Transdiagnostic Phenotyping Reveals a Host of Metacognitive Deficits Implicated in Compulsivity

Abstract

Recent work suggests that obsessive-compulsive disorder (OCD) patients have a breakdown in the relationship between explicit beliefs (i.e. confidence about states) and updates to behaviour. The precise computations underlying this disconnection are unclear because casecontrol and transdiagnostic studies yield conflicting results. Here, a large general population sample (N = 437) completed a predictive inference task previously studied in the context of OCD. We tested if confidence, and its relationship to action and environmental evidence, were specifically associated with self-reported OCD symptoms or common to an array of psychiatric symptoms. We then investigated if a transdiagnostic approach would reveal a stronger and more specific match between metacognitive deficits and clinical phenotypes.Consistent with prior case-control work, we found that decreases in action-confidence coupling were associated with OCD symptoms, but also 5/8 of the other clinical phenotypes tested (8/8 with no correction applied). This non-specific pattern was explained by a single transdiagnostic symptom dimension characterized by compulsivity that was linked to inflated confidence and several deficits in utilizing evidence to update confidence. These data highlight the importance of metacognitive deficits for our understanding of compulsivity and underscore how transdiagnostic methods may prove a more powerful alternative over studies examining single disorders.

Aberrant computational mechanisms of social learning and decision-making in schizophrenia and borderline personality disorder

“…Hypermentalizing is also a possible explanation for the findings of [ 59 ], where similar modeling as in the present study showed that healthy participants at the high end of the paranoia spectrum used similar weighting of social information irrespective of whether incorrect advice was framed to be intentional or not, while low-paranoia participants reduced their social weighting when negative advice was cued to be intentional. Furthermore, a study of healthy participants by our group [ 29 ] found that stronger weighting of social over non-social predictions during decision-making was associated with increased activity in the putamen and anterior insula.…”

“…In addition to looking for learning and decision-making differences between the different diagnostic groups that were defined by traditional ICD-10 criteria, we adopted a transdiagnostic perspective to investigate the relation between computational mechanisms of social learning and decision-making with ACIPS, a self-report measure of social anhedonia. Previous studies have adopted such a dimensional approach in the general population and found that patterns in aversive learning mapped onto distinct symptoms of depression, social anxiety, and compulsivity [ 48 , 59 , 60 ]. We, however, could not find any transdiagnostic association of social anhedonia with computational parameters of social learning and decision-making in our data.…”

Model-based learning deficits in compulsivity are linked to faulty representations of task structure

“…This was because our sample size had too low a subject-to-variable ratio (N = 192) for de novo factor analysis, as compared to the original study (N = 1413). Prior studies have demonstrated the stability of the factor structure in new data (Rouault et al, 2018;Seow & Gillan, 2020). Consistent with prior work, the resulting dimension scores were moderately intercorrelated (r = 0.33 to 0.42).…”

“…For example, individuals high in compulsivity exhibit over-confidence in perceptual decision making tasks and may also have some difficulty in knowing when they are right versus wrong (Rouault, Seow, Gillan, & Fleming, 2018). A subsequent investigation of metacognition with respect to reinforcement learning also found that compulsive individuals were over-confident, but also that their confidence did not update appropriately in response to new evidence and did not inform their behaviour as strongly as those low in compulsivity (Seow & Gillan, 2020). Although not studied in the context of model-based planning specifically, these metacognitive findings suggest the possibility that in compulsivity, model-based planning failures may stem from fundamental issues in acquiring and maintaining an accurate internal model of the environment.…”

Null results from a dimensional study of error-related negativity (ERN) and self-reported psychiatric symptoms

“…We also showed that this method can reveal associations that are hidden by categorical disorder groupings. For example, anxious-depression is linked to reduced confidence, while individuals high on the spectrum of compulsivity have elevated confidence (Rouault et al, 2018;Seow and Gillan, 2019). This finding might explain why group level effects in OCD (where patients have high levels of both compulsivity and anxious-depression) have not revealed confidence abnormalities (Hauser et al, 2017;Vaghi et al, 2017).…”