Current Psychology

https://doi.org/10.1007/s12144-020-00681-9

Relationships between Probabilistic Inferences,

Meta-Cognitions, Obsessional Beliefs, Dissociative Experiences
and Obsessive-Compulsive Symptoms: a Mixture Structural Equation
Modeling Approach
Murat Boysan 1 & Abdullah Yıldırım 2 & Anıl Cemre Ökmen 3

# Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
A dissociative tendency in obsessive-compulsive disorder (OCD) has long been documented. It is recognized that dissociative
symptoms in OCD may interfere with response to treatment. The current study investigated whether cognitive vulnerability
factors are differentially associated with dissociative experiences and obsessive-compulsive (O-C) symptoms in a general
population sample. Moreover, using the mixture structural equation modeling (MSEM) approach, we explored whether a latent
psychopathological profile exists that may differ in severity of dissociation, O-C symptoms, and cognitive vulnerability factors in
the sample. The structural equation analysis showed that probabilistic inferences directly contributed to the variances of both
dissociative and O-C symptoms. Probabilistic inferences mediated the relationships of meta-cognitions with both dissociation
and O-C symptoms. Obsessional beliefs were directly associated with O-C symptoms and indirectly contributed to dissociation
via obsessions. Two latent profiles emerged in the MSEM: a healthy group and a psychopathological group. Participants
classified into the latent psychopathological profile were high in O-C symptoms and dissociation as well as cognitive vulnera-
bility factors of meta-cognitions, obsessional beliefs, and probabilistic inferences. The mixture analysis provided further support
for the significant associations between the variables of interest. Further research is needed to better understand the underpinnings
of the relationships between O-C symptoms and dissociation.

Keywords Latent profile analysis . Cognitive model . Risk factors . OCD . Dissociation

Introduction normal integration of consciousness, memory, identity, per-

ception, and motor performance (American Psychiatric
Dissociation is defined as an experienced loss of control over Association 2013; Cardena and Carlson 2011). The term dis-
mental processes that result in a functional disconnection in sociative symptomatology has been assumed to cover a rela-
tively wide range of phenomena on a continuum, including
relatively mundane experiences, i.e., absorption or fantasy
* Abdullah Yıldırım proneness, at one end which extends to more severe forms
yldrmabdullah@yahoo.com of dissociative symptomatology, i.e., dissociative amnesia
and depersonalization/derealization (Boysan 2016;
Murat Boysan
Dalenberg et al. 2012). This functional disconnection may
murat.boysan@asbu.edu.tr
refer to integration deficits in memory and identity as in dis-
Anıl Cemre Ökmen sociative amnesia, or disconnection in the perception of sur-
anilcemreokmen@yyu.edu.tr
roundings or one’s self, as in depersonalization/ derealization
1
Department of Psychology, Faculty of Social Sciences and
(Michal et al. 2009). Another aspect of the dissociative pro-
Humanities, Ankara Social Sciences University, Ankara, Turkey cess is absorption, which refers to narrowing one’s attention,
2
Department of Psychiatry, Kahramanmaraş Sütçü İmam University
immersing in an internal or external experience in which one
School of Medicine, Kahramanmaraş, Turkey is oblivious to other sensations and perceptions (Soffer-Dudek
3
Department of Psychiatry, Van Yüzüncü Yıl University School of
et al. 2015; Tellegen and Atkinson 1974). Low levels of dis-
Medicine, Van, Turkey sociation have been regarded as ‘nonpathological,’ operating

