Compared with DSM-IV, what change did DSM-5 introduce regarding insight in obsessive-compulsive disorder?

• A It introduced insight specifiers ranging from good insight to absent insight with delusional beliefs ✓
• B It mandated that all patients retain full insight for the diagnosis
• C It reclassified poor-insight OCD as delusional disorder
• D It removed insight from all diagnostic consideration

Explanation

DSM-IV required that adults recognize at some point that their obsessions or compulsions were excessive or unreasonable. DSM-5 removed this requirement and added a graded insight specifier: good or fair insight, poor insight, and absent insight with delusional beliefs. Importantly, a patient whose OCD beliefs are fully delusional still receives a diagnosis of OCD, not delusional disorder, and such patients still respond to SSRIs.

Reference: Diagnostic and Statistical Manual of Mental Disorders, DSM-5-TR, Text Revision ed.

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