Do People with OCD Have Less Confidence in Their Memory and Perception?

What you need to know

• People with obsessive-compulsive disorder (OCD) tend to have less confidence in their memory and perception than people without OCD.
• This lack of confidence goes beyond actual performance deficits - people with OCD underestimate their abilities more than is warranted.
• Understanding this tendency toward under-confidence may help improve treatment approaches for OCD.

Understanding confidence in OCD

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). For over a century, researchers and clinicians have observed that doubt and uncertainty play a central role in OCD. Many people with OCD report doubting their memory, perception, and other cognitive abilities.

For example, someone with OCD might repeatedly check that they’ve locked the front door, even though they remember doing so, because they don’t trust their memory. Or they might struggle to leave the house, repeatedly checking windows and appliances, because they can’t feel certain everything is secure.

But how much of this doubt reflects real deficits in cognitive abilities, and how much is excessive lack of confidence? To answer this question, researchers conducted a comprehensive review and analysis of studies comparing people with OCD to those without OCD on both cognitive performance and confidence in that performance.

Examining performance and confidence

The researchers identified 19 relevant studies that met their criteria for inclusion. These studies typically had participants complete cognitive tasks related to memory or perception and then report how confident they felt about their performance.

For example, in one study, participants answered general knowledge questions and then rated how likely they thought their answers were to be correct. In another study, participants tried to remember details about objects they had seen and rated their confidence in their memories.

By looking at both actual performance and reported confidence across many studies, the researchers could determine:

1. Whether people with OCD actually perform worse on cognitive tasks
2. Whether people with OCD report lower confidence in their performance
3. Whether any lack of confidence in OCD goes beyond what would be justified by actual performance deficits

Key findings on performance and confidence in OCD

The analysis revealed several important findings:

1. On average, people with OCD did perform somewhat worse than those without OCD on the cognitive tasks examined. The difference was small but statistically significant.

2. People with OCD reported substantially lower confidence in their performance compared to those without OCD. This difference in confidence was larger than the difference in actual performance.

3. The gap between confidence and performance was greater for people with OCD than for those without OCD. In other words, people with OCD were under-confident - they doubted their abilities more than was warranted by any actual deficits.

These findings held true across different types of cognitive tasks, including tests of memory and perception.

What this means for understanding OCD

This pattern of results helps explain the pervasive doubt often seen in OCD. People with OCD don’t just perform slightly worse on cognitive tasks - they also trust their cognitive abilities less than they should based on their actual capabilities.

This tendency toward under-confidence may contribute to many OCD symptoms. For instance, someone who deeply doubts their memory might feel compelled to check and re-check that they’ve completed important tasks. Someone who doesn’t trust their perception might repeatedly seek reassurance that they’ve understood things correctly.

Potential explanations for under-confidence in OCD

The researchers discuss several possible reasons why people with OCD might develop this pattern of under-confidence:

1. Difficulty accessing internal states: Some theories suggest that people with OCD have trouble tuning into their own internal experiences, including cognitive processes. This could make it harder to accurately assess their own abilities.

2. Impaired metacognition: Metacognition refers to our ability to think about our own thinking. If this process is disrupted in OCD, it could lead to inaccurate judgments about cognitive performance.

3. Overreliance on prior beliefs: People with OCD may have developed beliefs about their cognitive deficits that override their ability to accurately assess their performance in the moment.

4. Actual mild cognitive deficits leading to exaggerated doubt: The small but real differences in cognitive performance might trigger disproportionate doubt in people prone to OCD thinking patterns.

Implications for treatment

Understanding this tendency toward under-confidence could help improve treatment approaches for OCD. Some possibilities the researchers suggest include:

1. Helping people with OCD learn to better access and trust their internal cognitive experiences.

2. Training metacognitive skills to improve the accuracy of self-assessments.

3. Challenging prior negative beliefs about cognitive abilities.

4. Using mindfulness techniques to help people focus on present experiences rather than doubts and fears.

Conclusions

• People with OCD tend to underestimate their cognitive abilities compared to their actual performance.
• This under-confidence goes beyond any real deficits and may contribute to OCD symptoms.
• Understanding and addressing this tendency toward under-confidence could improve OCD treatment approaches.
• More research is needed to clarify the mechanisms behind this under-confidence and develop targeted interventions.