as a buffering response in the wake of stressful life events
(Boysan 2014; Butler et al. 1996). However, pathological dis-
sociation plays a counterproductive role in emotion modula-
tion by exacerbating the symptoms of psychiatric disorders
(Boysan 2016).
The corresponding phenomenon is assumed to be
transdiagnostic in nature that several psychiatric disorders
such as post-traumatic stress disorder (Aydin et al. 2012;
Kadak et al. 2014; Kadak et al. 2013), affective disorders
(Boysan et al. 2009; Kefeli et al. 2018), and obsessive-
compulsive disorder (OCD) (Boysan et al. 2018; Tapanci
et al. 2018) feature pathological dissociation.
The relationship between dissociation and OCD has been a
focus of growing clinical interest (Soffer-Dudek et al. 2015).
A body of accumulated evidence has underscored the recip-
rocal influences between these two clinical entities (Belli et al.
2012; Fontenelle et al. 2007; Goff et al. 1992; Grabe et al.
1999; Lochner et al. 2004; Norton et al. 1990; Rufer et al.
2006a; Watson et al. 2004). In a more recent case-control
study, Tatlı et al. (2018) identified moderate correlations be-
tween dissociation and O-C symptoms, ranging from 0.36 to
0.61, and both dissociative experiences and childhood
traumas significantly contributed to O-C symptom severity
as measured by the Padua Inventory (Sanavio 1988) in a clin-
ical sample. Soffer-Dudek (2014) suggested that absorption /
imaginative involvement component of the dissociative ten-
dency brings about uncertainty for one’s actions that gives rise
to obsessions, particularly for checking and obsessive-
compulsive symptoms that may, in turn, provoke a
dissociative-OCD cycle. Absorption and imaginative involve-
ment, a tendency for totally immersed attention, which is gen-
erally considered as the nonpathological aspect of dissociative
tendency, has been empirically demonstrated to be significant-
ly associated with exacerbation of obsessive-compulsive
symptoms in the relevant literature (Soffer-Dudek et al. 2015).
First-line treatment choices for OCD include pharma-
cotherapy and cognitive behavioral therapy, which in-
volves exposure and response to intervention as well as
working on beliefs peculiar to OCD that hold the person
more sensitive and reactive to obsessional intrusions
(Frost and Steketee 2002). The cognitive models of
OCD, heavily relying on diathesis-stress hypothesis,
claims that importance and interpretation attributed to
the intrusions by underlying cognitive vulnerability fac-
tors such as obsessional beliefs, meta-cognitions or prob-
abilistic inferences lead to the transmission of ‘normal
obsessions’ to ‘abnormal obsessions’ (Gulec et al. 2014;
Purdon and Clark 1999; Salkovskis 1989). Despite the
prevailing notion in the literature, questions arise from
the clinical practice that cognitive components of the
cognitive-behavioral interventions do not add substantial-
ly to psychotherapy outcomes rather behavioral interven-
tions are at the heart of treatment modality, in particular,
Curr Psychol
exposure and response prevention (Emmelkamp 2002;
Fama and Wilhelm 2005). Significant associations be-
tween the symptom severity and cognitive vulnerability
factors seem to strengthen the general acceptance of cog-
nitive models of OCD in the literature; nevertheless, data
from the longitudinal studies do not provide compelling
evidence for causal involvement of cognitive appraisals in
the onset of OCD and their unique predictive value in
treatment outcomes (Abramowitz et al. 2007; Coles
et al. 2008). Finally, current cognitive-behavioral inter-
ventions do not reveal promising solutions to improve
the more complicated clinical expression of symptoms in
patients with lack of insight and highly convicted with
their counterproductive appraisals and obsessions
(Neziroglu et al. 2001; O'Dwyer and Marks 2000; Veale
2006). Moreover, OCD patients with a tendency for high
dissociation showed a poorer prognosis and less adher-
ence to therapeutic modality throughout the treatment
compared to OCD patients with lower levels of dissocia-
tive symptomatology (Rufer et al. 2006b; Semiz et al.
2014). In a case-controlled clinical study, Prasko et al.
(2010) identified that, in comparison to healthy controls,
even mild levels of dissociative symptomatology were
predictive of increases in anxiety, depression, and
obsessive-compulsive symptoms.
More recent conceptualizations of the underlying mecha-
nisms of OCD holds that pathological doubt and obsessional
beliefs emerge from a cognitive process characterized by two
components: a distrust to the senses and an overreliance on the
imagination, and over-investment on remote possibilities
(O'Connor et al. 2005). Obsessions become more egosyntonic
and delusional and lead to dissociation and reduced self-
confidence dependent on the degree to which the process of
giving credibility to the imagination rather than the senses in
here and now (Audet et al. 2016; Grenier et al. 2010; Julien
et al. 2009). A more recent study by Soffer-Dudek and Somer
(2018) with a longitudinal research design, spanning 14-day,
addressed the relationships between maladaptive
daydreaming, a trait construct characterized by frequent and
intense engagement in vivid and fanciful dreaming for hours,
dissociative symptomatology and OCD. Maladaptive
daydreaming was identified as a temporal antecedent of
OCD symptoms and dissociation on the following day in
which, in particular, a significant increase in OCD symptoms
had a significant temporal effect on an increase in maladaptive
