Poor insight in pediatric obsessive compulsive disorder: Developmental considerations, treatment implications, and potential strategies for improving insight

Insight in Obsessive Compulsive Disorder (OCD) entails recognizing obsessive thoughts as unrealistic and false. OCD is characterized by varying degrees of insight and children often demonstrate poorer insight, which has been associated with greater symptoms severity, greater functional impairment and poorer treatment response. This clinical discussion raises the following question with regard to pediatric OCD and poor insight: What is the developmental context of insight in pediatric OCD? What are the treatment implications of poor insight for conducting Cognitive Behavioral Therapy with this population? What are the potential benefits and pitfalls of clinical strategies for improving children's insight regarding their OCD symptoms? The need for empirical research in each of these domains is discussed.

► In this clinical discussion we examine the developmental context of insight in pediatric OCD.
► We discuss the implications of low insight, particularly for the course of cognitive behavioral treatment.
► We propose and discuss some potential strategies for improving insight in children with OCD.