Abstract
Poor insight into obsessive-compulsive disorder (OCD) symptoms is relatively common, occurring in between 9 and 30 % of cases. Poor insight is associated with increased OCD severity, earlier age of symptom onset, increased likelihood of comorbidity, and decreased treatment response. Furthermore, individuals with poor insight are only half as likely as others with good insight to seek treatment for their symptoms. No research to date has systematically treated insight levels in addition to OCD symptoms. We present the case of a 55-year-old woman who sought a psychological assessment for general dysfunction who had not been employed for over 33 years and was completely unaware of the obsessive-compulsive nature of her symptoms. We discuss the assessment process and thought process in differential diagnosis of a case with little symptom insight. We subsequently emphasize the role of insight and, specifically, the relationship between improved insight and treatment response during the course of 20 weeks of cognitive-behavioral therapy (CBT) with exposure and response prevention. Specific alterations to traditional CBT protocols due to her poor insight, including additional psychoeducation, focusing on insight and symptom identification, consistent treatment frequency, and additional sessions focusing on symptom insight, are highlighted. Overall, the woman showed a strong response to treatment that continues to be maintained after an 11-week period following treatment conclusion. Adjusting treatment to emphasize symptom education and insight can be beneficial in treating individuals with poor insight into their OCD-related symptoms.
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Larson, M., Whitcomb, K., Hunt, I., Bjornn, D. (2016). Treatment of Individuals with Obsessive-Compulsive Disorder Who Have Poor Insight. In: Storch, E., Lewin, A. (eds) Clinical Handbook of Obsessive-Compulsive and Related Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-17139-5_27
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DOI: https://doi.org/10.1007/978-3-319-17139-5_27
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