ROCD and related constructs
We have argued that ROCD involves features that are unique to the relational domain as well as features that are common with other OCD symptoms. Yet, if ROCD is to be understood as a distinct phenomenon, it is essential to differentiate it from other related constructs. In this section, we review the conceptual and empirical links between relationship-centered OC symptoms and related constructs, such as worry and social anxiety. We also deal with the potential links between partner-focused OC phenomena and body-dysmorphic symptoms.
Relationship-centered OC symptoms and worries.
Traditionally, relationships are considered to fall within the realm of general worries (Clark, 2004). It is important, therefore, to differentiate between relationship-centered OC phenomena and worry. Clinical experience and initial empirical findings suggest that relationship-centered obsessions can be differentiated from general worries in both content and form. Relationship-centered obsessions, by definition, focus on one’s current feelings towards a partner, a partner’s feelings towards oneself, and the rightness of a current or past relationship. In contrast, worry often relates to future consequences of real situations (Clark, 2004; e.g., “what will I do if I break up with my girlfriend?”). Like other forms of obsessions, relationship-centered obsessions are experienced as more unwanted, intrusive, and unacceptable than normal worries and appear to be more strongly resisted. Clients often describe thoughts, questions, and doubts “springing up into their mind”. These intrusions are perceived as exaggerated, having slight or no realistic basis, and as contradicting a person’s strong feelings towards a partner. Relationship-centered obsessions are therefore less self-congruent, more likely to be associated with neutralizing efforts, and are perceived as less rational than worries. Furthermore, whereas worries commonly appear in verbal format, relationship-centered obsessions come in a variety of forms, including images, thoughts and urges.
There is initial empirical evidence supporting the differentiation between relationship-centred obsessions and general worries. In a recent study, Doron et al. (2013) showed only a small-size correlation (r = .21) between the ROCI and one of the most commonly used measures of general worry – the Pen State Worry Questionnaire (PSWQ; Meyer et al., 1990).
Relationship-centered OC symptoms and social anxiety.
Both relationship-centered obsessions and social anxiety may relate to individuals’ close relationships and affect interpersonal interactions. However, whereas relationship-centered obsessions concern a person’s relational appraisals, feelings, and experiences, social anxiety concern a person’s perceived functioning in interpersonal situations. For instance, a person with relationship-centered obsession is likely to be preoccupied with his/her own feelings towards a partner during or following a romantic encounter. In contrast, a person with social anxiety is more likely to fear his/her perceived incompetence in a future romantic encounter (i.e., anticipated anxiety), during the romantic encounter (am I sweating?) or following the romantic encounter (how did I look? Did I blush?). Social anxiety symptoms are more likely to include physical symptoms (e.g., blushing and sweating) than relationship-centered OC symptoms and tend to be associated with more self-congruent negative self-talk. Indeed, in a yet unpublished study with a community cohort (N = 218), the ROCI showed only a small correlation (r = .22) with social anxiety symptoms, as measured by the Social Interaction Anxiety Scale (SIAS; Mattick & Clarke, 1998).
Partner-focused OC symptoms and BDD.
Partner-focused OC symptoms are defined by marked preoccupation and neutralizing behavior concerning perceived partner’s deficits or flaws. Like in body dysmorphic disorder (BDD), partner-focused OC symptoms may focus on physical appearance (also termed BDD by Proxy, see Josephson & Hollander, 1997; Greenberg et al., 2013). BDD, however, is defined by excessive preoccupation with one’s own, rather than one’s partner’s perceived physical flaws. Furthermore, although partner-focused OC symptoms may relate to the partner’s physical features, they often relate to other characteristics, such as social qualities (e.g., sociability) or personality attributes (e.g., morality). Nonetheless, both BDD and partner-focused symptoms include hypervigilance to perceived defects or flaws and the catastrophic interpretation of the consequence of such flaws. Furthermore, aesthetic sensitivity may be common to both disorders (Lambrou, Veale, & Wilson, 2011). Therefore, moderate correlations between BDD and partner-focused OC symptoms would be expected. Consistent with these expectations, Doron, Derby et al. (2012b) have found a medium-size correlation between BDD symptoms and the PROCSI total score (r = .39). Furthermore, besides the ROCI score, BDD symptoms were the only significant predictor of changes in PROCSI scores in a one month follow-up analysis. Importantly, BDD symptoms did not show a stronger correlation with the PROCSI appearance subscale (r=.32) than with the other PROCSI subscales, supporting a more generalized underlying common predisposition (Doron, Derby et al., 2012b).