Exploring The Relationship of Symptom Dimensions with Insight and Functioning in Obsessive-Compulsive Disorder: A Cross-Sectional Study

Abstract

Background: In patients with obsessive-compulsive disorder (OCD), insight is a reflection of their understanding that their symptoms are irrational. Variations in insight have been associated with differences in symptom dimensions, severity, and overall prognosis. Moreover, specific psychopathological dimensions may differentially impact social and occupational functioning in OCD patients.
Aim: To explore the association of symptom dimensions with insight levels and to examine their impact on social and occupational functioning in patients with obsessive-compulsive disorder (OCD).
Methods: This cross-sectional study included 100 patients diagnosed with OCD according to DSM-5 criteria, aged 18–60 years, at a tertiary care center. Based on the Y-BOCS Item-11, patients were categorized as having good or poor insight. For assessing symptom dimensions, the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) was used, while the Social and Occupational Functioning Assessment Scale (SOFAS) was utilized to evaluate functioning.
Results: Of the 100 patients, 78% had good insight, while 22% exhibited poor insight. Overall, no statistically significant difference was found in the presence or severity of symptom dimensions between the two groups. A significant negative correlation was observed between the sexual/religious symptom dimension and SOFAS scores (p<0.05), indicating that greater severity in this domain was linked to poorer social and occupational functioning.
Conclusions: Poor insight was associated with higher symptom severity, divorce/separation and longer duration of untreated illness. Insight levels did not significantly differ across symptom dimensions. However, sexual-religious obsessions were strongly associated with poorer functioning, underscoring the need for domain-specific interventions beyond insight-based management.