres how insight impacts the diagnosis and treatment of OCD. Levels of Insight According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), one of the diagnostic criteria for OCD is that at some point in time, a person has recognized that the obsessions or compulsions they experience are “excessive or unreasonable.” Insight is the acknowledgment of the irrational nature of OCD symptoms. However, people who treat and study OCD have observed that people with the condition do not always recognize or agree that their obsessions and compulsions are irrational. In reality, it seems that insight exists on a continuum. Some people completely acknowledge that their symptoms do not make sense, while others have a very strong belief in the validity of their obsessions and compulsions. For this reason, the DSM-5 has been modified to include distinctions in levels of OCD insight, including good or fair insight, poor insight, and absent/insight delusional (a person views their OCD symptoms as completely rational and true). What Are OCD Obsessions? Insight also pertains to how a person views OCD in their day-to-day life. Someone with OCD may recognize the irrationality of their obsessions and compulsions but fail to understand or acknowledge that OCD has affected their ability to function. They may struggle at work or school and have issues with responsibilities at home that can be frustrating for family members. Children with OCD  are a unique situation as they usually dont have as much insight into their symptoms as adults do. Children simply lack the necessary life experience for a high level of insight and are often unable to grasp the irrational nature of their thoughts or behaviors. Parents and therapists can work together to help a child with OCD gain a different perspective on their symptoms. How OCD Is Different for Kids Insight Into OCD Symptoms and Treatment While there is some disagreement, poor or absent insight into OCD symptoms is thought to predict a worse response to psychological and medical treatments. Poor or absent insight can make it harder for someone with OCD to feel motivated, do the hard work that therapy requires, or stick to taking medication (especially if there are unpleasant side effects). People with poor insight may also be less likely to attend regular appointments or contact a healthcare provider at all. Common Cognitive Distortions in OCD Insight Into OCD Symptoms Can Change Insight into the excessive or unreasonable nature of obsessions and compulsions can fluctuate over time. For example, while obsessions or compulsions may at first seem completely reasonable or even helpful, a person may come to question these beliefs or behaviors over time. Insight can also change with a persons situation. For instance, while someone with OCD may be perfectly able to acknowledge that their obsessions and compulsions do not make sense while sitting in the therapists office, they may nevertheless feel they have to engage in these behaviors or thoughts when confronted with the actual feared situation. Someone with OCD may have intellectual insight but lack emotional insight. Insight into OCD symptoms and the effect they have on functioning can also change after treatment with psychotherapy or medication. However, these changes usually occur slowly and can also fluctuate over time. The 9 Best Online Therapy Programs