Cognitive confidence in obsessive-compulsive disorder: Distrusting perception, attention and memory

Previous studies have established that obsessive-compulsive disorder (OCD) is characterised by significant levels of distrust in memory (e.g. for actions). Ironically, this lowered confidence is at least in part due to repeated checking, which is assumed to lower perceptual processing and thereby reduces vividness and detail of the recollections. In a previous study, Hermans, D., Martens, K., De Cort, K., Pieters, G., and Eelen, P. [(2003). Reality monitoring and metacognitive beliefs related to cognitive confidence in OCD. Behaviour Research and Therapy, 41, 383–401] observed that OCD is not only characterised by reduced confidence in memory, but also by a similar distrust in attention (Hermans et al., 2003). The present study aimed at replicating and extending this finding. It was observed (a) that patients suffering from OCD showed less confidence in attention and memory than a clinical and a nonclinical control group; (b) that confidence in attention was uniquely related to checking behaviour, and (c) that repeated checking caused increased levels of distrust in attention. In addition, it was observed that cognitive distrust while performing OCD-related actions not only extends to attention, but also to perception. It is argued that research on metacognition in OCD should move beyond the study of memory.