Right or flawed: relationship obsessions and sexual satisfaction

The Network Structure of Relationship Obsessive-Compulsive Disorder Presentations: The Interplay between ROCD Symptoms with Maladaptive and Non-Maladaptive Personality Traits

INTRODUCTION

The current study aimed to utilize a network perspective to identify the core symptoms of Relationship Obsessive-Compulsive Disorder (ROCD), encompassing both partner-focused and relationship-centered presentations. Additionally, we examined the interaction between ROCD symptoms and personality traits.

METHOD

493 participants were included in the current study. The Personality Inventory for DSM-5 - short form (PID-5-SF), NEO Five-Factor Inventory, Partner-Related Obsessive-Compulsive Symptoms Inventory (PROCSI), and Relationship Obsessive-Compulsive Inventory (ROCI) were used to estimate the network structure. Specifically, we computed network structure, bridge expected influence (BEI), and Exploratory Graph Analysis (EGA) for ROCD scales.

RESULTS

In the ROCI network, items 1 and 11 (ROCI.1: "The idea that my affection for my partner is not genuine troubles me," ROCI.7: Thoughts that something is "off" in my relationship significantly disturb me.) emerged as the most important nodes (ROCI.1: Betweenness:1.777, Closeness:1.025, Strength: .872; ROCI.11" Betweenness: 1.097, Closeness:0.457, strength:.699). Additionally, ROCI.7 stands out with significant Betweenness and Expected Influence, emphasizing its importance in facilitating communication and influencing information flow. Conversely, in the PROCI network, item 2 (PROCI.2: "I am constantly questioning whether my partner is deep and intelligent enough") was identified as the most crucial node (Betweenness: 2.568, Closeness: 2.528, Strength: 1.905). Neuroticism is highly influential in the interaction of personality traits with the ROCI scale (BEI: .3781), connecting non-maladaptive traits, while Negative affect, a maladaptive trait, has a significant impact (Bridge Value: .283).

CONCLUSION

The present study provided a detailed examination of the psychological dynamics within romantic relationships, highlighting key cognitive processes and personality trait.

Relationship Obsessive Compulsive Disorder: A Systematic Review

Obsessive Compulsive Disorder (OCD) is a disorder characterized by obsessions and compulsions and negatively affects the functionality of individuals. OCD symptoms with romantic relationship content have been investigated in the literature for the last 10 years. OCD symptoms with romantic relationship content are divided into two types: relationship-centered and partner-focused. The aim of this systematic review was to examine the relationship between OCD symptoms with romantic relationship content and individual and relational variables. Studies in the literature were reviewed in detail in order to evaluate the results regarding the relationship between OCD symptoms in romantic relationships and individual and relational factors. In the national and international literature, no systematic review study on this subject was found. Accordingly, studies published between 2012 and 2022 in internationally accepted electronic databases using the terms "relationship obsessive compulsive disorder", "relationship centered obsessive compulsive symptoms" and "partner focused obsessive compulsive symptoms" were reviewed. As a result of the search, according to the inclusion criteria, 12 empirical studies on the relationship between OCD in romantic relationships and individual and relational variables with full-text access and written in English were analyzed. The methodological characteristics and results of the 12 included studies are presented in this systematic review study. The results of the studies suggest that symptoms related to romantic relationships negatively affect the functioning of individuals similar to OCD. When the variables associated with obsessive-compulsive symptoms in romantic relationships are analyzed in individual and relational context, they are related to many factors such as psychopathologies, attachment styles, self and relationship satisfaction. In this context, there is a need for empirical studies carried out with clinical samples, exploring the effectiveness of psychotherapy and cross-cultural studies on obsessive-compulsive symptoms related to romantic relationships. Keywords:

Promoting couples' resilience to relationship obsessive compulsive disorder (ROCD) symptoms using a CBT-based mobile application: A randomized controlled trial

Relationship Obsessive Compulsive Disorder (ROCD) is a disabling form of obsessive-compulsive disorder (OCD) centering on interpersonal relationships. Previous findings suggest ROCD symptoms are particularly detrimental to romantic relationships. In this randomized controlled trial (RCT), we assessed influence a CBT-based mobile application used by both partners on resilience to ROCD symptoms, cognitions, and relationship dissatisfaction. The app consists of brief, daily exercises targeting OCD symptoms, related cognitions and attachment insecurities. Heterosexual couples (Ncouples = 103; Mage = 26.15) were randomly assigned to individually use a mobile application for 15 days (n = 49 couples) or to a control group (n = 54 couples). All participants completed questionnaires at baseline (T1), 15 days from baseline (T2), and 45 days from baseline (T3). All couples also underwent an ROCD resilience task at T2. Intention-to-treat analyses revealed that, in contrast to the control group, couples who used the app exhibited enhanced resilience in the resilience task, as well as measures of ROCD symptoms, cognitions, and relationship dissatisfaction. These observed effects persisted even at the 1-month follow-up. Concurrent use of brief mobile delivered cognitive training by both romantic partners may foster resilience in romantic couples.

