Obsessions, overvalued ideas, and delusions in obsessive-compulsive disorder

doi:10.1016/0005-7967(94)90132-5

Behaviour Research and Therapy

Volume 32, Issue 3, March 1994, Pages 343-353

https://doi.org/10.1016/0005-7967(94)90132-5 Get rights and content

Abstract

The prevailing view is that individuals with obsessive-compulsive disorder (OCD) are able to think rationally about their obsessive concerns and are thus able to recognize them as senseless. However, clinical observations indicate that at least some obsessive-compulsives do not regard their symptoms as unreasonable or excessive, and their ideas have been characterized as overvalued or delusional. In the present paper the concepts of obsessions, overvalued ideas, and delusions are discussed and compared, and the available studies of insight among obsessive-compulsives are reviewed. It is concluded that obsessive-compulsive ideas can not satisfactorily be dichotomized according to patients' insight, and that the notion of a continuum of strength of obsessive-compulsive beliefs is more appropriate. The relationship between degree of obsessive-compulsive conviction and outcome of therapy remains unclear. Methodological issues that complicate our understanding of OCD are considered, and theories of delusions are examined in relation to their development in OCD.

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Combined with the high relevance of insight to adult populations and clinical experiences in which insight has impacted youth's obtainment or meaningful engagement in intervention, further exploration of insight in pediatric OCD remains valuable. Although often discussed as a single construct (Association, 2013), insight is more likely multi-faceted, including, for example, an individual's ability to defuse themselves from their symptom experiences, their recognition of symptoms as excessive, unreasonable, and/or impairing, their perception of obsessive beliefs as accurate and/or compulsions as protective, and the extent of their personal alignment with their symptoms (Eisen et al., 1998; Kozak & Foa, 1994; Selles et al., 2019; Önen et al., 2013). Given that responses to subdomains may not be consistent within individuals (e.g., a youth recognizes symptoms as excessive, but believes cleanliness is important and cannot defuse from experiences of disgust), multi-faceted assessment of insight is warranted.
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Obsessions, overvalued ideas, and delusions in obsessive-compulsive disorder

Abstract

Journal of Anxiety Disorders

Journal of Verbal Learning and Verbal Behavior

Journal of Psychosomatic Research

Behaviour Research and Therapy

Diagnostic and statistical manual of mental disorders

Diagnostic and statistical manual of mental disorders—revised

Content specific information processing and persecutory delusions: an investigation using the emotional Stroop test

British Journal of Medical Psychology

Obsessive-compulsive states

Illusory correlations in paranoid and non-paranoid schizophrenia

British Journal of Clinical Psychology

Measuring delusional experiences: a method and its application

British Journal of Clinical Psychology

Measurement and modification of delusional beliefs

Journal of Consulting and Clinical Psychology

Selective processing of food words in anorexia nervosa

British Journal of Clinical Psychology

Treatment of obsessive-compulsive disorder with clomipramine

Psychiatric Annals

The specific laws of logic in schizophrenia

Obsessive-compulsive disorder with psychotic features

Poster presented at the Meeting of the American Psychiatric Association, San Francisco, CA

Processing of threat-related information in rape victims

Journal of Abnormal Psychology

Success and failure in the behavioral treatment of obsessive-compulsives

Journal of Consulting and Clinical Psychology

Information processing in obsessive-compulsive disorder

Cognitive Therapy and Research

DSM-IV field trial: obsessive-compulsive disorder

Delusions: problems in definitions and measurement

British Journal of Medical Psychology

Follow-up studies in obsessional neurosis

Archives of General Psychiatry

Transition of obsessions into delusions: evaluation of obsessional phenomena from the prognostic standpoint

American Journal of Psychiatry

Construct accessibility and depression

Journal of Personality and Social Psychology

Fish's clinical psychopathology

A cognitive investigation of schizophrenic delusions

Psychiatry

Body dysmorphic disorder and its relationship to obsessive-compulsive disorder

Obsessive-compulsive disorder with psychotic features: a phenomenological analysis

American Journal of Psychiatry

Les obsessions et al psychasthenie

General psychopathology

Concomitant obsessive-compulsive disorder and schizotypal personality disorder

American Journal of Psychiatry