The inferential confusion
When we talk about a specific psychological disorder in the cognitive-behavioral field, the focus of analysis is classically aimed at the cognitive or metacognitive and behavioral mechanisms involved in the debut and maintenance of the symptoms manifested by the person.
However, in recent decades, recovering paradigms relating to neuropsychology, an increasing number of research has been conducted aimed at identifying, in mental disorders, the presence of deficit in information processing and in the main executive functions.
Among these cognitive dysfunctions there is the inferential confusiondescribed as a specific deficit characterized by difficulties in discriminating between mental images and real events perceived.
In particular, the inferential confusion would be a method of processing the information characterized by a tendency to store greater trust towards one’s mental images or thoughts at the expense of data relating to their senses.
It is evident that the inferential confusion Both a deficit that can present itself in several psychopathological paintings but some authors have specifically examined the role of the inferential confusion in obsessive-compulsive disorder (Aardema and O’Connor, 2003) in order to explain the tendency of the patient affected by DOC to repeat repeatedly of what he perceives to give more credit to what he imagines or thinks.
Obsessive-compulsive disorder and inferential confusion
Obsessive-compulsive (DOC) disorder is a mental disorder characterized by the presence of Recurring intrusive thoughts (obsessions) e repetitive and/or ritualized behaviors (Compulsions) put in place to cancel or reduce the discomfort associated with obsessions.
Among the different forms that the DOC can take, one of the most common is that characterized by recursive doubts related to the fear that they may happen or that terrible events have happened that the subject himself, by inattention or negligence, could cause or not completely succeeding in avoiding.
We make a typical example thinking about Roberto’s case that we could define a classic check obsessive-compulsive. Roberto is constantly haunted by concerns relating to being able to leave open windows or doors with the risk that the house will be burgled with thieves.
Consequently, every time he finds himself having to get out of his home, to try to contain the anxiety and fear induced by these obsessions, he dwells in controls that he has actually closed doors, roller shutters and windows well.
Despite paying a lot of attention while performing the necessary action to reassure, shortly after the doubt it reappears by tormenting it again: Roberto then goes back to check again both looking carefully that the window is tight is trying several times to lower the door handle or turn the key in the patch to verify its correct closure.
Based on cases like this some authors (Aardema and O’Connor, 2003; Aardema and collaborators, 2006) have speculated that the inferential confusion may play a role in the tendency of these subjects to rely more on their mental scenarios imagined rather than the information deriving from their senses (view and touch, in the case of Roberto).
The same authors also highlighted how this deficit was, in Obsessive patients Overwhelmed, independent of other well -known cognitive mechanisms such as the merger thought reality and the overestimation of the threat (Aardema and collaborators 2006).
The Research on inferential confusion in obsessive-compulsive disorder They are placed within a larger number of studies relating to the association between obsessive-compulsive disorder and cognitive deficit in general.
Obsessive patients show mnestic and executive dysfunctions and it is common opinion that these dysfunctions can play an important role in memory changes that patients try to compensate with non -effective organizational strategies (déttore, 2011).
However, this paradigm was questioned by a series of empirical and clinical observations (Fadda et al., 2016). With particular reference to the inferential confusion, a study by Gangemi, Mancini and Dar (2015) partially disconnected the hypothesis that it can explain the mechanism for which the subjects like Roberto doubt that the door of the house is closed then persevering in checks (checking) compulsive mold.
The authors, through an experimental procedure, have in fact demonstrated that obsessive patients tend to give more credit to information confirming their fear, regardless of being derived from their senses or mental representations.
It would therefore be the evaluation of information (thought or perception) as “dangerous” to guide the subject in the tendency to give more credit or value to that data at the expense of another.
Dissociation and inferential confusion in obsessive-compulsive disorder
According to some authors (Liotti and Costantini 2011), the inferential confusion It would be placed within a continuum of gravity in which the metacognitive deficit of differentiation between reality and internal representations are placed on a less serious level while the opposite pole of extreme dysfunction occur cases of failure of the integrating functions of the consciousness and a real belief that one’s representations is real derives.
In this more serious event, the inferential confusion presents aspects in common with dissociation (Liotti and Costantini, 2011).
Research data indicate the presence of symptoms of pathological dissociation (disintegration of the functions of memory, consciousness, identity and perception) in some subgroups of Obsessive-compulsive disorder.
In particular, some controlled studies have highlighted symptoms of derealization, depersonalization and dissociative amnesia in these clinical subjects, especially in checkers (Eg, Ecker and Engelkamp, 1995; Grabe and collaborators, 1999; Rufer and collaborators, 2006).