Associations between pathological eating, relational attitudes and satisfaction in romantic relationships

OBJECTIVE

Women with disordered eating report low satisfaction from romantic relationships. We wished to examine whether this may be explained in part by a restricted or inflated sense of relational entitlement, pathological concern and low authenticity levels.

METHOD

A community sample of 170 women aged 18-60 (M = 24.89 + 6.22), who had experienced a meaningful romantic relationship, completed questionnaires online. These included measures of disordered eating (EDE-Q), sense of relational entitlement (SRE-R), pathological concern (PCQ), relational authenticity (AIRS) and basic relational needs satisfaction (BNSRS). Structural equation model (SEM) was employed to assess the mediating effect of the SRE-R, PCQ and AIRS on the association between ED symptoms and BNSRS.

RESULTS

Participants with high EDE-Q scores tended to score high on inflated and restricted SRE-R, PCQ, AIRS and BNSRS. SRE-R, PCQ and AIRS scores mediated the negative association between EDE-Q and BNSRS scores.

CONCLUSIONS

An imbalanced sense of relational entitlement, pathological concern and inauthenticity seem to underlie the dissatisfaction that women with disordered eating experience from romantic relationships. Since these relational characteristics seem to take a high toll on the intimate relationships, it is important to encourage healthy eating attitudes and assertiveness within romantic relationships, in life and in therapy.

LEVEL OF EVIDENCE

Level III: evidence obtained from well-designed cohort or case-control analytic studies.

Semantic Linkages of Obsessions From an International Obsessive-Compulsive Disorder Mobile App Data Set: Big Data Analytics Study

BACKGROUND

Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts, urges, or images (obsessions) and repetitive physical or mental behaviors (compulsions). Previous factor analytic and clustering studies suggest the presence of three or four subtypes of OCD symptoms. However, these studies have relied on predefined symptom checklists, which are limited in breadth and may be biased toward researchers' previous conceptualizations of OCD.

OBJECTIVE

In this study, we examine a large data set of freely reported obsession symptoms obtained from an OCD mobile app as an alternative to uncovering potential OCD subtypes. From this, we examine data-driven clusters of obsessions based on their latent semantic relationships in the English language using word embeddings.

METHODS

We extracted free-text entry words describing obsessions in a large sample of users of a mobile app, NOCD. Semantic vector space modeling was applied using the Global Vectors for Word Representation algorithm. A domain-specific extension, Mittens, was also applied to enhance the corpus with OCD-specific words. The resulting representations provided linear substructures of the word vector in a 100-dimensional space. We applied principal component analysis to the 100-dimensional vector representation of the most frequent words, followed by k-means clustering to obtain clusters of related words.

RESULTS

We obtained 7001 unique words representing obsessions from 25,369 individuals. Heuristics for determining the optimal number of clusters pointed to a three-cluster solution for grouping subtypes of OCD. The first had themes relating to relationship and just-right; the second had themes relating to doubt and checking; and the third had themes relating to contamination, somatic, physical harm, and sexual harm. All three clusters showed close semantic relationships with each other in the central area of convergence, with themes relating to harm. An equal-sized split-sample analysis across individuals and a split-sample analysis over time both showed overall stable cluster solutions. Words in the third cluster were the most frequently occurring words, followed by words in the first cluster.

CONCLUSIONS

The clustering of naturally acquired obsessional words resulted in three major groupings of semantic themes, which partially overlapped with predefined checklists from previous studies. Furthermore, the closeness of the overall embedded relationships across clusters and their central convergence on harm suggests that, at least at the level of self-reported obsessional thoughts, most obsessions have close semantic relationships. Harm to self or others may be an underlying organizing theme across many obsessions. Notably, relationship-themed words, not previously included in factor-analytic studies, clustered with just-right words. These novel insights have potential implications for understanding how an apparent multitude of obsessional symptoms are connected by underlying themes. This observation could aid exposure-based treatment approaches and could be used as a conceptual framework for future research.

