Are inflated responsibility beliefs specific to ocd? Meta-analysis of the relations of responsibility to ocd, anxiety disorders, and depression symptoms

Abstract Objective:cognitive models assumed that responsibility beliefs are a vulnerability and maintenance cognitive factor specific to OCD symptoms. Several studies have been conducted on the specificity of responsibility to OCD relative to anxiety disorders (AD) or depression (DEP). Evidence to date appeared inconsistent, and a meta-analysis on this issue does not exist yet. Using meta-analytic techniques the current study summarized cross-sectional data to examine: (a) whether stronger responsibility beliefs are related to ocd compared to AD or DEP symptoms in clinical and non-clinical samples; (b) whether ocd patients have stronger responsibility beliefs than AD patients; (c) potential moderators of the relation of responsibility to OCD symptoms. Method: Online databases were searched. Cross-sectional studies were included if they (a) assessed responsibility with validated tools, (b) assessed ocd, AD or DEP symptoms in clinical or non-clinical samples, (c) reported correlations or between-groups data (OCD vs. AD or DEP patients) on responsibility. Fifty-eight studies (n = 15678) were included in random-effect meta-analyses. Results: Effect size on relation of responsibility beliefs to OCD symptoms was medium. Responsibility was more strongly associated with OCD [r= 0.43, p=.0001] than DEP symptoms [r= 0.33, p= .0001] but equally associated with ocd and AS symptoms [Q = 7.30, p>.01], despite a stronger relation was found for OCD at a trend level. A medium effect size on responsibility favoring ocd over AD patients was found [d = 0.66, p< .01]. Responsibility was more strongly associated with OCD symptoms in adult [Q= 6.24, p<.01] than in children/adolescent samples, and more strongly associated with ocd symptoms in non-Western [Q = 6.29, p <.01] than in Western samples. When analyses were restricted to responsibility measures created by the obsessive compulsive cognitions Working Group, responsibility was not significantly more related to OCD [r= 0.42, p=.0001] than AD [r= 0.33, p=.0001] or DEP [r= 0.34, p=.0001]. Conclusions: 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.