Insight in obsessive-compulsive disorder (OCD) refers to patients' recognition that their obsessions and compulsions are symptoms rather than necessary or natural thoughts and behaviors.<sup>1</sup> It has been estimated that 20% to 45% of youth with OCD exhibit poor or absent insight.<sup>2-4</sup> Identified correlates of poor insight include younger age,<sup>2,3,5,6</sup> increased OCD severity,<sup>2,4,7</sup> impairment,<sup>4,7,8</sup> and family accommodation<sup>2,4</sup>; lower intellectual and adaptive functioning<sup>3</sup>; and greater depressive symptoms.<sup>2,3</sup> Poorer insight has also been associated with reduced response across treatment groups (ie, selective serotonin reuptake inhibitor [SSRI], cognitive behavioral therapy [CBT], combined SSRI plus CBT, or pill placebo).<sup>9</sup>.