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Cited by 28Obsessive-Compulsive Spectrum DisordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPerfectionism, Procrastination, Anxiety Studies

Differences in metacognitive functioning between obsessive–compulsive disorder patients and highly compulsive individuals from the general population

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Hoven, Monja, Rouault, Marion, van Holst, Ruth, Luigjes, Judy·2023·Psychological Medicine
DOI 10.1017/s003329172300209xPMC PMC10755250
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Abstract

Background: Our confidence, a form of metacognition, guides our behavior. Confidence abnormalities have been found in obsessive–compulsive disorder (OCD). A first notion based on clinical case–control studies suggests lower confidence in OCD patients compared to healthy controls. Contrarily, studies in highly compulsive individuals from general population samples showed that obsessive–compulsive symptoms related positively or not at all to confidence. A second notion suggests that an impairment in confidence estimation and usage is related to compulsive behavior, which is more often supported by studies in general population samples. These opposite findings call into question whether findings from highly compulsive individuals from the general population are generalizable to OCD patient populations. Methods: To test this, we investigated confidence at three hierarchical levels: local confidence in single decisions, global confidence in task performance and higher-order self-beliefs in 40 OCD patients (medication-free, no comorbid diagnoses), 40 controls, and 40 matched highly compulsive individuals from the general population (HComp). Results: In line with the first notion we found that OCD patients exhibited relative underconfidence at all three hierarchical levels. In contrast, HComp individuals showed local and global over confidence and worsened metacognitive sensitivity compared with OCD patients, in line with the second notion. Conclusions: Metacognitive functioning observed in a general highly compulsive population, often used as an analog for OCD, is distinct from that in a clinical OCD population, suggesting that OC symptoms in these two groups relate differently to (meta)cognitive processes. These findings call for caution in generalizing (meta)cognitive findings from general population to clinical samples.

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  • In obsessive-compulsive disorder, both global and local metacognitive abilities are reduced.

    “При обсессивно-компульсивном расстройстве снижены как глобальные, так и локальные метакогнитивные способности (Hoven et al., 2023).”

    From Когнитивные механизмы дисфункционального принятия решений при психических расстройствах (2025) · cites this paper as Hoven et al., 2023

    The Discussion reports decreased local and global confidence in OCD patients compared with healthy controls, supporting the claim if ‘abilities’ refers to confidence. But it explicitly finds no impairment in confidence estimation or use, so it does not support a general reduction in metacognitive abilities. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Hoven, M., Rouault, M., van Holst, R., & Luigjes, J.
Affiliations
  • Amsterdam University Medical Centers (NL)
  • Université Paris Sciences et Lettres (FR)
Corresponding author
Hoven, Monja
ORCID
Venue
Psychological Medicine
Publisher
Cambridge University Press (CUP)
Published
2023-08-09
Volume
53
Issue
16
Pages
7933-7942
ISSN
  • 0033-2917 (ISSN-L)
  • 1469-8978
DOI
10.1017/s003329172300209x
PMC
PMC10755250
OpenAlex
W4385684749
Cited by
28
References
9
Citations by year
2026: 3 · 2025: 11 · 2024: 10 · 2023: 4
FWCI
8.16
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychological Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, cc-by)
  • Pure Amsterdam UMC (submittedVersion, cc-by)
  • PsyArXiv (OSF Preprints) (submittedVersion, cc-by)
  • PsyArXiv (OSF Preprints) (submittedVersion)
Funders
  • AXA Research Fund
  • Fondation des Treilles
Topics
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Perfectionism, Procrastination, Anxiety Studies
Keywords
obsessive-compulsive disorder, metacognition, confidence, metacognitive sensitivity, general population comparison, self-belief, compulsive behavior
MeSH terms
Metacognition, Humans, Obsessive-Compulsive Disorder, Comorbidity, Case-Control Studies

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