daydreaming in a vicious cycle of compulsions.
As mentioned above, the accumulated evidence has con-
sistently and strongly supported the robust associations be-
tween obsessive-compulsive symptoms and dissociation.
Informed by the emerging evidence, the reciprocal relation-
ships between obsessive-compulsive symptoms and dissocia-
tion seem to be evident that constitute a vicious cycle of psy-
chopathology (Soffer-Dudek 2017; Soffer-Dudek et al. 2015;
Curr Psychol
Soffer-Dudek and Somer 2018; Soffer-Dudek 2018). In a
more recent study of relationships between obsessions and
dissociative symptoms, Boysan et al. (2018) coined the term
‘obsessional dissociation,’ which refers to a dissociative ten-
dency in response to intrusive thoughts. In this study, our main
aim was to investigate the associations between obsessions
and dissociation concerning cognitive vulnerability factors
of obsessional beliefs, meta-cognitions, and obsessional prob-
abilistic inferences. Although there has been a body of re-
search indicating substantial dose-response relationship be-
tween obsessive-compulsive symptoms with cognitive risk
factors such as meta-cognitions (Fisher and Wells 2005;
Gwilliam et al. 2004; Purdon and Clark 1999) and obsessional
beliefs (Abramowitz et al. 2006), there has been a paucity of
investigation addressing the interplay between dissociation
and obsessive-compulsive symptoms with cognitive vulnera-
bility factors such as metacognitions, obsessive-beliefs, and
probabilistic inferences. Despite the rare research, pre-
liminary evidence indicated that cognitive vulnerability
factors seem to be positively correlated with dissociative
symptoms, in particular, metacognitions (Barlow and
Goldsmith 2014; Selvi et al. 2012) and perfectionism
domain of obsessive beliefs (Pozza and Dèttore 2019)
that give rise to these hypotheses: i) the relationship
between obsessions and dissociative symptoms is sub-
stantial, ii) metacognitive beliefs positively contribute
to dissociation and obsessive-compulsive symptoms, iii)
high obsessional probabilistic inferences is significantly
associated with both obsessions and dissociation, and
iv) O-C symptoms mediate the substantial indirect rela-
tionships of dissociative experiences with cognitive vul-
nerability factors. We tested these hypotheses using a
latent structural equation model. Also, we speculated
that a latent psychopathological profile exists in the
sample. We speculated that using a mixture structural
equation modeling (MSEM) approach and a psychopa-
thology group would be identified based on the latent
structural relationships between dissociation, obsessions,
metacognitions, dysfunctional beliefs, and obsessional
probabilistic inferences.
Method
Participants and Procedure
Participants were recruited from various majors at Van
Yüzüncü Yıl University through the convenience sampling
procedure. Two hundred thirty college students volunteered
to participate in the study and completed a battery of question-
naires in their classroom with the help of a researcher. The
average age of the sample was 22.60 (SD ± 2.080). 59.57% of
the sample were female.
All participants provided written informed consent. All
study procedures were approved by the local ethical commit-
tee of Van Yüzüncü Yıl University.
Instruments
Padua Inventory-Revised (PI-R)
A 41-item self-report instrument designed to measure the
presence and severity of obsessive-compulsive symptoms
(Sanavio 1988; Van Oppen 1992). A total score may be elic-
ited, and five dimensions of obsessions can be obtained: im-
pulses, washing, checking, rumination, and precision.
Subscale scores of the PI-R are calculated by summing up
the answers on respective items. The Turkish version was
adapted by Besiroglu et al. (2005), which was reported to have
promising and sound psychometric properties with a
Cronbach’s alpha of α = 0.95.
Dissociative Experiences Scale (DES)
Dissociation was assessed by the most widely used instru-
ment, Dissociative Experiences Scale (Carlson and Putnam
1993), in which participants are asked to rate the percentage
of time ranging from 0 to 100% they experience 28 dissocia-
tive symptoms. Total DES scores are calculated by averaging
the sum of all items. The Turkish version of the DES has
excellent psychometric properties comparable to the original
English version (Yargic et al. 1995).
Obsessive Beliefs Questionnaire (OBQ)
The OBQ is a 44-item self-report questionnaire designed to
measure cognitive appraisals and beliefs considered critical to
the pathogenesis of obsessions (Obsessive Compulsive
Cognition Working Group 2005). The instrument yields three
subscales of Responsibility and threat estimation, Perfectionism
and intolerance for uncertainty, and Importance and control of
thoughts. The scores are calculated by summing up the respec-
tive items of the subscales. The Turkish version revealed excel-
lent construct validity and reliability with an internal consisten-
cy of α = 0.95 (Boysan et al. 2010).
Meta-Cognitions Questionnaire (MCQ)
The shortened MCQ was designed to measure a range of meta-
cognitions in clinical and non-clinical samples (Wells and
Cartwright-Hatton 2004). The instrument consists of 30 self-
report items, and each item is rated on a four-point Likert type
scale: 1 (do not agree), 2 (agree slightly), 3 (agree moderately),
and 4 (agree very much). The MCQ yields scores on five di-
mensions of meta-cognitions: positive beliefs about worry, be-
liefs about the uncontrollability of thoughts, negative beliefs

