Lower confidence and increased error sensitivity in OCD patients while learning under volatility

A decoupling between confidence and action could relate to compulsive behaviour as seen in obsessive-compulsive disorder (OCD). The link between confidence and action in OCD has been investigated in clinical case-control studies and in the general population with discrepant findings. The generalizability of findings from highly-compulsive general population samples to clinical OCD samples has been questioned. Here, we investigate action-confidence coupling for 38 OCD patients compared to 37 healthy controls (HC), using a predictive inference task. We compared those results to a comparison between matched high and low compulsive individuals from the general population. Action-updating, confidence and their coupling were compared between the groups. Moreover, computational modeling was performed to compare groups on error sensitivity and environmental parameters. OCD patients showed lower confidence and higher learning rates in reaction to (small) prediction errors than HC, signaling hyperactive error signaling and lower confidence estimation. No evidence was found for differences in action-confidence coupling between groups. In contrast high the compulsive group showed higher confidence and stronger decoupling than the low compulsive group, both of which were related to symptoms. The underlying mechanisms of obsessive-compulsive behaviour might differ between clinical and highly-compulsive general population samples, resulting in different (meta)cognitive profiles.