The relationship between treatment resistance, insight, and theory of mind in patients with obsessive-compulsive disorder

Objective: The aim of the present study is to investigate whether insight and mentalizing abilities are related to the severity of OCD (obsessive compulsive disorder) in treatment resistant OCD. We also intend to examine the association between treatment resistance, insight, and mentalizing ability (theory of mind).

Methods: Participants included 71 individuals diagnosed with OCD; 30 (42.3%) of them met the criteria for treatment resistant OCD (resistant group), whereas the other 41 (57.7%) were labeled as responder group. The intensity of obsessions and compulsions was evaluated using the Yale-Brown obsessive–compulsive scale (Y-BOCS). All patients were assessed with “Reading the Mind in the Eyes Test”, Brown Assessment of Beliefs Scale (BABS), Beck Cognitive Insight Scale (BCIS), Mood Disorder Questionnaire, Mini International Neuropsychiatric Interview, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI).

Results: Responder and resistant groups were similar in terms of age, gender, and education. The resistant group received higher mean scores of depression and anxiety than responders. Patients from the resistant group had significantly longer duration of the illness than the responders. The mentalizing score, as assessed by the “Reading the Mind in the Eyes Test” was significantly higher for responder patients. The Y-BOCS insight score, BCIS self-certainty dimension score, the number of positively answered questions on the Mood Disorder Questionnaire, and the score of BABS for the resistant group were statistically significantly higher than in the responder group. Pearson correlation analyses indicated that BCIS self-certainty dimension as well as BABS scores were significantly related to mentalizing total scores.

Conclusion: This study investigated the relationships between mentalizing ability and clinical and cognitive insight, and treatment resistance in OCD. The responder group of OCD patients has better mentalizing abilities. Resistant patients have poorer insight. BCIS selfcertainty dimension and BABS scores were negatively correlated with mentalizing total scores. Results suggest that treatments targeting mentalization abilities may improve insight deficits associated with poor outcome in OCD.