about cognitive confidence, negative beliefs concerning the
need to control thoughts, and cognitive self-consciousness.
The scores are calculated by summing up the respective items.
The Turkish version of the short form of the MCQ was dem-
onstrated to have good psychometric properties with a
Cronbach’s alpha of α = 0.86 (Tosun and Irak 2008).
Obsessional Probabilistic Inferences Scale (OPIS)
The OPIS is a 20-item questionnaire measuring the unidimen-
sional concept of probabilistic inferences referring to a tenden-
cy to elicit apriori negative appraisals and expectations, in-
cluding harm, contamination, losing control, making mis-
takes, and behaving socially and religiously inappropriate
(Gulec et al. 2014). The OPIS scores are calculated by sum-
ming up all items of the scale. The questionnaire satisfactorily
discerned OCD patients compared with either major depres-
sive patients or healthy controls. The internal reliability of the
measure was α = 0.88.
Data Analysis
The statistical analysis consisted of i) descriptive statistics of
the sample characteristics, ii) convergence of a specified struc-
tural equation model utilizing modification indexes
representing the association between O-C symptoms and dis-
sociation in relation to cognitive predisposing factors, more
specifically probabilistic inferences, metacognitions and ob-
sessive beliefs, iii) latent profile analysis of the converged
structural equation model to identify the sample of those indi-
viduals who were at higher risk of psychopathology, and iv)
one-way analysis of covariance (ANCOVA) of scores on the
study psychometric measures across latent sub-groups to de-
scribe characteristics of latent profiles obtained using MSEM.
MSEM is a two-step approach, conducted using MPlus
version 4.01 (Muthén and Muthén 1998-2006). In Phase 1,
the structural model reflecting the significant relationships be-
tween obsessive-compulsive symptoms, dissociative experi-
ences, and cognitive vulnerability factors were specified.
Relying on the model generating approach, the use of modi-
fication indices specified the final model (Jöreskog 1993).
Maximum likelihood estimation with robust standard errors
was used as the estimation method. Informed by the guide-
lines (Bentler 1990; Bentler and Bonett 1980; Hooper et al.
2008; Hu and Bentler 1999; Steiger 1990), the following
goodness of fit indexes and thresholds were applied to the
structural equation model being tested: χ2 / df [1; 4], Root
Mean Square Error of Approximation (RMSEA) [0.05; 0.08],
Standardized Root Mean Square Residual (SRMR) [0.05;
0.08], and Comparative Fit Index (CFI) [0.90;0.95].
MSEM was proceeded to uncover the optimal latent pro-
files. Optimal latent profile models were evaluated using the
Bayesian information criterion (Schwarz 1978) with the
Curr Psychol
lowest values preferred (Burnham and Anderson 2004;
Nylund et al. 2007; Preacher and Hayes 2008). Entropy values
greater than >0.80 are preferred (Celeux and Soromenho
1996).
Once the best class solution was determined, we used the
one-way ANCOVAs to explore the differences between latent
profiles on the mean scale scores after controlling for age and
sex. Finally, a multiple logistic regression analysis was con-
ducted to understand the most prominent indicators of latent
profiles when multivariate relationships between cognitive
vulnerability factors (obsessive beliefs, meta-cognitions, and
obsessional probabilistic inferences), obsessive-compulsive
symptoms and dissociative symptomatology were taken into
account. Logistic regression coefficients were transformed to
odds ratios (ORs) with 95% confidence intervals for ease of
interpretation. The significance threshold was held at p < 0.05.
Results
Structural Equation Model of Relations
between Dissociation, Obsessive-Compulsive
Symptoms, and Cognitive Vulnerability Factors
Using the latent structural equation modeling approach, we
tested our hypotheses concerning the relationships between
variables of interest. The specified pathways were tested with
MPlus 4.01 (Muthén and Muthén 1998-2006), using the max-
imum likelihood parameter estimates with standard errors and
a mean-adjusted chi-square test statistic that are robust to non-
normality. We began with a tentative initial model in which O-
C symptoms and dissociative experiences were endogenous
variables that were regressed on exogenous variables obses-
sive beliefs, meta-cognitive attributional styles, and obses-
sional probabilistic inferences. To improve the hypothesized
model, we considered the fit indices, standardized residuals,
modification indices, and expected change values (Bentler
2007; Jöreskog 1993; Schermelleh-Engel et al. 2003). The
specified model was tested after controlling for the potential
effects of gender and age on the latent variables. The mini-
mum fit function chi-square for the specified model was sig-
nificant, Satorra-Bentler χ2 (172) = 422.161, p < 0.001,
whereas χ2/df ratio was 2.45, reflecting an adequate
fit. Also, other model fit indices suggested that the hy-
pothesized structural latent model fit the data consider-
ably well. RMSEA, a population-based index that in-
volves analysis of residuals, was 0.08, 90%CI = 0.070–
0.089, p < 0.001, and SRMR, another residual-based in-
dex represents the differences between the observed cor-
relations and estimated correlations, was 0.06. An incre-
mental fit index of CFI was 0.90. Standardized esti-
mates for the final model are presented in Fig. 1.
Curr Psychol
Fig. 1 The latent structural equation model represents the relationships
between dissociation, obsessive-compulsive symptoms, probabilistic in-
ferences, meta-cognitions and obsessional beliefs after controlling for age
and sex. MCQ Meta-Cognitions Questionnaire, PosCog Positive meta-
cognitions, Uncont Uncontrollability beliefs, CogConf Cognitive confi-
dence, CogCont Cognitive control, CogAwar Cognitive awareness, OPIS
Meta-cognitions were associated significantly with obses-
sional probabilistic inferences (β = 0.52; p < 0.01), which in
turn, were indirectly associated with dissociative experiences
through probabilistic inferences (indirect β = 0.16; p < 0.01)
and obsessive-compulsive symptoms (indirect β = 0.10;
p < 0.01). Although obsessional probabilistic inferences sig-
nificantly contributed to both obsessive-compulsive symp-
toms (β = 0.48; p < 0.01) and dissociation (β = 0.32;
p < 0.01), an indirect relationship between obsessional proba-
bilistic inferences and dissociative symptomatology mediated
by obsessive-compulsive symptoms (indirect β = 0.19;
p < 0.01) was also identified. Dissociative experiences were
associated with obsessive-compulsive symptoms (β = 0.38;
p < 0.01). The relationship between dissociative experiences
and obsessional beliefs was mediated by obsessive-
compulsive symptoms (indirect β = 0.14; p < 0.01).
Mixture Analysis of the Latent Structural Model
The MSEM is an advanced statistical procedure used to iden-
tify homogenous subsets of individuals that reveal similar
characteristics on continuous variables of interest (Collins
and Lanza, 2010). Based on the previously converged struc-
tural equation model, an MSEM was performed to identify
participants who were at greater risk of developing psychopa-
thology as identified relationships between O-C symptoms
and dissociative experiences concerning cognitive
Obsessional Probabilistic Inference Scale, OBQ Obsessive Beliefs
Questionnaire, RTE Responsibility/ Threat estimation, PC
Perfectionism/ Certainty, ICT Importance / Control of thoughts, PI-R
Padua Inventory – Revised, DES Dissociative Experiences Scale, Abs /
ImInv Absorption / Imaginative involvement, Dep/ Der
Depersonalization / Derealization
vulnerability factors including meta-cognition, probabilistic
inferences, and obsessive beliefs. The MSEM was carried
out with 2 to 3 latent profiles, and BIC was utilized to deter-
mine the optimal number of latent profiles, with lower values
indicating more parsimonious models. The entropy index in-
dicates the accuracy of the classification of respondents, with
higher values suggesting a more accurate classification of the
participants. Using the model fit criteria, we identified that
two-class solution (BIC = 32,320.869; entropy = 0.876) was
preferential relative to three-class solution (BIC =
32,342.383; entropy = 0.810).
ANCOVAs between Latent Profiles
Lower levels of psychopathology characterized individuals
allocated into the first latent profile (normal group) using the
MSEM as they generally scored low on all dimensions of
either dissociation or obsessive-compulsive symptoms and
by less endorsement of cognitive vulnerability factors, i.e.,
obsessive beliefs, meta-cognitions and a tendency to negative
probabilistic inferences (n = 182, 79.13%). On the other hand,
after controlling for age and sex, individuals belonging to
second latent profile (psychopathology group; n = 48,
20.87%) reported considerably higher scores on the subscales
of the DES and PI-R, as well as on the OPIS, and all dimen-
sions of the OBQ and MCQ compared to individuals belong-
ing to normal latent profile. The main feature of these non-
 Curr Psychol

