Association between obsession, compulsion, depression and insight in obsessive-compulsive disorder: a meta-analysis

Abstract

Background

Previous studies examining potential relationships of impaired insight with severity obsessive-compulsive (O-C) symptoms and depressive symptoms in patients diagnosed with obsessive-compulsive disorder (OCD) have produced mixed results. Here, we examined differences in these clinical characteristics and their changes after treatment in adult patients with OCD who have poor insight (OCD-PI) versus in those who have good insight (OCD-GI).

Methods

Fifty-nine full-text articles were screened for eligibility with 20 studies ultimately being included in the present meta-analysis.

Results

The OCD-PI and OCD-GI groups differed from each other with respect to O-C symptom (p < 0.001, g > 0.7) and depressive symptom (p < 0.001, g = 0.614) severity. Significant and moderate correlations were observed between insight and treatment outcomes (O-C symptoms, r = 0.33; depressive symptoms, r = 0.47). Exploratory meta-regression showed that methodological factors influenced the magnitudes of inter-group O-C symptom differences.

Conclusions

The current meta-analysis indicates that poorer insight is associated with more severe O-C and depression, and less improvement of symptoms in patients with OCD. Insight impairment may be a critical and core OCD-related deficit.

Keywords:

• Insight
• obsession
• compulsion
• depression
• treatment outcome

Acknowledgments

J.G. and J.H. searched databases, reviewed the paper and extracted data; J.G. analyzed data and wrote the paper. J.H., X.Z.Z and H.F. participated in the revision and polishing of the article. All authors reviewed the paper.

This research has not been funded by any organization.

Disclosure statement

The authors declare no competing financial interest.

Additional information

Notes on contributors

Jun Gan

Jun Gan, PhD, is currently doing the postdoctoral work at School of Psychology, Nanjing Normal University;

Jing He

Jing He, PhD, is a clinical psychologist and researcher at Department of Psychology, Hunan First Normal University;

Hong Fu

Hong Fu, PhD, is the professor and Head of School of Psychology, Nanjing Normal University;

Xiongzhao Zhu

Xiongzhao Zhu, M.D., is a psychiatrist, a professor and Head of Medical Psychological center, the Second Xiangya Hospital, Central South University.