Stott, Richard; (2001) 'Responsibility insight' in obsessive compulsive disorder. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Aim. Cognitive models have proposed that inflated responsibility for harm plays a central role in Obsessive Compulsive Disorder (OCD) (Salkovskis, 1985, 1989). This study aimed to explore the concept of 'responsibility insight', i.e. the awareness in people with OCD of the idiosyncrasy of their own responsibility biases. This concept had not previously been addressed. Methods. 32 adults with OCD participated. Two approaches were taken, each involving ratings for 'oneself and 'others' (i.e. "How would the average person in the street react.") First, a new scale was developed, the Self Compared to Others Reactions to Events Scale (SCORES), employing hypothetical scenarios with a theme of responsibility for harm. Second, direct belief ratings were obtained on a variety of responsibility beliefs, taken from the Obsessive Beliefs Questionnaire (OBQ; OCCWG, 2001). Matched control participants contributed to the validation process. Results. On average, the OCD group demonstrated good evidence of responsibility insight. Consistent with previous studies, responsibility predicted severity of OCD. Moreover, on the SCORES, poor responsibility insight was also predictive of greater severity of OCD. Furthermore, this association was independent of responsibility levels. However, this finding was not paralleled using the belief ratings approach. Methodological problems may account for this, including effects of response bias. It was also found, contrary to expectation, that a subgroup who had experience of therapy scored significantly lower on responsibility insight on the SCORES. Conclusions. Poor responsibility insight may predict severity of OCD independently of responsibility, although more research is needed. One explanation is that obsessive individuals can use their specific insight to partially ameliorate their difficulties by employing strategies such as cognitive self-talk. Some methodological refinement is suggested for future research. Also, the maintenance of responsibility beliefs despite good responsibility insight deserves exploration. It is argued that responsibility insight, not previously studied, may have a significant bearing on both models and treatment of the disorder.

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