OCD is a debilitating disorder with a wide variety of obsessional themes. While some OCD themes have been the subject of intense investigations leading to significant theoretical and clinical advancements, research on relationship-related obsessive-compulsive phenomena has only recently begun. In this paper, we presented relationship obsessive-compulsive disorder (ROCD), defined its main features, and described its phenomenology. Measures of ROCD symptom severity were presented and their associations with other OCD themes discussed.
Drawing on recent cognitive-behavioral models of OCD, social psychology and attachment research, we discussed the role of OCD-related beliefs, processes related to dysfunctional monitoring of internal states, and perceptions of relational commitment in the development and maintenance of ROCD. We then implicated pre-existing self-vulnerabilities and attachment insecurities in the exacerbation of common relationship worries into obsessions and evaluated the potential role of personality factors, societal influences, parenting, and family environments in the etiology and preservation of ROCD symptoms. The relational and personal impact of ROCD symptoms and the reciprocal associations between relationship-centered and partner-focused OC symptoms were also discussed. Finally, we reviewed the conceptual and empirical links between ROCD symptoms and related constructs and suggested theoretically driven assessment and interventions procedures.
Although consistent with our theoretical model, this new body of research has several limitations. Many of the proposed factors hypothesized to be involved in ROCD are yet to be empirically evaluated. Furthermore, many studies have been conducted with non-clinical samples. Although non-clinical individuals experience OCD-related beliefs and symptoms, they may differ from clinical patients in the type and severity of symptoms and the resulting degree of impairment. Future ROCD research should include clinical samples. Examining different clinical groups would facilitate the identification of both general and specific factors associated with ROCD symptoms. Laboratory and longitudinal studies should further examine the hypothesized causal and correlational relationships proposed in this paper.
This conceptual framework has focused on a relatively new area of OCD related research. Our aim is to enhance our understanding of OCD phenomena by drawing attention to what we believe is an important OCD theme – relationships. We also identified possible factors that may lead to the development of ROCD. This, we hope, will enable a better understanding of the etiology of ROCD, its development, treatment, and even prevention.
Aardema, F., & O’Connor, K. (2007). The menace within: obsessions and the self. Journal of Cognitive Psychotherapy, 21, 182–197.
Aardema. F, Moulding. R, Radomsky. A. S, Doron. G, Allamby. J. (in press). Fear of Self and Obsessionality: Development and Validation of the Fear of Self Questionnaire. Journal of Obsessive- Compulsive and Related Disorders.
Abramowitz, J. S., McKay, D., & Taylor, S. (2008). Obsessive-compulsive disorder: Subtypes and spectrum conditions. Amsterdam: Elsevier.
Adams, J. M., & Jones, W. H. (1997). The conceptualization of marital commitment: An integrative analysis. Journal of personality and social psychology, 72(5), 1177- 1196.
Amato, P. R. (2000). The consequences of divorce for adults and children. Journal of marriage and family, 62(4), 1269-1287.
Amato, P. R. (2001). Children of divorce in the 1990s: an update of the Amato and Keith (1991) meta-analysis. Journal of family psychology, 15(3), 355.
Amato, P. R., Loomis, L. S., & Booth, A. (1995). Parental divorce, marital conflict, and offspring well-being during early adulthood. Social Forces, 73(3), 895-915.
Angst, J., Gamma, A., Endrass, J., Goodwin, R., Ajdacic, V., Eich, D., & Rössler, W. (2004). Obsessive-compulsive severity spectrum in the community: prevalence, comorbidity, and course. European archives of psychiatry and clinical neuroscience, 254(3), 156-164.
Barelds, D. P. H., & Dijkstra, P. (2011). Positive illusions about a partner’s personality and relationship quality. Journal of Research in Personality, 45, 37–43.
Boeding, S. E., Paprocki, C. M., Baucom, D. H., Abramowitz, J. S., Wheaton, M. G., Fabricant, L. E., & Fischer, M. S. (2013). Let Me Check That for You: Symptom Accommodation in Romantic Partners of Adults with Obsessive-Compulsive Disorder. Behaviour research and therapy, 51, 316-322.
