For more information about ROCD press HERE.
From our paper entitled:"Relationship obsessive compulsive disorder (ROCD): A conceptual framework"
David, a 32-year-old man, enters my office and describes his problem: “I’ve been in a relationship for a year, but I can’t stop thinking about whether this is the right relationship for me. I see other woman on the street or on Facebook and I can’t stop thinking whether I will be happier with them? Whether I will feel more in love with them? I ask my friends what they think. I check what I feel for her all the time. I know I love my partner, but I have to check and recheck”. Jane, a 28 year-old woman, in a 2-year relationship, describes a different preoccupation: “I love my partner, I know I can’t live without him, but I can’t stop thinking he does not have the right body proportions. I know I love him, and I know these thoughts are not rational, he looks good. I hate myself for having these thoughts, I don’t think looks are all that important, but I just can’t get it out of my head. These thoughts just jump into my mind all the time. I can’t handle this anymore. It depresses me and ruins our relationship. I look at other men, I am attracted to other men, so I feel I can’t marry him like this. Why do I always have to compare his looks to other men’s?”.
David and Jane suffer from what is commonly referred to as Relationship Obsessive Compulsive Disorder (ROCD) — obsessive-compulsive symptoms that focus on intimate relationships. Obsessive Compulsive Disorder (OCD) is an incapacitating disorder with a wide variety of obsessional themes including contamination fears, fear of harm to self or others, and scrupulosity (Abramowitz, McKay & Taylor, 2008). Relationship Obsessive Compulsive Disorder (ROCD) refers to an increasingly researched obsessional theme – romantic relationships. ROCD often involves preoccupation, doubts, and neutralizing behaviors centered on one’s feelings towards a relationship partner, the partner’s feelings towards oneself, and the “rightness” of the relationship experience (relationship-centered; Doron, Derby, Szepsenwol, & Talmor, 2012a). Relationship-related OC phenomena may also include disabling preoccupation with the perceived flaws of one’s relationship partner (partner-focused; Doron, Derby, Szepsenwol, & Talmor, 2012b).
This paper outlines a theory of ROCD and reviews recent findings. We argue that consideration of this obsessional theme may lead to a broader understanding of the development and maintenance of OCD, especially within a relational context. Although relationship-related obsessive-compulsive symptoms may occur in various types of relationships including people’s relationship with their parents, children, mentors, or even their God, in this paper we will refer to ROCD within the context of romantic relationships. Consistent with prior OCD-related theoretical work (e.g. Doron & Kyrios, 2005; Rachman, 1997; OCCWG, 1997), we propose several processes involved in the development and maintenance of ROCD and review initial evidence for their role in relationship obsessive-compulsive phenomena. We also argue that early childhood environments, and specifically parent-child relationships, influence the development of dysfunctional cognitive biases, self-perceptions, and attachment representations relevant to ROCD. Thus, this paper aims to extend the focus of current OCD research by exploring potential distal and proximal vulnerability factors that might contribute to the development and maintenance of ROCD-related dysfunctional beliefs and symptoms.
ROCD is manifested in obsessive doubts and preoccupations regarding romantic relationships and compulsive behaviors performed in order to alleviate the distress associated with the presence and/or content of the obsessions. Relationship obsessions often come in the form of thoughts (e.g., “is he the right one?”) and images of the relationship partner, but can also occur in the form of urges (e.g., to leave one’s current partner). Compulsive behaviors in ROCD include, but are not limited to, repeated checking of one’s own feelings and thoughts toward the partner or the relationship, comparing partner’s characteristics or behaviors to others’, reassurance seeking, and self-reassurance. Relationship-related intrusions are often ego-dystonic as they contradict the individual’s subjective experience of the relationship (e.g., “I love her, but I can’t stop questioning my feelings”) or his or her personal values (e.g., “appearance should not be important in selecting a relationship partner”). Such intrusions are perceived as unacceptable and unwanted, and often bring about feelings of guilt and shame regarding their occurrence and/or content. For instance, individuals may feel shame about having critical thoughts about their partner’s intelligence, looks, or social competencies. Guilt and shame may also be associated with neutralizing behaviors, such as comparing one’s partner with other potential partners.
