Transdiagnostic phenotyping reveals a range of metacognitive deficits associated with compulsivity
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Description: Recent work suggests that obsessive-compulsive disorder (OCD) is underpinned by a breakdown in the relationship between explicit beliefs about how the world works (i.e. confidence about states) and updates to behaviour. The present study aimed to test the precise computations that underlie this disconnection and ascertain their specificity to OCD symptoms. We phenotyped a large general population sample (N = 437), who also completed a predictive inference task and found that decreases in action-confidence coupling were not only associated with OCD symptoms, but also several other clinical phenotypes (6/9 corrected for multiple comparisons). This non-specific pattern was explained by a transdiagnostic compulsive symptom dimension. Action-confidence decoupling in high compulsives was associated with a marked inability to update confidence estimates (but not behaviour) according to unexpected outcomes, uncertainty and positive feedback. Our findings suggest that compulsive behaviour may be explained by difficulty in building an accurate explicit model of the world.