Bhar, S., & Kyrios, M. (2007). An investigation of self-ambivalence in obsessive-compulsive disorder. Behaviour Research and Therapy, 45, 1845–1857.
Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger. New York: Basic Books.
Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment (2nd ed.). New York: Basic Books. (Original ed. 1969)
Brennan, K. A., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult attachment. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 46-76). New York: Guilford Press.
Caughlin, J. P., & Huston, T. L. (2006). The affective structure of marriage. In A. L. Vangelisti & D. Perlman (Eds.), The Cambridge handbook of personal relationships (pp. 131–156). New York: Cambridge University Press.
Clark, D. A., & Purdon, C. (1993). New perspectives for a cognitive theory of obsessions. Australian Psychologist, 28, 161–167.
Dar-Nimrod, I., Rawn, C. D., Lehman, D. R., & Schwartz, B. (2009). The maximization paradox: The costs of seeking alternatives. Personality and Individual Differences, 46(5), 631-635.
Doron, G., Derby, D., Szepsenwol. O., & Talmor. D. (2012a). Tainted Love: Exploring relationship-centered obsessive compulsive symptoms in two non-clinical cohorts. Journal of Obsessive-Compulsive and Related Disorders, 1, 16-24.
Doron, G., Derby, D., Szepsenwol. O., & Talmor. D. (2012b). Flaws and All: Exploring Partner-Focused Obsessive-Compulsive Symptoms. Journal of Obsessive-Compulsive and Related Disorders, 1, 234-243.
Doron, G., Szepsenwol, O., Derby, D., & Nahaloni, E. (2012). Relationship-related obsessive-compulsive phenomena: The case of relationship-centered and partner-focused obsessive compulsive symptoms. Psicoterapia Cognitiva e Comportamentale, 18(3).
Doron, G., & Kyrios, M. (2005). Obsessive compulsive disorder: A review of possible specific internal representations within a broader cognitive theory. Clinical Psychology Review, 25, 415-432.
Doron, G., & Moulding, R. (2009). Cognitive behavioral treatment of obsessive compulsive disorder: A broader framework. The Israel journal of psychiatry and related sciences, 46, 257-263.
Doron, G., Moulding, R., Kyrios, M., Nedeljkovic, M., & Mikulincer, M. (2009). Adult attachment insecurities are related to obsessive compulsive phenomena. Journal of Social and Clinical Psychology, 28, 1022-1049.
Doron, G., Sar-El, D., & Mikulincer, M. (2012). Threats to moral self-perceptions trigger obsessive compulsive contamination-related behavioral tendencies. Journal of Behavior Therapy and Experimental Psychiatry, 43, 884-890.
Doron, G., Szepsenwol. O., Karp. E., & Gal. N. (2013). Obsessing about intimate-relationships: Testing the double relationship-vulnerability hypothesis. Journal of Behavior Therapy and Experimental Psychiatry 44, 433-440.
Duran-Aydintug, C. (1997). Adult children of divorce revisited: When they speak up. Journal of Divorce & Remarriage, 27, 71-83.
Emmelkamp, P. M., De Haan, E., & Hoogduin, C. A. (1990). Marital adjustment and obsessive-compulsive disorder. The British Journal of Psychiatry, 156(1), 55-60.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (2012). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinician Version, Administration Booklet. American Psychiatric Pub.
Fletcher, G. J. O., Simpson, J. A., & Thomas, G. (2000). Ideals, perceptions, and evaluations in early relationship development. Journal of Personality and Social Psychology, 79, 933-940.
García-Soriano, G., Clark, D. A., Belloch, A., del Palacio, A., & Castañeiras, C. (2012). Self-worth contingencies and obsessionality: A promising approach to vulnerability? Journal of Obsessive-Compulsive and Related Disorders, 1, 196–202.
Hanson, T. L. (1999). Does parental conflict explain why divorce is negatively associated with child welfare? Social Forces, 77, 1283-1316.
