Assessment of sense of agency in obsessive-compulsive disorder using a virtual reality stove-checking paradigm

Obsessive-compulsive disorder (OCD) has previously been linked to a lower sense of agency (SoA), i.e. the sense of being the initiator and executor of one's own actions. Beyond that, not just right experiences and feelings of incompleteness have been discussed as relevant aspects in the perpetuation of compulsions. In the present study, we examined SoA in OCD using a symptom-provoking virtual reality (VR) task. Twenty individuals with OCD and 23 healthy controls had to turn off a virtual stove using an embodiable virtual hand under four experimental conditions. These conditions differed with respect to whether the virtual hand accurately reflected the participant's real hand movements or was visually manipulated, and whether the stove actually turned off or remained on. Subjective ratings of SoA, certainty and anxiety were recorded. Furthermore, repeated checking was assessed in a second block. Across conditions, individuals with OCD exhibited a significantly lower SoA, which was also more sensitive to experimental manipulation. Moreover, a lower SoA was significantly associated with increased levels of incompleteness and inflated responsibility attitudes. Our findings suggest that incompleteness, inflated responsibility and a lower SoA may mutually reinforce each other in a vicious cycle, contributing to the maintenance and exacerbation of OCD symptoms.