Poor insight in obsessive-compulsive disorder: Examining the role of cognitive and metacognitive variables

The purpose of the current study was to examine the cognitive and metacognitive constructs that conceptually relate to poor insight in obsessive-compulsive disorder (OCD). Associations between various dimensions of insight in OCD (e.g., clinical insight, conviction in one's beliefs) and cognitive and metacognitive variables (e.g., cognitive insight, decentering) were examined. Participants with OCD (N = 80) referred for treatment at an outpatient anxiety disorders clinic completed a clinical interview and a computer-administered questionnaire package assessing the variables of interest. Cognitive insight, a type of metacognitive process, was significantly negatively associated with delusional thinking, and cognitive self-consciousness was significantly negatively correlated with delusional thinking regarding a psychiatric source for one's symptoms. Finally, insight decreased during recall of times when OCD symptoms were activated for both the good and poor insight groups, and did not significantly vary as a function of insight group status. Implications, limitations, and directions for future research are discussed.