Predictors of Insight in Pediatric OCD: The Impact of Autistic Traits, Age, and Symptom Dimensions
R. Fuller, K. Prasanna, O. Consortium, M. GradosIntroduction
Obsessive-compulsive disorder (OCD) is characterized by intrusive, unwanted thoughts (obsessions) and rigid, ritualistic behaviors (compulsions). Insight in OCD refers to the recognition of the external nature of the symptoms through the identification of their irrational and unreasonable nature.
Objectives
1) To test the association of autistic traits and insight in OCD using a pediatric OCD sample; 2) to assess the association of insight with OCD severity and OCD symptom dimensions.
Methods
The sample was derived from the OCD Collaborative Genetics Association Study (OCGAS). Inclusion criteria were: 1) youth ages 8-17 years; 2) primary diagnosis of OCD; 3) proband in the family sample. Exclusion criteria were diagnoses of autism, Tourette syndrome, primary mood or psychotic disorder. Insight used a Likert scale (1-4): excellent, good, fair, poor/absent. Autistic traits used the parent-rated Social Responsiveness Scale (SRS). Anova and T-tests analyzed frequency data, and linear regression were used for continuous data. Outlier identification and exclusion used the Interquartile Range (IQR) Method. OCD severity used the Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, and symptom dimensions were extracted as factors using a principal components factor analysis approach.
Results
172 youth (ages 8–17, mean 13; 53% male) comprised the OCGAS subset sample. Younger age was associated with poorer insight (F=2.6, p=0.053), while higher SRS total scores (autistic traits) also predicted poorer insight (β=0.156, p=0.04, Figure 1).
When controlling for age, the strength of the relationship between autism traits and poorer insight increased (β=0.167, p=0.03), and it was stronger in adolescents (β=0.186, p=0.04) than school-aged participants (β=0.160, p=0.3). SRS Social Cognition (β=0.201, p=0.01), Communication (β=0.173, p=0.02) were significant but not Repetitive Phenomena (β=0.149, p=0.06). There was no association between CY-BOCS severity and insight in this sample.
Aggressive and sexual obsessions, as well as checking and counting compulsions, are associated with relatively better insight, while contamination obsessions have a trend with worse insight (p=0.06). When examining OCD dimensions, the Taboo factor (aggressive, sexual, religious, checking) predicted better insight (β=-0.143, p=0.06), while contamination-cleaning predicted worse insight (β=0.140, p=0.07). Hoarding and the symmetry-counting-ordering-miscellaneous factor are not associated with insight.
Image 1: Long description.