Initial Evidence for Symptoms of Postpartum Parent-Infant Relationship Obsessive Compulsive Disorder (PI-ROCD) and Associated Risk for Perturbed Maternal Behavior and Infant Social Disengagement From Mother

Infant socioemotional development and underlying brain maturation occur primarily within the context of early caregiver-infant relationships. Perinatal research demonstrates detrimental impact of postpartum pathology, including postnatal onset of maternal OCD-on the mother-infant relationship. The present study is the first to examine postnatal onset of a particular dimension of OCD symptoms focusing on close interpersonal relationships (relationship-OCD, i.e., ROCD) within a general population sample. Specifically, we assessed whether symptoms of Parent-Child ROCD (PC-ROCD), may onset postnatally, thus yielding symptoms of Parent-Infant ROCD (PI-ROCD). We adapted the previously validated Parent-Child ROCD measure for use during infancy to assess symptoms of PI-ROCD. The adapted measure, Parent-Infant Relationship Obsessive Compulsive Symptoms Inventory (PI-PROCSI), was administered to 143 mothers from the general population at 4-months postpartum. We investigated concurrent associations between postnatal onset of PI-ROCD, maternal depression and bonding, as well as longitudinal predictive associations with observed maternal and infant behaviors in dyadic interactions at 10 months. Due to dropout across the 1st year postpartum, the subsample with longitudinal data was substantially reduced compared to the full sample. PI-PROCSI scores explained unique variance in concurrent maternal depression over and above concurrent anxiety. PI-PROCSI scores also associated with concurrent impairments of maternal bonding. Moreover, unique associations emerged between maternal PI-ROCD scores and perturbations in both maternal and infant observable behaviors at 10-months. Specifically, observable perturbations in maternal behaviors mediated associations between symptoms of PI-ROCD at 4-months and observable infant avoidance of social engagement behaviors at 10-months. Findings suggest that parent-child ROCD symptoms may onset during the postnatal period, and that such symptoms may play a significant role in shaping quality of reciprocal caregiver-infant interactions. Theoretical and clinical implications are discussed.

Reaching reliable change using short, daily, cognitive training exercises delivered on a mobile application: The case of Relationship Obsessive Compulsive Disorder (ROCD) symptoms and cognitions in a subclinical cohort

BACKGROUND

Relationship Obsessive Compulsive Disorder (ROCD) is a presentation of OCD centering on interpersonal relationships. The aim of this Randomized Control Trial (RCT) was to assess the efficacy of short, game like, daily cognitive interventions delivered via mobile application in reducing subclinical ROCD symptoms and associated phenomena.

METHODS

Fifty university students identified as having subclinical levels of ROCD symptoms (using the Structured Clinical Interview for DSM-5 Clinical Version) were randomized into: immediate-use group (iApp group; n = 25) and delayed-use group (dApp group; n = 25). The iApp group started using the evaluated cognitive-behavioral training application at baseline for 15 days (T0 to T1). The dApp group commenced using the application at T1 for 15 days (T1 to T2). All participants completed questionnaires at baseline (T0), 15 days from baseline (T1), and 30 days from baseline (T2).

RESULTS

Repeated measure MANOVAs showed significant Group (iApp vs. dApp) × Time (T0 vs. T1) interactions. These interactions indicated greater decrease in ROCD symptoms, OCD beliefs and social anxiety symptoms, as well as a greater increase in self-esteem in the iApp group compared to dApp group at T1. Moreover, the Reliable Change Index (RCI) indicated reliable change on ROCD symptoms for a significant portion of participants (42-52%).

LIMITATIONS

Sample size and the use of self-report measures limits the generalizability of the results.

CONCLUSIONS

Short, daily cognitive training interventions delivered via mobile applications may be useful in reducing subclinical ROCD symptoms and associated features. Further testing is needed for clinical populations.

Predicting marriage and divorce in obsessive-compulsive disorder

Single (N = 472, 51.7%), married or living in stable cohabitation (N = 375, 41.1%) and divorced or separated (N = 66, 7.2%) patients with obsessive-compulsive disorder (OCD) were compared in terms of their sociodemographic features, OCD phenotypes, and comorbidity profile. Using single status as a reference group, a multinominal regression analysis found increased age, lower severity of hoarding, increased rates of panic disorder without agoraphobia, and lower rates of dysthymic disorder to be associated with married or stable cohabitation status. Concomitantly, increased age, higher severity of symmetry symptoms, and increased rates of skin picking disorder were found to be associated with divorced status. These findings suggest that there is a relationship between marital status and different OCD phenotypes.

A novel approach to challenging OCD related beliefs using a mobile-app: An exploratory study

BACKGROUND AND OBJECTIVES

According to cognitive models, obsessive compulsive symptoms result from catastrophic misinterpretations of commonly occurring intrusive experiences and the use of counterproductive strategies to manage them. Obsessive Compulsive Disorder (OCD) related beliefs such as inflated responsibility, importance of thoughts and perfectionism increases the likelihood of such misinterpretations. Consistent with a growing body of literature supporting the usefulness of mobile delivered technologies in fostering cognitive behavior change, the present study assessed the effectiveness of a novel cognitive training exercise designed to challenge OCD-related beliefs. This mobile app training exercise consists of users having to pull statements challenging OCD beliefs towards themselves (downwards) and to throw away (push upwards) contra-productive self-statements.