clinical individuals classified in the latent psychopathology
profile was a tendency to dissociate with high eta squared
values (η2 > 0.44) accompanied by considerable levels of
obsessive-compulsive symptoms (η2 > 0.11 for the PI-R to-
tal). ANCOVAs showed that psychopathology group reported
significantly higher scores on all measures of meta-cognitions,
obsessive-beliefs, and probabilistic inferences. ANCOVA re-
sults are presented in Table 1.
Discussion
There has been a growing literature indicating significant as-
sociations between dissociation and obsessive-compulsive
symptoms (Boysan et al. 2018; Soffer-Dudek et al. 2015;
Soffer-Dudek and Somer 2018). Cognitive vulnerability fac-
tors such as meta-cognitions, obsessional beliefs, and proba-
bilistic inferences are thought to be substantial predisposing
factors in the development and maintenance of ‘abnormal ob-
sessions.’ If obsessions are significantly associated with a dis-
sociative tendency, cognitive determinants of OCD may argu-
ably be associated with dissociative experiences to an extent.
However, relationships between dissociative symptomatology
and cognitive risk factors of OCD have remained almost
elusive in the literature. Although research is rare on such
relationships, a clinical study conducted in a sample of 75
OCD patients showed that imaginative, schizotypal, and dis-
sociative processes were significantly linked to each other,
and dissociative experiences were the most prominent phe-
nomena among patients who had more complicated clinical
manifestation of O-C symptoms. Intriguingly, correlations be-
tween dissociation and subscales of the OBQ were not signif-
icant (ranging from 0.09 to 0.21) among this clinical group
(Paradisis et al. 2015). However, Boysan et al. (2018) identi-
fied a significant relationship between dissociation as indexed
by the DES and obsessive beliefs as measured by the OBQ-44
after controlling for age, sex, and obsessional dissociation as
measured by the Van Obsessional Dissociation Questionnaire
among volunteers from the general population. In further stud-
ies, robust associations between dissociative experiences and
metacognitions were found among earthquake survivor ado-
lescents (Kadak et al. 2013), adult OCD patients (Selvi et al.
2012), and in a sample of clinical and nonclinical individuals
(Perona-Garcelan et al. 2012).
In the current study, using the latent structural equation
modeling approach, we identified that obsessional probabilis-
tic inferences were significantly associated with both dissoci-
ation and obsessive-compulsive symptoms. According to the

