Metacognitive beliefs in obsessive-compulsive patients: a comparison with healthy and schizophrenia participants

Distorted metacognitive beliefs are increasingly considered in theoretical models of obsessive-compulsive disorder (OCD). However, so far no consensus has emerged regarding the specific metacognitive profile of OCD.

Participants with OCD (n=55), schizophrenia (n=39), and nonclinical controls (n=49) were assessed with the Metacognitions Questionnaire (MCQ-30).

Except for positive beliefs about worry, both patient samples exceeded nonclinical controls on all MCQ subscales. The MCQ "need to control thoughts" and "negative beliefs about uncontrollability and danger" subscales showed strong correlations with obsessions, and scores in the former scale were elevated in hallucinators. In contrast to several prior studies, "cognitive confidence" was related neither to core OCD nor to schizophrenia symptomatology.

Notwithstanding large pathogenetic differences between OCD and schizophrenia, findings suggest that obsessions and hallucinations may share a common metacognitive pathway. Need to control thoughts and dysfunctional beliefs about the malleability of worries may represent critical prerequisites for the two phenomena to emerge.