Insight in body dysmorphic, obsessive-compulsive and social anxiety disorders: Investigation of a transdiagnostically relevant feature

Abstract

Background: Body dysmorphic disorder (BDD) is often characterized by poor insight into the disorder up to delusional beliefs about perceived flaws or defects in one’s own physical appearance, which are only slightly or not visible to others. Although insight has often been studied in BDD, research on insight comparing different psychological disorders is sparse. Objective: This study investigated whether insight in individuals with BDD, obsessive-compulsive disorder (OCD), and social anxiety disorder (SAD) is different with respect to dimensional and categorical perspectives. Material and methods: Individuals with BDD (n = 36), OCD (n = 38), and SAD (n = 36) completed several diagnostic interviews and questionnaires. Insight was assessed using a semi-structured interview measuring different facets and degrees of insight (Brown Assessment of Beliefs Scale). Results: All clinical groups reported different degrees of insight in the complete spectrum from excellent to absent. Mean sum scores corresponded to poor insight in persons with BDD (M = 13.25, SD ± 6.32), fair insight in SAD (M = 10.39, SD ± 5.70) and good insight in OCD (M = 4.74, SD ± 5.49). Apart from a stronger fixity of beliefs in BDD, insight in BDD and SAD was dimensionally and categorically not significantly different but in both disorders poorer than in OCD. Discussion: The findings confirmed that BDD is associated with poor insight; however, this applied almost equally to SAD. Insight into the disorder seems relevant in every disorder investigated in this study and should be taken into consideration in the diagnostics and psychotherapy from the very beginning.