intermediateOCDinsightego-dystonicdelusional disorderMSEdifferential diagnosis
A 33-year-old female reports 4 months of intrusive, repetitive thoughts that she may have accidentally hit someone with her car. She drives back to check the route, sometimes multiple times, and reviews dashcam footage nightly. She knows the thoughts are irrational but cannot stop. Which symptom characteristic MOST differentiates this from a psychotic disorder?