Andrea Pozza^{1, 2,}, Davide Dèttore^{2, 3}

Leading cognitive theories posited that inflated responsibility beliefs play as a vulnerability and maintenance cognitive factor for obsessive compulsive disorder (OCD). A great body of research tested the specificity of responsibility to OCD, comparing on responsibility outcomes patients with OCD relative to normal controls or patients with anxiety disorders (AD). However, findings appeared inconclusive, and a systematic review summarizing evidence has not been conducted, yet. The current systematic review and meta-analysis provided a quantitative synthesis of findings from published cross-sectional case-control studies investigating whether inflated responsibility beliefs are specific to OCD. It was hypothesized that patients with primary OCD endorse stronger inflated responsibility beliefs compared to (1) healthy controls, and to (2) patients with any primary anxiety disorder. Electronic databases were searched. Cross-sectional case-control studies were included if they compared patients with primary OCD to healthy controls or patients with any primary anxiety disorder, and they used validated outcome self-report measures of responsibility. Studies conducted on primary hoarding were excluded. Studies on patients with comorbid conditions were not excluded. Twenty-two studies (n= 8541, 48 effect sizes overall) were included in random-effect meta-analyses. A large effect size favouring patients with OCD relative to controls was found [d=1.13, SE= 0.09, 99% CI: 0.87-1.37, p= 0.0001]. A medium effect size on responsibility favoring OCD over AD patients was found [d=0.66, SE= 0.10, 99% CI: 0.39-0.92, p= 0.0001], but the results appeared to be confounded by a publication bias effect. Current findings did not seem to confirm definitively the specificity of responsibility to OCD. Responsibility could be a transdiagnostic factor for psychopathology. Implications for case-formulation and treatment are discussed. Causal inferences on the role of responsibility in OCD development cannot be made due to the cross-sectional nature of studies. Further prospective studies are needed. Further research with experimental designs should address whether changes in responsibility beliefs mediate OCD symptom changes during cognitive behaviour therapy targeting the responsibility domain.

obsessive compulsive disorder, inflated responsibility, beliefs, cognitive specificity, meta-analysis