Objective: Obsessive-compulsive disorder (OCD) is clinically heterogeneous, and the autogenous–reactive distinction may help characterize this heterogeneity. This study compared adolescents with reactive OCD, autogenous OCD, and healthy controls in terms of clinical characteristics, metacognitive beliefs, and social cognition, and examined associations between metacognitive beliefs and social cognition within OCD subtypes.
Methods: This cross-sectional case-control study included 102 adolescents: 33 with reactive OCD, 31 with autogenous OCD, and 38 healthy controls. Diagnoses were confirmed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version (K-SADS-PL). OCD severity, metacognitive beliefs, and social cognition were assessed using the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), the Metacognitions Questionnaire for Children and Adolescents, the Reading the Mind in the Eyes Test, and the Faux Pas Test. Group comparisons and correlation analyses were performed.
Results: The reactive and autogenous OCD groups differed primarily in symptom content, with cleaning and checking symptoms more common in the reactive group and religious and sexual obsessions more common in the autogenous group. The OCD subtypes did not differ in overall OCD severity or global functioning. After correction for multiple comparisons, metacognitive belief domains differed across groups; however, post hoc analyses revealed no significant differences between the two OCD subtypes. No significant group differences were observed in social cognition measures. Correlation analyses suggested selective associations between metacognitive beliefs and social understanding, particularly in the autogenous group.
Conclusion: In adolescent OCD, the autogenous–reactive distinction appears to reflect differences in symptom content rather than distinct metacognitive or social cognitive profiles. Larger longitudinal studies are needed to clarify subtype-related cognitive heterogeneity.