Insight is something that OCD sufferers are usually expected to have. The idea is that we are able to recognize that our obsessions and compulsions are irrational, although we may succumb to them anyway. For sufferers who do not appear to have this insight (but not children, I think), diagnosis by the DSM could include the specifier “with poor insight”. This is supposed to be associated with a poorer prognosis. I can understand that, because it is much harder to fight an enemy that you cannot see. Like just about everything, people have come to realize that it is not as simple as either having or not having insight and that, in fact, insight exists on a continuum.
I think my insight might be moving down that continuum. I asked the neuropsychiatrist why I am having more and more trouble determining what is real and what isn’t. He told me not to read into it, but that it is probably a result of my thinking having become more complex. I’m trying not to read into in a bad way, but I’m still reading into it. I wonder if this is one of the disadvantages (not that I’m suggesting there are advantages) of having grown up with OCD: as I have gotten smarter, so has it, and at every step it has been able to learn how to outsmart me. My OCD brain has become adept at hiding the exit in the personal hell it generates for me on a daily basis, and my healthy brain is struggling more and more to find it.