The age of onset of ROCD is unknown. In our clinic, clients presenting with ROCD often report the onset of symptoms in early adulthood. In such cases, ROCD symptoms seem to persist throughout the individuals’ history of romantic relationships. Some individuals, however, trace back the onset of their ROCD symptoms to the first time they faced commitment-related romantic decisions (e.g., getting married, having children). Although ROCD symptoms can occur outside of an ongoing romantic relationship (e.g., obsessing about past or future relationships), such symptoms seem to be most distressing and debilitating when experienced in the course of an ongoing romantic relationship.
The dyadic context provides abundant triggers of relationship-centered and partner-focused OC phenomena. Nevertheless, for some individuals, ROCD symptoms may be activated by the termination of a romantic relationship. In this case, people may report being obsessively preoccupied with their previous partner “being the right one” and “missing the ONE”. Such cases are frequently associated with extreme fear of anticipated regret and are commonly accompanied by self-reassuring behaviors (e.g., recalling the reasons for relationship termination), compulsive comparisons (i.e., with current partners), and compulsive recollection of previous experiences (e.g., relationship conflicts). Other people report avoiding romantic relationships altogether for dread of hurting others (e.g., “I will drive her crazy”; “It will be a lie”) or fear of re-experiencing ROCD symptoms. For instance, clients may report avoiding second dates for years for fear of obsessing about the flaws of their partners or their partners becoming overly attached to them.
To continue reading from this paper press HERE
********************
Doron et al., (2012a, 2012b) described two main types of obsessive-compulsive symptoms focusing on intimate relationships: Relationship-Centered Obsessive-Compulsive Symptom including obsessive doubts, preoccupation, checking, and reassurance seeking behaviors on three relational dimensions; feelings towards one’s partner (e.g., "I continuously reassess whether I really love my partner“; ), one’s perception of partner's feelings (e.g., "I continuously doubt my partner's love for me“( and one’s appraisal of the "rightness" of the relationship (e.g., "I check and recheck whether my relationship feels right“). Partner-Focused Obsessive-Compulsive Symptom include preoccupation, checking, and reassurance seeking behaviors relating to one's partner's perceived flaws in six domains; physical appearance, sociability, morality, emotional stability, intelligence and competence.
Relationship-Centered Obsessive-Compulsive Symptoms (ROCD Type I)
Previous research has indicated that, compared with the general population, OCD patients often report disturbances in relationship functioning, including lower likelihood of marrying and increased marital distress (Emmelkamp, de Haan, & Hoogduin, 1990; Rasmussen & Eisen, 1992; Riggs, Hiss, & Foa, 1992). Recently, Doron et al. (2012) proposed that OC phenomena affect intimate relationships more directly when the main focus of the symptoms is the relationship itself. Doron et al. (2012) conducted two independent studies using community cohorts to assess relationship-centered OC phenomena and its links with related constructs. In the first study, Doron et al. (2012) examined the factorial structure of a newly constructed self-report measure – the Relationship Obsessive-Compulsive Inventory (ROCI; see Measures page). This 12-item measure taps the severity of obsessive (e.g., preoccupation and doubts) and compulsive (e.g., checking and reassurance seeking) behaviors on three relational dimensions: one's feelings towards a relationship partner (e.g., "I continuously reassess whether I really love my partner"), the partner's feelings towards oneself (e.g., "I continuously doubt my partner's love for me"), and the "rightness" of the relationship ("I check and recheck whether my relationship feels right").
In a second study, Doron et al., (2012) replicated the factor structure of the ROCI and assessed the link between relationship-centered OC phenomena, OCD symptoms and cognitions, negative affect, low self-esteem, and relationship variables such as relationship ambivalence and attachment insecurity. Findings showed the expected positive associations between ROCI scores and these theoretically related measures. Moreover, the ROCI significantly predicted relationship dissatisfaction and depression over and above common OCD symptoms, relationship ambivalence, and other mental health and relationship insecurity measures.
