Relational and Personal Consequences of ROCD
Research has shown that OCD can carry negative consequences for relational functioning (e.g., Angst et al., 2004). For example, the continuous pressure that people with OCD exert on their relationship partners to participate in compulsive rituals has been found to be a source of relational tension and conflict and to impair relationship quality (Koran, 2000). Accordingly, partner’s accommodation to OCD symptoms (e.g., taking part in rituals or in avoidance of anxiety-provoking situations) has also been linked with symptom severity, treatment outcomes, and lower relationship satisfaction of the individual with OCD (Beoding et al., 2013). Furthermore, OCD severity has been associated with decreased family, work, and social functioning (Ruscio, Stein, Chiu, & Kessler, 2010), higher caregiver burden and distress (Ramos-Cerqueira, Torres, Torresan, Negreiros, & Vitorino, 2008; Vikas, Avasthi, & Sharan, 2011) and increased marital distress (Emmelkamp, de Haan, & Hoogduin, 1990; Rasmussen & Eisen, 1992; Riggs, Hiss, & Foa, 1992). Only recently, research has begun to explore the contribution of ROCD symptoms to poor relational and personal outcomes.
ROCD and relationship satisfaction.
ROCD symptoms may be particularly detrimental to intimate relationships. Similar to common OCD symptoms, ROCD symptoms may bring about negative responses from the relationship partner and be a source of relationship conflict. This may be even more prominent in ROCD, because the focus of the preoccupation is the relationship itself or the relationship partner. Constant relational conflict may seriously undermine relationship satisfaction and endanger the relationship’s stability (Amato, 2000).
Yet, ROCD symptoms may impact relationship satisfaction in additional ways. Repeatedly doubting one’s relationship or relationship partner may seriously undermine core relationship processes and directly destabilize the relationship. For instance, positive ideals about one’s relationship and romantic partner were identified as beneficial cognitive biases of individuals in successful romantic relationships (e.g., Fletcher, Simpson, & Thomas, 2000; Overall, Fletcher, & Simpson, 2006). Idealized relationship and partner perceptions have been linked to positive relational outcomes ,such as greater satisfaction, less conflict, and more stable relationships (e.g., Barelds & Dijkstra, 2011; Murray et al., 2011; Murray et al., 1996; Rusbult et al., 2000), whereas the fading of such idealized perceptions has been linked to relationship breakup (Caughlin & Huston, 2006). Individuals with ROCD are likely to find it difficult to maintain idealized relationship and partner perceptions, or even positive ones, in the face of repeated intrusions, and are hence more likely to experience poor relationship satisfaction.
Two studies conducted in nonclinical samples have found the expected relationship between ROCD symptoms and poor relationship satisfaction. In one study, relationship-centered OC symptoms, as measured by the ROCI, were significantly associated with relationship dissatisfaction, even when controlling for common OCD symptoms, mood symptoms, low self-esteem, attachment anxiety and avoidance, and relationship ambivalence (Doron, Derby et al, 2012a). This finding was replicated in a subsequent study with similar controls (Doron, Derby et al, 2012b). Partner-focused OC symptoms, as measured by the PROCSI, were also found to be significantly associated with relationship dissatisfaction, even when controlling for relationship-centered symptoms in addition to all the other controls mentioned above. In fact, both partner-focused and relationship-centered OC symptoms had their own unique statistical contribution to relationship dissatisfaction, suggesting somewhat divergent causal paths (Doron, Derby et al, 2012b). It should be noted, however, that the relationship between relationship satisfaction and ROCD is likely to be bidirectional. That is, poor relationship satisfaction rooted in other factors may promote relationship-centered and partner-focused doubts, just like endogenous relationship-centered and partner-focused doubts may promote poor relationship satisfaction.
ROCD and well-being.
ROCD symptoms may lead to extreme distress, anxiety, and disability. Clients frequently report feelings of shame and guilt about their doubts and preoccupations. These feelings encourage self-criticism and may lower psychological well-being. In addition, neutralizing behaviors involved in ROCD are experienced as uncontrollable and irrational, thereby promoting negative self-perceptions. The time and energy dedicated to preoccupations with a relationship often comes at the expense of work and academic functioning. Indeed, individuals with ROCD report distress due to their symptoms, the related disability stemming for these symptoms, and the anguish they believe they are causing close others.
Recent findings from studies conducted in non-clinical samples support such client reports. In one study, relationship-centered OC symptoms, as measured by the ROCI, were significantly associated with depression, even when controlling for common OCD symptoms, relationship ambivalence, attachment anxiety and avoidance, and low self-esteem (Doron, Derby et al, 2012a). This finding was replicated in a subsequent study, in which anxiety and stress were statistically controlled in addition to self-esteem and common OCD symptoms (Doron et al, 2012b). Doron, Derby et al. (2012b) also found that partner-focused OC symptoms, as measured by the PROCSI, were significantly associated with depression, even when relationship-centered OC symptoms were added to all the above mentioned controls. In fact, partner-focused OC symptoms were found to be more consequential to depression than relationship-centered OC symptoms. Whereas partner-focused symptoms predicted depression over and above relationship-centered symptoms, the opposite was not true.