Rotter M, Goodman W
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY.
Bull Am Acad Psychiatry Law. 1993;21(2):245-52.
In this paper the authors examine the relationship between insight and control in patients with obsessive-compulsive disorder (OCD) in an effort to better understand the concept of volitional control of behavior especially as it relates to changes in the insanity defense that were recommended by the American Psychiatric Association (APA), specifically that the volitional prong be dropped. Yale-Brown Obsessive Compulsive Scale ratings in 56 subjects with OCD were reviewed with specific attention to items measuring the patients' subjective sense of decreased volitional control over their compulsions and their insight into their behavior. No statistically significant correlation was found between the control over compulsions item and the insight item. The authors conclude that the experience of volitional control in patients with OCD is not significantly related to the level of insight they have into the irrationality of their behavior. The authors then review cognitive therapy literature and show that though cognition and volition may appear to be dissociated in some disorders, even in the absence of insight, a relatively gross measure of legally relevant cognitive disturbance, subtle cognitive changes can be identified in patients with seemingly purely volitional disorders such as OCD.
在本文中，作者研究了强迫症（OCD）患者洞察力与行为控制之间的关系，以便更好地理解行为的意志控制概念，尤其是这一概念与美国精神病学协会（APA）所建议的精神错乱辩护的变化之间的关系，具体而言是指放弃意志这一标准。回顾了56名强迫症患者的耶鲁-布朗强迫症量表评分，特别关注那些测量患者对其强迫行为意志控制减弱的主观感受以及对自身行为洞察力的项目。在对强迫行为的控制项目与洞察力项目之间未发现具有统计学意义的相关性。作者得出结论，强迫症患者的意志控制体验与他们对自身行为不合理性的洞察水平没有显著关联。作者随后回顾了认知治疗文献，并表明尽管在某些疾病中认知与意志可能看似分离，即便缺乏洞察力，在诸如强迫症这类看似纯粹是意志性疾病的患者中，虽只是对具有法律相关性的认知障碍进行相对粗略的测量，但仍能识别出细微的认知变化。
