Cognitive Confidence and Inferential Confusion in Obsessive-Compulsive Disorder: Differences Across Subtypes

Abstract

A lack of cognitive confidence (CC), defined as a distrust of one’s attention, perception, and memory, has been implicated in obsessive-compulsive disorder (OCD) and could account for its core symptoms. The early research focus has been on CC in the context of checking OCD, yet research suggests that the construct may also apply to other OCD subtypes. A closely intertwined construct also implicated in OCD is inferential confusion (IC), whereby a distrust of the senses leads to an investment in imaginary possibilities. This study aimed to simultaneously examine these constructs across OCD subtypes. A total of 128 participants with OCD completed a measure of CC (MCQ-65; Metacognitions Questionnaire), IC (ICQ-EV; Inferential Confusion Questionnaire), and OCD symptoms (VOCI; Vancouver Obsessional Compulsive Inventory). TwoStep cluster analyses for CC revealed two clusters: (1) low CC/high checking/higher OCD symptoms and (2) high CC/low checking/lower OCD symptoms. The analyses for IC resulted in three clusters: (1) average IC/high “just right”/high contamination/low obsessionality, (2) high IC/ high “just right”/high obsessionality, and (3) low IC/low obsessionality/low checking. Results are discussed in terms of the heterogeneity of OCD, which highlight the need to tailor research paradigms and treatment targets to different OCD presentations.