ORIGINAL ARTICLE Insight in obsessive–compulsive disorder: a study ofanItaliansample Donatella Marazziti*, Liliana Dell’Osso, Elena Di Nasso, Chiara Pfanner, Silvio Presta, Francesco Mungai, Giovanni B. Cassano Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, via Roma, 67, 56100 Pisa, Italy (Received 5 February 2002; accepted 18 April 2002) Summary – Insight is a complex phenomenon that can be interpreted according to a dimensional model. Given the controversial data of insight in obsessive–compulsive disorder (OCD), our study aimed to investigate insight in an Italian sample of patients with OCD by means of the specific item on the Yale–Brown obsessive–compulsive scale (Y-BOCS) and to explore the possible correlations between it and clinical features. One hundred and seventeen out-patients with a DSM-IV diagnosis of OCD and different comorbid psychiatric disorders were included in the study and assessed by means of the Y-BOCS, Hamilton rating scale for depression (HRSD) and the global clinical impression. The results showed that almost 50% of the patients had an excellent level of insight and 15% had a little or no insight. No correlation between levels of insight and clinical features was observed, except for a negative trend with the presence of somatic obsessions. In addition, a trend towards a lower level of insight was observed in those bipolar patients with a positive history of repeated manic or hypomanic episodes. Further studies seem to be necessary in order to establish whether or not OCD patients with poor insight represent a distinct sub-group of patients. © 2002 Éditions scientifiques et médicales Elsevier SAS Obsessive–compulsive disorder / Insight / Y-BOCS / OCD sub-typing INTRODUCTION Insight is a multidimensional and complex pheno- menon, which involves motivational, cognitive and perceptive processes. According to a multidimensional view [1,2], it has been divided into two components: “awareness of illness” and “attribution of symptoms”. Some authors have argued that insight includes both “current” and “retrospective” dimensions which can change during the course of a patient’s disorder [2,6,15]. The absence or presence of insight is traditionally considered to distinguish “psychotic” from “neurotic” disorders. According to DSM classification, however, the dichotomy between neurotic and psychotic disor- ders is lost and insight can be defined according to a dimensional perspective. Insight and awareness of illness are critical concepts in the differentiation of obsessions and delusions. In the past, the term “obsessive–compulsive disorder (OCD) with prevalent ideas” has been used in the literature referring to those patients with thought disorders, which were neither egodystonic nor, at the same time, true delusions [19]. Others [18] have referred to patients with “OCD and psychotic features”, who were charac- terized by the presence of paranoid symptoms and delusions. A similar definition was adopted by Eisen and Rasmussen [8], who divided OCD patients into groups named: “OCD without insight”, “OCD and schizophrenia”, “OCD and delusional disorder” and *Corresponding author. E-mail address: dmarazzi@psico.med.unipi.it (D. Marazziti). Eur Psychiatry 2002; 17: 407-10 © 2002 Éditions scientifiques et médicales Elsevier SAS. All rights reserved S0924933802006971/FLA