{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T07:54:24Z","timestamp":1792223664201,"version":"4.4.0"},"reference-count":48,"publisher":"Cambridge University Press (CUP)","issue":"16","license":[{"start":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T00:00:00Z","timestamp":1691539200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S003329172300209X_sec_a1\"><jats:title>Background<\/jats:title><jats:p>Our confidence, a form of metacognition, guides our behavior. Confidence abnormalities have been found in obsessive\u2013compulsive disorder (OCD). A first notion based on clinical case\u2013control studies suggests lower confidence in OCD patients compared to healthy controls. Contrarily, studies in highly compulsive individuals from general population samples showed that obsessive\u2013compulsive symptoms related positively or not at all to confidence. A second notion suggests that an impairment in confidence estimation and usage is related to compulsive behavior, which is more often supported by studies in general population samples. These opposite findings call into question whether findings from highly compulsive individuals from the general population are generalizable to OCD patient populations.<\/jats:p><\/jats:sec><jats:sec id=\"S003329172300209X_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>To test this, we investigated confidence at three hierarchical levels: local confidence in single decisions, global confidence in task performance and higher-order self-beliefs in 40 OCD patients (medication-free, no comorbid diagnoses), 40 controls, and 40 matched highly compulsive individuals from the general population (HComp).<\/jats:p><\/jats:sec><jats:sec id=\"S003329172300209X_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>In line with the first notion we found that OCD patients exhibited relative underconfidence at all three hierarchical levels. In contrast, HComp individuals showed local and global <jats:italic>over<\/jats:italic>confidence and worsened metacognitive sensitivity compared with OCD patients, in line with the second notion.<\/jats:p><\/jats:sec><jats:sec id=\"S003329172300209X_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Metacognitive functioning observed in a general highly compulsive population, often used as an analog for OCD, is distinct from that in a clinical OCD population, suggesting that OC symptoms in these two groups relate differently to (meta)cognitive processes. These findings call for caution in generalizing (meta)cognitive findings from general population to clinical samples.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s003329172300209x","type":"journal-article","created":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T06:34:48Z","timestamp":1691562888000},"page":"7933-7942","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":18,"title":["Differences in metacognitive functioning between obsessive\u2013compulsive disorder patients and highly compulsive individuals from the general population"],"prefix":"10.1017","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0900-8565","authenticated-orcid":false,"given":"Monja","family":"Hoven","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Rouault","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"van Holst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Luigjes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2023,8,9]]},"reference":[{"key":"S003329172300209X_ref3","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-15561-w"},{"key":"S003329172300209X_ref2","doi-asserted-by":"publisher","DOI":"10.3758\/s13428-019-01237-x"},{"key":"S003329172300209X_ref11","doi-asserted-by":"publisher","DOI":"10.1037\/1040-3590.14.4.485"},{"key":"S003329172300209X_ref17","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-019-0602-7"},{"key":"S003329172300209X_ref8","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.2620-18.2019"},{"key":"S003329172300209X_ref14","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.13388"},{"key":"S003329172300209X_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocrd.2021.100665"},{"key":"S003329172300209X_ref24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0218182"},{"key":"S003329172300209X_ref25","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20514"},{"key":"S003329172300209X_ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2014.05.008"},{"key":"S003329172300209X_ref31","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2005.02.005"},{"key":"S003329172300209X_ref33","first-page":"1","article-title":"Rosenberg self-esteem scale (RSE)","volume":"61","author":"Rosenberg","year":"1965","journal-title":"Acceptance and Commitment Therapy. 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