Association between insight, neurological soft signs, and minor physical anomalies in OCD patients

Introduction: Obsessive-compulsive disorder (OCD) is a chronic mental disorder characterized by the presence of obsessions and/or compulsions, significantly impairing an individual's functionality and quality of life. One of the most critical factors influencing the course and treatment response of OCD is the patient's insight. According to the DSM-5, the level of insight in OCD patients is classified into three categories: good, poor, and absent (delusional). The question of whether OCD patients with poor or absent insight fall within the psychotic spectrum remains controversial. OCD patients with poor insight are more closely associated with the psychotic spectrum, suggesting that these patients may represent a distinct neurobiological subtype of OCD. Our study aims to compare OCD patients with poor or absent insight to those with good insight in terms of subtle neurological signs (SNS) and minor physical anomalies (MPAs). Additionally, we aim to explore the relationship between insight and these signs and provide new insights into the neurodevelopmental underpinnings of OCD. Method: Patients diagnosed with OCD through clinical evaluation at a psychiatry outpatient clinic were included in the study. Participants completed the Sociodemographic and Clinical Characteristics Data Form, the Yale-Brown Obsessive- Compulsive Scale (Y-BOCS), the Scale for the Assessment of the Three Components of Insight, the Waldrop Minor Physical Anomalies Scale, and the Neurological Evaluation Scale. The groups were determined based on the Brown Assessment of Beliefs Scale (BABS) scores. Patients scoring 0-12 were classified as the High Insight Group, while those scoring 12-24 were classified as the Low Insight Group. Results: When OCD patients with low insight were compared to those with high insight, the MFA-Eye, MFA-Ear total score, Low Ear, Soft and Bendable ear, High palate MFA ratios were found to be significantly higher. In our study, when groups were evaluated in terms of MFA Waldrop Total Score, the MFA Waldrop total score of patients with low insight was higher than those with high insight; however, this difference was not statistically significant. When groups were evaluated in terms of Cranio-Facial MFA total score, the Cranio-Facial MFA total score was higher in the low insight group, but this difference was not statistically significant. When groups were examined in terms of Peripheral MFA total scores, the Peripheral MFA total score was higher in the low insight group, but this difference was not statistically significant. When the groups were examined, the total score of soft neurological signs, sensory integration, motor coordination, complex motor movements, and other signs were found to be significantly higher in the low insight group compared to the high insight group. Conclusion: Our study is the first in the literature to evaluate minor physical anomalies in OCD patients with low insight. Consistent with our hypothesis, OCD patients with low insight exhibited higher rates of minor physical anomalies and subtle neurological signs compared to those with good insight. This supports the view that OCD patients with low insight may represent a distinct subtype explained by the neurodevelopmental model of early-onset OCD. Our findings extend the existing literature, which indicates that these anomalies are more prevalent in various neurodevelopmental disorders and conditions. Our study is the first in the literature to concurrently evaluate minor physical anomalies and subtle neurological signs in OCD patients. Minor physical anomalies reflect the development of the skin and its appendages, while subtle neurological signs indicate brain development related to motor functions. The high prevalence of these variables in OCD patients with low insight supports the neurodevelopmental model and suggests a potential place within the psychotic spectrum. Keywords: Insight, Minor physical anomalies, soft neurological signs, neurodevelopmental hypothesis.