Although a part of the supplementary memory deficits has been explained as a consequence, rather than as a cause, absorption in repetitive neutralization rituals (eg, Hermans, 2003, 2008), it is still clear that there are cases in which frankly dissociative experiences of depersonalization and derealization precede the appearance of obsessive symptoms and cannot therefore be attributable to a secondary effect of rituals (Liotti and Liotti and Liotti Costantini, 2011).
In the light of the previous hypotheses still controversial, an Italian study (Returiai, Pozza e Dèttore, 2017) conducted on a clinical sample made up of 60 obsessive subjects investigated the effects of Interaction between dissociation and inferential confusion on the development of obsessive-compulsive symptoms.
The results highlighted a significant correlation between inferential confusion and depersonalization/derealization and between inferential confusion and dissociative amnesia.
In particular, the variable of inferential confusion was a moderator of the relationship between symptoms of depersonalization/derealization and obsessive-compulsive. The moderator of inferential confusion also existed in the relationship between dissociative amnesia and obsessive-compulsive symptoms, but only for subjects with symptoms relating to the subtype characterized by insufficient control of thoughts.
Therapeutic repercussions
These results indicate how it is It is also important to consider symptoms of dissociation and inferential confusion indexes in the context of the DOC treatment.
Among the possibilities, theInference Based Approach (O’Connor and collaborators, 2005) It could be a possibility of integration in the treatment of obsessive-compulsive disorder based on the classic protocols Evidence Based of cognitive-behavioral psychotherapy.
In fact, there are data that suggest an association between the presence of dissociative symptoms and persistence of compulsive obsessive symptoms after cognitive-behavioral therapy interventions.
In particular, the subjects with significantly worse prognosis were those with higher dissociation symptoms at the beginning of the treatment (higher scores at the Des scale) than those who responded positively to the treatment and this difference remained significant also by controlling variables such as depression, other comorbilities and the type of pharmacological treatment used (Rufer et al., 2006).
This could suggest that the classics cognitive-behavioral interventions For the symptomatology of obsessive-compulsive disorder, they could be insufficient for complicated paintings by the presence of pathological dissociative symptoms.
Bibliographic references
- Aardema, F., O’Connor, K. (2003). Seeing White Bears that are not there: Inference Processes in Obsessions. Journal of Cognitive Psychotherapy, 17, 23-37.
- Aardema, F., O’Connor, K., Emmelkamp, PMG (2006). Inferential Confusion and Obsessive Beliefs in Obsessive-Compulsive Disorder. Cogn Behav Ther, 35 (3), 138-47.
- Dèttore, D. (2011). Doc and errors of thought. Cognitive and behavioral psychotherapy. Volume 17, number 3, p.381-394.
- Ecker, W., Engelkamp, J. (1995). Memory for Actions in compulsive obsessive disords. Behavioral and Cognitive Psychotherapy, 23, 349-371.
- Fadda, S., Gragnani, A., Couyumdjian, A., Mancini, F. (2016). Cognitive deficit and obsessive compulsive disorder. In the obsessive mind. Mancini, F. (edited by). Raffaello Cortina ed.
- Gangemi, A., Mancini, F., Dar, R. (2015). An expertimental re-examination of the inferential confusion hypothesis of obsessive compulsive doubt. Journal of Behavior Therapy and Experimental Psychiatry, 48, 90-97.
- Grabe, HJ, Goldschmidt, F., Lehmkuhl, L., Gansicke, M., Spitzer, C., Freyberger, HJ (1999). Dissociative sympoms in obsessive-compulsive dimensions. Psychopathology, 32, 319-324.
- Hermans, D., Engelen, U., Grouwels, L., Joos, E., Lemmens, J., Pieters, G. (2008). Cohnive Confidence in OCD: Distrusting Perception, Attention and Memory. Behaviour Research and Therapy, 41, 383-401.
- Liotti, G. and Costantini, M. (2011). The dissociation in obsessive-compulsive disorder: a critical review. Clinical cognitivism, 8.1, 47-59.
- O’Connor, KP, Aardema, F., Bouthillier, D., Fournier, S., Guay, S., Robillard, s., Pe´lissier, Mc, Landry, P., Todorov, C., Tremblay, M and Pitre, M. (2005). Evaluation of an inference-based landing landed obsessive-compulsive disorder. Cognitive Behaviour Therapy, vol 34, no 3, pp. 148–163.
- Rufer, M., Held, D., Cremer, J., Fricke, S., Moritz, S., Peter, H., Hand, I (2006). Dissociation as a predictor of cognitive behavior therapy outcome in patients with compulsive obsessive disorder. Psychotherapy and Psychosomatics, 75, 40-46.
- I returned, S., Pozza, A. and Dettore, D. (2017). Inferential confusion and dissociative experiences in the doc. Presentation at the Forum of Psychotherapy and Research of Specialization Schools of Cognitive Studies, Riccione, 5-6 May 2017.
