Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Motivation, Brain & Behavior (MBB) Lab, Paris Brain Institute (ICM), Hôpital de la Pitié-Salpêtrière, Paris, France.
Psychol Med. 2023 Dec;53(16):7933-7942. doi: 10.1017/S003329172300209X. Epub 2023 Aug 9.
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.
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).
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 confidence and worsened metacognitive sensitivity compared with OCD patients, in line with the second notion.
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.
我们的信心是一种元认知形式，指导着我们的行为。强迫症（OCD）患者存在信心异常。基于临床病例对照研究的初步观点表明，与健康对照组相比，OCD 患者的信心较低。相反，来自普通人群样本的高度强迫个体的研究表明，强迫症状与信心呈正相关或不相关。第二种观点表明，信心估计和使用的障碍与强迫行为有关，而这在普通人群样本的研究中更为常见。这些相反的发现引发了一个问题，即来自普通人群的高度强迫个体的发现是否可以推广到 OCD 患者群体。
为了验证这一点，我们在三个层次上研究了信心：对单个决策的局部信心、对任务表现的全局信心和对 40 名 OCD 患者（无药物治疗，无合并诊断）、40 名对照和 40 名匹配的普通人群中高度强迫个体的更高阶自我信念的信心。
与第一个观点一致，我们发现 OCD 患者在所有三个层次上都表现出相对的不自信。相比之下，HComp 个体表现出局部和全局信心，并且与 OCD 患者相比，元认知敏感性恶化，这与第二个观点一致。
在普通高度强迫人群中观察到的元认知功能，通常被用作 OCD 的模拟物，与临床 OCD 人群中的元认知功能不同，这表明这两个群体中的 OC 症状与（元）认知过程的关系不同。这些发现呼吁在将（元）认知发现从普通人群推广到临床样本时要谨慎。
