Obsessive-compulsive disorder, or OCD, comes in many forms. An individual facing this condition may find that their OCD is mainly focused on the possibility of contracting a fatal disease, worrying about a catastrophe befalling their loved ones, or endlessly doubting whether they did, in fact, turn off their stove. And while these are among the most common OCD-related obsessions, a new fixation has recently been gaining attention: relationship OCD, which causes individuals to dissect the details of their personal relationships, is receiving greater exposure and serving as the focus for a growing number of studies. Read on for a more in-depth understanding of this fascinating condition.
Obsessive-Compulsive Disorder: Running Up that Hill
Obsessive-compulsive disorder, or OCD, is a mental health condition marked by intrusive, unwanted, and adverse thought content, together with repetitive, time-consuming, and often ritualistic behavior.
The obsessive thoughts at the core of OCD can cause the individual experiencing them to ruminate over a particular subject of concern for extended periods of time. The four most common OCD-related obsessions are:
Cleanliness and worrying about the chance of becoming ill due to contamination.
Catastrophizing concerns revolving around a terrible occurrence affecting the individual’s life or that of a loved one. Focusing on a catastrophe such as the house blowing up because they forgot to unplug the iron can lead to checking and rechecking behavior (more on that in a moment).
Organization or “just right” thinking, which ceaselessly draws one’s attention to items that are out of place, not set at a right angle, and so forth.
Taboo thoughts, which relentlessly cause the individual to imagine actions or scenarios that go against social norms or that are considered unacceptable in their society.
OCD-related compulsive behavior often stems from OCD-related obsessions, which initially accost the individual with such troubling and distracting thought content that they eventually develop some sort of ritual in an effort to calm themselves down. Over time, though, these same rituals become impossible to skip, otherwise the individual will feel the same rush of stress and disquiet. As these repetitive rituals begin to feel mandatory, they are added to the individual’s obsessive thoughts, as another cyclical and sisyphic symptom of their disorder.
Examples of OCD-related rituals can be incredibly diverse, at times intuitively linked to the obsession that brought it on (such as repeatedly sanitizing all the surfaces in one’s house for fear of picking up allergens), and at times seemingly random (repeating an elaborate dance to “counter” the chance of a beloved friend getting into an accident).
In addition to compulsive behavior, OCD can also induce compulsive thinking: for example, a disturbing thought about committing an act of violence (an OCD-related obsession) can be warded off by repeating the lyrics of a specific song in one’s head (an OCD-related compulsive thought pattern). Regardless of whether their OCD triggers a repetitive action or thought pattern, OCD compulsions eventually only add to one’s frustration from the condition’s effects on their quality of life.
1%-2.3% of US children and adolescents, as well as 2.3% of US adults face OCD. While symptoms of this condition can develop at any age, they most commonly appear between the ages of ten and early adulthood. That said, patients on average only receive an official OCD diagnosis, and are treated for it, between the ages of 14-17. This is due to OCD often being hard to identify, as many times its behavioral symptoms are initially rationalized as personal eccentricities, rather than signs of a mental health condition.
Anxiety and Distress: Two Possible Origin Stories
In its latest mental health manual from 2013, the American Psychiatry Association (APA) separated OCD from its previous inclusion in the anxiety chapter, giving it (and other OCD-related disorders) their own section. This granted OCD a greater spotlight, following scientific discoveries that uncovered specific neural pathways unique to this condition, as well as OCD treatments that showed significant levels of efficacy.
Despite this, the APA continues to define OCD as an anxiety-centric disorder, underscoring how OCD causes a feeling of adverse hyperarousal, much like other anxiety disorders. OCD, it reaffirms, causes the individual experiencing it to turn their attention toward stressful triggers (disease for those concerned with illness, taboo thoughts for those concerned with immorality), in an attempt to survive their harmful potential.
Yet more recent research points in a different direction, focusing instead on distress as the possible root cause for OCD. While anxiety is considered an overgeneralization of fear that helps keep us alive by focusing on a perceived threat, distress is seen as extreme uneasiness and difficulty to once again feel calm due to an unpleasant stimulus.
One way to tell the anxiety from distress is to compare facing a terrifying situation versus an exceptionally irritating one: someone experiencing a paralyzing fear from dark streets may have anxiety. Someone who is constantly frustrated by their coworkers’ conversations, and who is easily distracted by their loud exchanges with one another, may be dealing with distress.
The OCD-as-distress hypothesis acts as further reasoning why this disorder should be separated from anxiety-based disorders, as its main symptoms underscore the nagging, unrelenting feeling experienced by the individual, rather than a fearsome one.
Relationship OCD: Is It In His Kiss?
Relationship obsessive-compulsive disorder, or ROCD, is defined as a case of OCD whose main focus is on the individual’s perception of the relationship with others. ROCD can revolve around someone’s romantic relationship, as they constantly question whether their significant other loves them, or whether they themselves are sure their partner is their “one true love.” It can ruminate over a parent-child relationship, dissecting every conversation in an effort to “prove” to themselves they are not living up to their parent’s expectations of them. Sibling ROCD can cause an endless preoccupation with comparisons and competitions. ROCD can also occur within a friendship, friend group, or a professional or academic setting.
Like other forms of OCD, ROCD is fueled by doubt. A minor, perceived flaw in one’s partner can cause them to obsess over their compatibility. A single misstep or critique made by a friend, may cause them to induce that perhaps they do not really appreciate them. Such questions will repeat themselves on a loop in cases of ROCD, with the individual experiencing them returning to the same, central dilemma: have they been overlooked their entire lives by their mother? Do they really love their partner? Are their professional skills truly appreciated by their boss? Etc.
As opposed to more encompassing personality disorders, ROCD (and OCD in general) do not usually cause a spiraling, dichotomous view of the world, or even a particular relationship: an individual with ROCD will more likely find themselves unsure about what to believe or whether they should feel safe within a specific relationship, than fluctuate between total adoration and unbearable betrayal, as is more often the case with personality disorders.
As romantic ROCD is among the more common forms of this condition, individuals with ROCD often report noticing their symptoms in early adulthood. Others trace it back to the first time they were faced with a significant romantic dilemma. Ruminating over regrets from past relationships can also cause those with ROCD to avoid beginning a new romantic relationship.
Despite its effects on the quality and experience of the relationships in the individual’s life, symptoms of ROCD were not found to be associated with relationship length or the patient’s gender. ROCD symptoms have, however, been linked to mental health issues such as mood, anxiety, and other OCD symptoms. ROCD symptoms have also been found to be related to difficulties within romantic or sexual relationships, such as dissatisfaction.
Research suggests ROCD symptoms are roughly as disabling to an individual’s quality of life as other types of OCD. The significance of this condition has made it a topic of greater discussion within the public sphere. As empirical studies attempt to shed a light on the ways in which ROCD presents itself, drawing on recent discoveries related to OCD as a whole and referring to OCD treatments recognized for their safety and efficacy.
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