Doron et al. (2012) proposed several mechanisms that may make relationship-centered OC symptoms particularly disabling. For instance, they suggested that symptoms such as repeated doubting about one's feelings towards a partner or the "rightness" of a relationship may destabilize the relational bond (e.g., "I can't trust her/him to stay with me"), increase fears of abandonment, promote relationship distress, and challenge mutual trust. In addition, continuous preoccupation with a partner's love may increase clinging and dependent behaviors resulting in maladaptive relationship dynamics (e.g., hierarchical relationships). Thus, relationship-centered OC symptoms can compromise satisfactory intimate relationships that are an important resource for individuals' resilience and wellbeing.
Partner-Focused Obsessive-Compulsive Symptoms (ROCD Type II)
Relationship-centered OC symptoms may be particularly detrimental to relationship quality. Yet, obsessive compulsive symptoms can affect relationships in additional ways. As intimate relationships progress, more attention is paid to one's partner's real or imagined faults (Hatfield & Sprecher, 1986; Sprecher & Metts, 1999). In fact, accepting that one's partner is less-than-perfect may be one of the most challenging aspects in the development of a long-term stable relationship (Murray & Holmes, 1993). It seems that forming a more balanced and realistic assessment of one's relationship partner, including their perceived flaws and deficits, is a necessary element in long-term relational involvements (Thompson & Holmes, 1996). For some individuals, however, preoccupation with the perceived deficits of their partner becomes increasingly time consuming, distressing, and a significant cause of dyadic distress (e.g., Josephson & Hollander, 1997).
Doron et al., (2012) attempted to extend previous findings on the links between OCD and close relationships by exploring an additional facet of relationship-related OC phenomena – partner-focused obsessive-compulsive symptoms. With this aim in mind, They constructed the Partner-Related Obsessive-Compulsive Inventory (PROCSI), a 24-item scale assessing the severity of OC symptoms relating to one's partner's perceived flaws in six domains: physical appearance, sociability, morality, emotional stability, intelligence and competence. The PROCSI was found to be internally consistent, had good test-retest reliability, and showed theoretically-coherent significant but moderate associations with existing measures of OCD symptoms and related cognitions, negative affect, low self-esteem, and relationship variables. Moreover, the PROCSI significantly predicted relationship dissatisfaction and depression, over and above relationship-centered OC symptoms and other mental health and relationship insecurity measures. Thus, findings indicated that the PROCSI has good validity and reliability and that it captures a distinct theoretical construct that has unique predictive value (see Measures page).
As hypothesized, moderate to high correlations were found between partner-focused OC symptoms and relationship-centered OC symptoms. These two relationship-related OC phenomena seem to be associated. Moreover, longitudinal analyses revealed a reciprocal association between the PROCSI and the ROCI, showing that both partner-focused OC symptoms at Time 1 predicted subsequent changes in relationship-centered OC symptoms, and relationship-centered OC symptoms at Time 1 predicted subsequent changes in partner-focused OC symptoms. Obsessing about partners' faults may heighten uncertainty, doubts, and preoccupation regarding the relationship itself and one's feelings towards his or her partner. These heightened relationship-centered obsessions and compulsions may, in turn, further increase one's vigilance towards his or her partner's perceived flaws.
Doron et al., findings also suggested that partner-focused OC symptoms may involve processes that are specific to this type of relationship-related OC phenomena. Specifically, the only additional significant unique predictor of the PROCSI (but not the ROCI) was a measure of dysmorphic body concerns. Hyper-attention to one's own perceived flaws in appearance and catastrophic misinterpretation of such flaws may reflect a general predisposition to detect perceived deficits and overestimate their consequences, not only in the self, but also in relationship partners. Indeed, this proposal is consistent with Josephson and Hollander's (1997) case discussions of BDD by proxy.