Table 1 One-way analysis of covariance of psychological variables between latent profiles ‡

Normal group n = 182, 79.13% Psychopathology group n = 48, 20.87%

Mean SD Mean SD F (1, 226) P η2

Padua Inventory-Revised 50.68 25.67 74.67 33.40 27.659 <0.001 0.109

Impulses 6.13 4.72 12.04 7.51 42.294 <0.001 0.158
Washing 15.14 8.57 19.63 11.01 8.896 0.003 0.038
Checking 10.59 6.80 14.73 8.31 11.298 0.001 0.048
Rumination 13.14 7.48 19.48 9.65 23.388 <0.001 0.094
Precision 5.69 4.79 8.79 5.76 13.472 <0.001 0.056
Dissociative Experiences Scale 16.34 9.53 49.13 12.20 383.913 <0.001 0.629
Absorption/imaginative involvement 22.55 12.89 52.34 15.64 179.043 <0.001 0.442
Amnesia 10.86 9.73 43.13 15.83 300.759 <0.001 0.571
Depersonalization/derealization 13.06 10.08 50.76 13.79 439.955 <0.001 0.661
Meta-Cognitions Questionnaire 69.23 13.26 77.00 12.97 14.380 <0.001 0.060
Positive beliefs 12.39 3.94 13.83 4.22 6.901 0.009 0.030
Uncontrollability and danger 14.21 3.55 16.21 3.83 10.928 0.001 0.046
Cognitive confidence 12.58 3.66 14.27 4.11 8.021 0.005 0.034
Need to control thoughts 13.97 4.05 15.42 3.77 5.593 0.019 0.024
Cognitive self-consciousness 16.07 3.51 17.27 3.29 4.673 0.032 0.020
Obsessive Beliefs Questionnaire-44 154.92 49.15 176.46 42.76 8.261 0.004 0.035
Responsibility / threat estimation 56.50 18.48 64.56 17.16 7.953 0.005 0.034
Perfectionism/ certainty 61.69 21.03 67.81 17.50 4.325 0.039 0.019
Importance/ control of thoughts 36.73 14.36 44.08 13.06 9.699 0.002 0.041
Obsessional Probabilistic Inference Scale 28.01 13.21 35.31 14.54 12.370 0.001 0.052

