The importance of insight, avoidance behavior, not-just-right perception and personality traits in pediatric obsessive-compulsive disorder (OCD): a naturalistic clinical study

Nord J Psychiatry. 2018 Oct;72(7):489-496. doi: 10.1080/08039488.2018.1486454. Epub 2018 Jul 11.


Purpose: The primary aim of the present explorative naturalistic study was to examine the association of poor insight, avoidance behavior, and not-just-right sensation with baseline parameters including obsessive-compulsive disorder (OCD) symptoms, baseline severity scores, comorbidity, and personality traits. A second aim was to examine how insight, avoidance and not-just-right sensation influence treatment outcome.

Materials and methods: In total, 317 medical records from children and adolescents with OCD referred to a specialized OCD clinic in Denmark were recorded for baseline parameters and treatment outcome. All information was used.

Results: Avoidance behavior and poor insight were associated with an increased baseline severity, whereas not-just-right perception was not. Avoidance behavior was associated with the contamination/cleaning subtype, and a not-just-right sensation with the hoarding/symmetry subtype. Lower insight and avoidance behavior were associated with comorbid conditions. At post-treatment, not-just-right perception was associated with a risk of relapse, whereas lower insight was negatively associated with gaining remission. Avoidance behavior reduced the probability of remission and increased the number of offered sessions as well as and the likelihood of having SRI prescribed. Different personality traits were associated with treatment outcome.

Conclusion: Insight, avoidance behavior, and not-just-right perceptions seem important for baseline severity and post-treatment outcome. Baseline examination should include a systematic description, which could guide treatment. The present study is an explorative study describing a naturalistic clinical population. Therefore, a number of limitations should be taken into consideration when interpreting the results. More systematic studies on the importance of insight, avoidance behavior and not-just-right perceptions are warranted.

Keywords: OCD; Obsessive-compulsive disorder; avoidance behavior; early-onset; insight; not-just-right perception.

Publication types

  • Pragmatic Clinical Trial

MeSH terms

  • Adolescent
  • Avoidance Learning / physiology*
  • Child
  • Comorbidity
  • Denmark / epidemiology
  • Female
  • Humans
  • Male
  • Obsessive-Compulsive Disorder / diagnosis
  • Obsessive-Compulsive Disorder / epidemiology*
  • Obsessive-Compulsive Disorder / psychology*
  • Perception / physiology*
  • Personality / physiology*
  • Problem Solving / physiology