Haslam, N., Williams, B. J., Kyrios, M., McKay, D., & Taylor, S. (2005). Subtyping obsessive- compulsive disorder: A taxometric analysis. Behavior Therapy, 36, 381-391.
Hendrick, S. S., & Hendrick, C. (1992). Romantic love. Newbury Park, CA: Sage.
Hewitt, P., & Flett, G. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470.
Iyengar, S., Wells, R., & Schwartz, B. (2006). Doing better but feeling worse: Looking for the ‘best’ job undermines satisfaction. Psychological Science, 17, 143–150.
Jekielek, S. M. (1998). Parental conflict, marital disruption and children’s emotional well-being. Social Forces, 76(3), 905-936.
Koran, L. M. (2000). Quality of life in obsessive-compulsive disorder. Psychiatric Clinics of North America, 23(3), 509–517.
Lambrou, C., Veale, D., & Wilson, G. (2011). The role of aesthetic sensitivity in body dysmorphic disorder. Journal of abnormal psychology, 120, 443.
Lazarov, A., Dar, R., Oded, Y., & Liberman, N. (2010). Are obsessive–compulsive tendencies related to reliance on external proxies for internal states? Evidence from biofeedback-aided relaxation studies. Behaviour research and therapy, 48(6), 516-523.
Lazarov, A., Dar, R., Liberman, N., & Oded, Y. (2012). Obsessive-compulsive tendencies and undermined confidence are related to reliance on proxies for internal states in a false feedback paradigm. Journal of behavior therapy and experimental psychiatry, 43(1), 556-564.
Liberman, N., & Dar, R. (2009). Normal and pathological consequences of encountering difficulties in monitoring progress toward goals. In G. Moskowitz, & H. Grant (Eds.), The psychology of goals (pp. 277-303). New York: Guilford Press.
Lydon, J. E. (2010). How to forego forbidden fruit: The regulation of attractive alternatives as a commitment mechanism. Social and Personality Psychology Compass, 4(8), 635-644.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487-495.
Mikulincer, M., & Shaver, P. R. (2003). The attachment behavioral system in adulthood: Activation, psychodynamics, and interpersonal processes. In M. P. Zanna (Ed.), Advances in experimental social psychology (Vol. 35, pp. 53-152). New York: Academic Press.
Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York: Guilford Press.
Montgomery, S. A., Kasper, S., Stein, D. J., Hedegaard, K. B., & Lemming, O. M. (2001). Citalopram 20 mg, 40 mg and 60 mg are all effective and well tolerated compared with placebo in obsessive-compulsive disorder. International clinical psychopharmacology, 16, 75-86.
Moulding, R., Anglim, J., Nedeljkovic, M., Doron, G., Kyrios, M., & Ayalon, A. (2011). The Obsessive Beliefs Questionnaire (OBQ): Examination in non-clinical samples and development of a short version, Assessment, 18, 357-374.
Murray, S. L., Griffin, D. W., Derrick, J. L., Harris, B., Aloni, M., & Leder, S. (2011). Tempting fate or inviting happiness? Unrealistic idealization prevents the decline of marital satisfaction. Psychological Science, 22, 619-626.
Murray, S. L., Holmes, J. G., & Griffin, D. W. (1996). The self-fulfilling nature of positive illusions in romantic relationships: Love is not blind, but prescient. Journal of Personality and Social Psychology, 71, 1155–1180.
Obsessive Compulsive Cognitions Working Group (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667-681.
Obsessive Compulsive Cognitions Working Group (2005). Psychometric validation of the Obsessive Beliefs Questionnaire: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527-1542.
Olatunji, B. O., Williams, B. J., Haslam, N., Abramowitz, J. S., & Tolin, D. F. (2008). The latent structure of obsessive‐compulsive symptoms: a taxometric study. Depression and Anxiety, 25(11), 956-968.
Overall, N. C., Fletcher, G. J. O., & Simpson, J. A. (2006). Regulation processes in intimate relationships: The role of ideal standards. Journal of Personality and Social Psychology, 91, 662–685. doi: 10.1037/0022-35184.108.40.2062
Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793-802.
Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16, 233-248.
Ramos‐Cerqueira, A. T. D. A., Torres, A. R., Torresan, R. C., Negreiros, A. P. M., & Vitorino, C. N. (2008). Emotional burden in caregivers of patients with obsessive‐compulsive disorder. Depression and anxiety, 25, 1020-1027.
Rasmussen, S. A., & Eisen, J. L. (1992). The epidemiology and clinical features of obsessive compulsive disorder. Psychiatric Clinics of North America, 15, 743-758.
Riggs, D. S., Hiss, H., & Foa, E. B. (1992). Marital distress and the treatment of obsessive compulsive disorder. Behavior Therapy, 23(4), 585-597.
Rusbult, C. E., Van Lange, P. A. M., Wildschut, T., Yovetich, N. A., & Verette, J. (2000). Perceived superiority in close relationships: Why it exists and persists. Journal of Personality and Social Psychology, 79, 521–545.
Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2008). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15(1), 53-63.
Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571-583.
Schwartz, B., Ward, A., Monterosso, J., Lyubomirsky, S., White, K., & Lehman, D. R. (2002). Maximizing versus satisficing: Happiness is a matter of choice. Journal of personality and social psychology, 83(5), 1178-1197.
Shapira, O., Gundar-Goshen, A., Liberman, N., & Dar, R. (2013). An ironic effect of monitoring closeness. Cognition & Emotion, (ahead-of-print), 1-9. DOI:10.1080/02699931.2013.794771.
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E et al., (1998). The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of clinical psychiatry, 59, 22-33.
Simon, H. A. (1956). Rational choice and the structure of the environment. Psychological Review, 63, 129–138.
Sparks, E. A., Ehrlinger, J., & Eibach, R. P. (2012). Failing to commit: Maximizers avoid commitment in a way that contributes to reduced satisfaction. Personality and Individual Differences, 52(1), 72-77.
Storch, E. A., Abramowitz, J. S., & Goodman, W. K. (2008). Where does obsessive compulsive disorder belong in DSM-V?. Depression and Anxiety, 25, 226–247.
Szepsenwol, O. Doron, G., &, Shahar, B. (2013). Letting it linger: Exploring the longitudinal effects of relationship-related obsessive-compulsive phenomena. Submitted for publication.
Tversky, A. & Shafir, E. (1992). Choice under conflict: The dynamics of deferred decision. Psychological Science, 3, 358-361.
Veale, D. (2004). Advances in a cognitive behavioural model of body dysmorphic disorder. Body Image, 1, 113–125.
Vikas, A., Avasthi, A., & Sharan, P. (2011). Psychosocial impact of obsessive-compulsive disorder on patients and their caregivers: A comparative study with depressive disorder. International Journal of Social Psychiatry, 57(1), 45-56.
Wilhelm, S., Buhlmann, U., Cook, L. C., Greenberg, J. L., & Dimaite, R. (2010). A cognitive–behavioral treatment approach for body dysmorphic disorder. Cognitive and Behavioral Practice, 17, 241–247.
Wihlem, S., & Neziroglu, F. (2002). Cognitive theory of body dysmorphic disorder. In: R. O. Frost, & G. Steketee G (Eds.), Cognitive approaches to obsessions and compulsions: Theory, assessment and treatment (pp. 203–214). Oxford: Elsevier Press.
Wu, P. L., & Chiou, W. B. (2009). More options lead to more searching and worse choices in finding partners for romantic relationships online: An experimental study. CyberPsychology & Behavior, 12, 315-318.
Yang, M. L., & Chiou, W. B. (2010). Looking online for the best romantic partner reduces decision quality: The moderating role of choice-making strategies. Cyberpsychology, Behavior, and Social Networking, 13(2), 207-210.
Zeelenberg, M. (1999). Anticipated regret, expected feedback and behavioral decision making. Journal of behavioral decision making, 12(2), 93-106.