Back in 1994, the DSM-IV introduced "with poor insight" as a specifier for obsessive-compulsive disorder (OCD). The DSM-5 took it a step further, allowing clinicians to diagnose OCD "with absent insight/delusional beliefs. " This change has blurred the line between OCD and psychosis. A recent study asked OCD experts about this insight specifier and the future of OCD classification.

The study included 60 OCD experts, with a verified subgroup of 35 experts having at least 6 years of clinical or research experience. Most experts agreed that the insight specifier should stay, but they differed on whether OCD with complete lack of insight should also include a second diagnosis, like delusional disorder.

An interesting split emerged: a slight majority of all experts (48. 4% yes vs. 36. 7% no) and a majority of verified experts (51. 4% vs. 34. 3%) suggested removing "delusional beliefs" as a specifier. They worried this might lead to unnecessary antipsychotic prescriptions and doubts about psychotherapy's effectiveness for OCD.

A clear majority (56. 7% of all experts, 60. 0% of verified experts) believed that some doubt or partial insight should be present for an OCD diagnosis. Additionally, most experts opposed reclassifying OCD as an anxiety disorder.

Looking ahead to the DSM-6, the study recommends emphasizing that complete lack of insight is rare in OCD and dropping the term "delusional beliefs. "

Expert Views on OCD Insight: Should It Be Part of the DSM-6?

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