4 - (SYM 67) Social Cognition in Obsessive-compulsive and Hoarding Disorders

Background: Obsessive-compulsive disorder (OCD) and hoarding disorder (HD) are associated with profound social dysfunction, and it is unclear whether disrupted social cognition explains this dysfunction. Few studies have examined social cognition in OCD and HD, and findings are mixed. Difficulties with emotion recognition and affective reasoning have been documented in OCD. Though one study using an analogue sample suggests theory of mind (ToM) deficits in HD, no research has examined social cognitive abilities in a clinical HD sample. This study aimed to clarify the nature of social cognitive abilities in individuals diagnosed with OCD and HD as compared to healthy controls (HC), and to explore whether social cognitive abilities are associated with insight and social dysfunction. 

Method: Three groups (OCD, HD, HC) of eighteen adults (N = 54) completed a self-report measure of social functioning, an emotion recognition task, and a ToM reasoning task. Participants in the OCD and HD groups were also administered an insight assessment. ANOVAs were used to examine group differences in emotion recognition, ToM reasoning, social functioning, and insight. 

Results: The HD group trended toward performing worse than the HC group on emotion recognition (M diff. = 3.00, p = .051), and worse on ToM reasoning than the OCD group (M diff. = 2.56, p = .084). Those with HD performed worse when making inferences about thoughts/intentions (versus affect) than those with OCD (M diff. = 2.11, p = .037), and made more errors due to selecting answer choices that are not a mental state (M diff. = 2.06, p < .008). Additionally, the HD group exhibited poorer insight than the OCD group, F (1,34) = 7.60, p = .009, η² = .18, and reported less engagement in socialization (p < .001) and prosocial activities than HCs (p = .017). The OCD group reported less engagement in prosocial activities, recreation, and activities of independent living than HCs (ps < .05).  

Conclusion: Although the clinical groups performed nearly equivalently to the HC group on social cognition tasks, they reported lower social functioning across several domains. This may indicate that social functioning difficulties are not necessarily due to social cognitive deficits. However, differences emerged in social cognitive ability and insight between those with HD and OCD, which may suggest a pattern of cognition that differentiates those with HD from those with OCD. Specifically, those with HD may evidence a pattern of literal thinking that interferes with reasoning about the mental states of the self and others.