METHODS

36 third-year BA students started the trial. Twenty completed pre and post measures of OCD-beliefs, mood and OCD symptoms including relationship-obsessions. Participants were instructed to complete 3 min of daily training for a period of 15 days.

RESULTS

No significant differences were found between completers and non-completers on demographic and most symptom related measures at Time 1. Repeated-measures MANOVA of the 20 completers showed a significant reduction on all OCD symptoms measures and on OCD-beliefs. No significant reduction was found in depression symptoms. Regression analysis showed change in levels of OCD-beliefs was associated with reduction in OCD symptoms at Time 2 over and above OCD symptoms at Time 1.

LIMITATIONS

The study is an open trial with non-clinical participants.

CONCLUSIONS

This mobile delivered training exercise may be useful for the reduction and relapse prevention of OCD-related beliefs and symptoms.

Schema Therapy in Sex Therapy: A Theoretical Conceptualization

Schema therapy is an integrative approach of psychotherapy developed by Jeffrey E. Young. Its aim is to help clients explore and understand their deep emotional needs and meet them in a healthy manner. It is suitable for complex pathologies, such as comorbidities and personality disorders. In sex therapy, schema therapy can serve as a method for a deep, evidence-based, integrative conceptualization of a client's difficulties and needs. However, its principles have never been demonstrated in sex therapy. In this paper, we briefly review schema therapy and introduce schema domains. We bring a case study of a couple undergoing sex therapy from the cognitive-behavioral perspective. We then return to the same case study, in order to demonstrate the usefulness of a schema therapy conceptualization.

Relationship Obsessive-Compulsive Disorder: Interference, Symptoms, and Maladaptive Beliefs

BACKGROUND

Obsessive preoccupation, doubts, and compulsive behaviors focusing on one's romantic relationship and partner are receiving increasing clinical, theoretical, and empirical attention. Commonly referred to as relationship obsessive-compulsive disorder (ROCD), such symptoms have been linked with decreased relational and sexual functioning and lower mood, even after controlling for other obsessive-compulsive disorder (OCD) symptoms. To date, however, these symptoms have been studied in community samples alone. In the present study, we compared levels of interference, OCD, and mood symptoms between clinical participants with ROCD, OCD, and community controls. We also examined group differences in maladaptive beliefs previously linked with OCD and ROCD.

METHOD

Participants included 22 ROCD clients, 22 OCD clients, and 28 community controls. The Mini International Neuropsychiatric Interview was used to attain clinical diagnoses of OCD and ROCD. The Yale-Brown Obsessive-Compulsive Scale was used to evaluate primary-symptoms severity. All participants completed measures of symptoms and dysfunctional beliefs.

RESULTS

ROCD clients reported more severe ROCD symptoms than the OCD and control groups. ROCD and OCD clients did not differ in severity of their -primary-symptoms. ROCD clients scored higher than the other groups on maladaptive OCD-related and relationship-related beliefs. Finally, ROCD clients showed more severe depression symptoms than community controls.

CONCLUSION

ROCD is a disabling presentation of OCD that warrants research attention. Maladaptive OCD-related and relationship-related beliefs may be implicated in the development and maintenance of ROCD.

Partner-focused obsessions and self-esteem: An experimental investigation

BACKGROUND

Relationship-related obsessive-compulsive phenomena (ROCD) are encountered frequently in the clinic, and involve severe consequences to personal and relational well-being. One common presentation of ROCD involves disabling preoccupation and doubts focusing on intimate partner's flaws (partner-focused obsessions). It was previously suggested that individuals perceiving their partner's failures or flaws as reflecting on their own self-worth may be more sensitive to intrusive thoughts pertaining to their partner's qualities and characteristics. In the current studies, we assessed the link between partner-focused OC symptoms and self-esteem contingent on partner-value.

METHODS

In two studies we assessed the impact of experimentally induced partner-focused intrusions on self-esteem. In Study 1, we assessed individuals' self-esteem after one of three primes: (a) intrusion about one's partner comparing unfavorably with others of the same sex (i.e., alternative partners), (b) intrusion about one's partner comparing unfavorably to oneself, (c) and a neutral prime. In study 2, we tried to replicate Study 1 using a pre-post design and also examine whether favorable intrusions of one's partner would have an opposite effect on self-esteem than unfavorable intrusions.

RESULTS

Compared with the other groups, participants who were primed with intrusions of their partner being unfavorably compared to others reported lower self-esteem, but only if they had high levels of partner-focused symptoms. Favorable intrusions of partner to others did not have a positive effect on self-esteem among individuals with high levels of partner-focused symptoms.

CONCLUSIONS

Partner-value self-sensitivity may be one of the perpetuating mechanisms involved in partner-focused OC phenomena.