A 30-year-old woman with OCD has good insight into the irrationality of her compulsions but cannot resist them. In DSM-5, which specifier would be applied to her OCD diagnosis?
- A With poor insight
- B With absent insight / delusional beliefs
- C With good or fair insight ✓
- D With tic-related OCD
Correct answer: C. With good or fair insight
Explanation
DSM-5 OCD includes an insight specifier: 'with good or fair insight' (most OCD patients; recognise beliefs are probably/possibly not true), 'with poor insight' (believes OCD beliefs are probably true), and 'with absent insight/delusional beliefs' (completely convinced beliefs are true — distinguished from psychotic disorders as OCD beliefs are confined to OCD domain). This patient, who recognises the irrationality, fits 'good or fair insight.' The insight specifier guides prognostication and ERP suitability.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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