Insight: New vistas into an aetiological and phenomenological role in the psychopathology of obsessive compulsive disorders

The current psychopathological models of obsessive/compulsive disorders (OCD) rely on a series of events whereby compulsions are expressed to self-medicate high anxiety levels generated by obsessions. These models do not take into account the implication of insight deficit in the development and expression of OCD. Although there is increasing interest in the role of insight deficits in obsessive/compulsive disorders, this interest has remained focused on the phenomenology of these disorders. If in apparent agreement with the clinical observation that OCD patients are overall well aware of their symptoms, such consideration of insights deficits restricted only to the phenomenology of obsessive disorders seems at odds both with other clinical dimensions than symptom awareness and psychometric measures. Indeed, several studies have demonstrated that some OCD patients do suffer from marked insight deficits. Therefore it seems necessary to reinvestigate the theoretical framework whereby insight may contribute to the psychopathology of obsessive disorders, obviously including OCD, but also drug addiction for instance. We therefore developed a model whereby insight deficits may not only contribute to the psychopathology of these disorders but also be involved in their aetiology. This model relies on a new theoretical framework that defines insight as a general psychological process integrating two sub-processes, namely psychic insight and somatosensory insight, feeding into each other. This model, providing the basis for a new insight scale, has heuristic and predictive values with regards to new alternative etiological and phenomenological models of OCD and drug addiction. This novel theoretical framework may prove a valuable tool to better understand the psychopathology of, and develop new therapeutical strategies for, obsessive disorders. (C) 2011 Elsevier Masson SAS. All rights reserved.