Cognitive models stress the importance of cognitive belief domains (CBD) for the pathogenesis of obsessive–compulsive disorder (OCD). However, the relative contribution of responsibility and metacognition – core aspects of CBD – to OC symptoms is not fully understood yet. Furthermore, two subcomponents of overestimation of threat (OET), overestimation of the personal probability (unrealistic pessimism) and overestimation of the general risk of negative events, require clarification. First, we investigated the relative contribution of responsibility and metacognition to OC symptoms. Second, we hypothesized that OCD patients overestimate the personal risk and display unrealistic pessimism. Thirty-four OCD patients and 34 healthy controls completed the Obsessive Beliefs Questionnaire (OBQ) and the Unrealistic Optimism Questionnaire (UO). Responsibility significantly predicted obsessive symptoms after controlling for metacognition. In contrast to previous findings, responsibility is not fully explained by metacognition. Finally, our results confirm unrealistic pessimism in OCD, even after controlling for depression.
Cognitive theories of obsessive–compulsive disorder (OCD) stress the importance of cognitive and metacognitive belief domains (Rachman, 1997, Salkovskis, 1985, Salkovskis, 1989 and Wells, 2009). A large body of literature have demonstrated the importance of an inflated sense of responsibility (Salkovskis et al., 2000, Shafran et al., 1996, Smari and Holmsteinsson, 2001 and Steketee et al., 1998) as well as the relevance of metacognition (Amir et al., 1997, Emmelkamp and Aardema, 1999, Solem et al., 2010 and Wells and Papageorgiou, 1998). In recent studies metacognition significantly predicted inflated responsibility (Gwilliam et al., 2004 and Myers and Wells, 2005) but not vice versa. It is currently unresolved whether responsibility is merely a by-product of metacognition with no additional contribution to OC symptoms (Wells, 1997, 2009), or has predictive value in its own right.
Overestimation of threat (OET) is another prominent cognitive bias discussed as being relevant for OCD. It is closely related to responsibility: both load on the same factor in the Obsessive Beliefs Questionnaire (OBQ-44; Obsessive–Compulsive Cognitions Working Group (OCCWG, 2005). OET is a complex construct comprising a number of independent components, which require systematic study of their individual contributions to obsessive symptoms. Recently, our group (Moritz and Jelinek, 2009, Moritz and Pohl, 2006 and Moritz and Pohl, 2009) applied the unrealistic optimism paradigm (Weinstein, 1982) to OCD to shed light on the relevance of two subcomponents for OCD, namely the overestimation of the personal and the objective incidence probability of negative events. This paradigm is well suited to help to clarify whether OCD patients are especially prone to a biased perception of their personal incidence probability. It can be used to investigate whether subjects display a bias towards enhanced subjective vulnerability, whether they have indeed experienced negative events in the past more often, or whether they merely or additionally overestimate the severity of harm (Moritz and Jelinek, 2009 and Moritz and Pohl, 2009). Unrealistic optimism arises from the overestimation of the subjective likelihood for positive events to happen to oneself, while at the same time the personal risk for negative events is underestimated. The reverse response pattern, labeled as unrealistic pessimism, might be an important component of OET. The UO paradigm goes beyond present questionnaires for OET which do not differentiate between these important components. Our group (Moritz and Jelinek, 2009, Moritz and Pohl, 2006 and Moritz and Pohl, 2009) found that patients with OCD overestimated their personal risk for negative events compared to healthy controls, but not the objective probability of threat. Since results are not fully consistent across studies, further clarification of unrealistic pessimism in OCD is necessary. Furthermore, its relationship with responsibility and metacognition awaits examination.