Significant p values are in bold. ‡ ANCOVAs was carried out after controlling for age and gender
Curr Psychol
specified and validated structural model, obsessive beliefs
contributed significantly to O-C symptoms, whereas
metacognitions were a significant predictor of obsessional in-
ferences. Moreover, metacognitions were indirectly associat-
ed with dissociative experiences via obsessional inferences.
Most importantly, metacognitions, obsessional beliefs, and
obsessional probabilistic inferences were indirectly associated
with a tendency to dissociate via obsessive-compulsive symp-
toms. In short, the specified structural model showed that mal-
adaptive cognitive styles have substantial linkages to a ten-
dency dissociate via obsessive-compulsive symptoms, proba-
bly in a reciprocal manner. These findings should be
interpreted with caution that the directions of causality cannot
be determined from the current data.
The results of this study showed that it was possible to iden-
tify a latent profile of psychopathology based on the structural
relations between metacognitions, dysfunctional beliefs, an in-
clination to overestimate probabilities of negative expectations
(or probabilistic inferences), obsessive-compulsive symptoms
and dissociative experiences. A high dissociative tendency on
all aspects of the DES subscales accompanied by considerable
levels of obsessive-compulsive symptoms was the hallmark for
individuals classified into the psychopathology group.
Participants exhibiting strong endorsement of obsession-
induced dissociation reported significantly higher levels of dys-
functional beliefs, i.e., responsibility/threat estimation,
perfectionism/certainty and importance/control of thoughts,
and metacognition, i.e., positive beliefs about worry, negative
beliefs about uncontrollability and danger, lack of cognitive
confidence, need to control thoughts, and cognitive self-con-
sciousness, as well as obsessional probabilistic inferences. The
results of the current study were all consistent with our hypoth-
eses. In keeping with fidings of a preliminary study by Boysan
et al. (2018), a tendency to dissociate in response to obsessional
thoughts, the process of which is also induced by maladaptive
cognitive appraisals, seems to play a central role in ‘abnormal
obsessions’. Further research is needed to identify more features
of obsessive-dissociative psychopathology, as indicated in the
latent psychopathology profile in the current data.
This study has several limitations. First, the present inves-
tigation was conducted in a sample of nonclinical college
students, posing issues of generalization. Future studies test-
ing these hypotheses are needed to develop a more sophisti-
cated understanding of a dissociative tendency in relation to
obsessions and their underlying mechanisms. Second, the
study was based entirely on self-report measures of variables
of interest rather than clinical interviews, raising questions on
its validity due to the subjectivity of self-administered appli-
cations. Third, in an exploration of the associations between
dissociative experiences and O-C symptoms concerning cog-
nitive vulnerability, we did not assess and control for anxiety
and depression, which are highly related to dissociation and
obsessionality (Boysan et al. 2009). Forth, indicators of meta-
cognitions were relatively low tentatively due to that the data
were collected from a non-clinical sample. Our findings
should be warranted in patient groups with OCD spectrum
disorders. Finally, the study had a cross-sectional design that
a prospective-longitudinal design investigation could have en-
abled drawing conclusions on causality issues.
Funding information The authors declare that any institution or organi-
zation did not financially support the current study.
Compliance with Ethical Standards
Conflict of Interest The authors declare no conflict of interest.
Ethical Approval All procedures performed in studies involving human
participants were under the ethical standards of the institutional or nation-
al research committee or both and with the 1964 Helsinki declaration and
its later amendments or comparable ethical standards.
Informed Consent Informed consent was obtained from all individual
participants included in the study.
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