Metacognitions in Symptomatic and Remitted Patients with Obsessive Compulsive Disorder: Preliminary Evidence for Metacognitive State and Trait Markers

BACKGROUND: The phenomenon of metacognition is instrumental in the conceptualization and management of obsessive compulsive disorder (OCD). Studies on the comparison between metacognitions in OCD patients and healthy controls or those with other clinical conditions have been conducted. We aimed to compare metacognitions among currently symptomatic OCD (S-OCD) patients, currently remitted OCD patients (R-OCD), and healthy controls (HC). METHOD: This cross-sectional research was conducted in the Department of Psychiatry of a tertiary care hospital in North India. Purposive sampling method was used to recruit 40 OCD patients, including an equal number of R-OCD and S-OCD patients, and 20 HC matched for age and education. Meta-Cognition Questionnaire and Thought Control Questionnaire were used to assess metacognitive functions. RESULTS: The findings showed a gradient of highest maladaptive metacognitions in the S-OCD group and lowest in HC. In the OCD subgroups, specific metacognitive beliefs (negative beliefs F = 65.52; need to control thoughts F = 61.03) and strategies (worry F = 83.55; low distraction F = 105.61) remained significantly different (P ≤ 0.001) between S-OCD and R-OCD patients. Certain other metacognitions remained consistently more or less stable between S-OCD and R-OCD patients, that is, metacognitive beliefs (cognitive confidence F = 11.43; cognitive self-consciousness F = 37.12) and strategies (punishment F = 17.45; low social control F = 12.89). This finding is further corroborated by positive correlations of severity of OCD with need to control thoughts (r = 0.66, P < 0.001), negative beliefs (r = 0.63, P < 0.001), and worry (r = 0.76, P < 0.001), and negative correlations with distraction (r = – 0.79, P < 0.001). CONCLUSION: The study provides preliminary evidence for specific metacognitions distinguished as potential state and trait markers for OCD, which needs to be established on a larger sample using a longitudinal study design.