 live another day, come across another proposed diagnosis, another clinical entity. There was a guy about a thousand years ago, 800 years ago, his name was Okam, and there's Okam's razor, which says that a proliferation of entities indicates bed science. I wonder whether he tells us about clinical or abnormal psychology. At any rate, I've contributed my share to this proliferation. Most recent contribution is covert borderline prior to the somatic narcissists, cerebral narcissists, inverted narcissists, and cold empathy, and you name it. So, I don't feel shy about my participation in this marathon. Today we're going to discuss yet another proposed way to pathologize you and your relationship, and this is Relationship Obsessive Compulsive Disorder. Yes, you've heard it well. Relationship Obsessive Compulsive Disorder. Or ROCD for short. Acronyms are a big thing in psychology because they confuse laymen and make us feel superior. Ok, Shoshanim, ROCD, Relationship Obsessive Compulsive Disorder, is, as the name implies, an obsessive compulsive disorder, shockingly, but it's focused on intimate relationships in several ways, which I will detail a bit later. Like every other obsession, compulsion, it's very debilitating. It has very negative impacts, not only on the relationship, but on life in general. These are thoughts, images, urges that are intrusive. They are unwanted. There's distress. There's interference with life. That is, experienced as an enemy within. It's kind of an attack on values and welfare and well-being and benefits and good feeling. Intrusive thoughts are followed usually by compulsive behaviors. These compulsive behaviors are rituals. It goes to neutralized the catastrophized feared consequence of the intrusive thought. It's a form of self-administered anxiolytic. The ritual, which is a behavior, reduces the anxiety, which is attendant upon the intrusive thought. When the individual tries to suppress or neutralize obsessions, ironically, they increase. The frequency and the distress only increases. Obsession, compulsion, feeds on itself. There's an intrusive thought and an anxiety-reducing ritual, but it only enhances the intrusive thoughts or at least the potency of the intrusive thoughts. There are many types of obsessions. There's germophobes, people who are terrified of contaminations and germs. Fears about harming oneself and others. Doubts, compulsive neatness and odiliness. You know, hercules pour haut, anyone who has seen the series. Religious obsessions, sexual obsessions. Obsessions are everywhere. Obsession is simply a dysfunctional pattern of coping with catastrophizing cognitions. And so it's easy to believe that there are obsessions related to relationships, past relationships and present relationships. It's a series of repetitive and intrusive thoughts about how you feel about relationships in general and how you feel about your partner in particular in different relational contexts. It could be parent-child, it could be romantic relationship, intimate partner, committed relationship of some sort. These are unwanted, intrusive, chronic and disabling thoughts. Relationship, obsessive, compulsive disorder. I'm going to describe it in broad strokes, broad brush strokes, and then I'm going to delve deeper. So those of you who just want the overview can stop after a while when I begin to delve much deeper into the clinical manifestations of this obsession compulsion. Obsessions and compulsions that have to do with relationships are naturally centered on relationships. People doubt. These are doubts, self-doubting, continuous questioning, hypervigilance, which is self-directed, suspiciousness and even paranoid ideation, which actually is self-directed or partner-directed. People doubt whether they love their partner, whether their relationship is the right relationship, whether their partner loves them. And when they love, these kind of people with this kind of obsession and compulsion constantly check, reassure themselves that this is the right feeling. They may even engage in abuse in order to test the partner's resilience, commitment and unconditional love. When they attempt to end the relationship, they're overwhelmed by anxiety. They stay in their relationship, but it doesn't help the anxiety. They're haunted by continuous doubts and so the anxiety only increases. They're between a rock and a hard place. They can't terminate their relationship because of the overwhelming abandonment anxiety and they can't stay in their relationship because of the relationship obsessive-compulsive disorder. Another form of ROCD includes preoccupation, checking, reassurance-seeking behaviors related to the partner's perceived shortcomings, flaws, frailties, vulnerabilities, misconduct. Instead of finding good in the partner, these kinds of obsessive-compulsive people constantly focus on what's wrong with the partner. They exaggerate these flaws. They use them to prove that their relationship is fundamentally bad because the partner is fundamentally wrong for them. And the fact that they are not able to concentrate on anything except how unworthy the partner is and what a bad choice it had been to be with this partner. They focus only on this. It causes them enormous anxiety and of course it undermines the intimacy and the relationship itself. Partner-focused ROCD symptoms occur not only with intimate partners, they occur between parent and child, for example. The parent is overwhelmed. The parent is preoccupied with the idea that the child is not something, is not good-looking, is not socially competent, is not moral, is not emotionally balanced, is anti-social, or sick somehow. And this obsession immediately leads to compassion. And the compassion in this case is increased parental stress, low mood, low depression, low level depression, dystemia, and control freakery. These kind of parents attempt to control what they perceive to be the negative aspects and dimensions in their children. And like all other forms of OCD, obsessive-compulsive disorder, there are probably psychological factors at play and biological factors at play. No one really knows. There are maladaptive ways of thinking and behaving and that's why CBT, cognitive behavior therapy, is very effective. But it's not, we don't know, we guess, we think that there are also genetic neurological and biological aspects to OCD because we know that medication works, reduces OCD. And medication of course operates on the body, not the mind. Overreliance on intimate relationships also plays a role. When you're dependent on the other person to regulate your sense of self-worth or self-esteem or to regulate your moods and your emotions, when the other person becomes an external regulator, when the value of the partner is disproportionate because the partner is in control of your inner landscape, of course this creates an enormous fear of abandonment. This is part of attachment theory. And it increases vulnerability. And just being aware of how dependent you are and how vulnerable you are to being rejected and abandoned, just being aware of that produces the anxiety that could lead to compulsion. And the anxiety translates into intrusive thoughts. This is very common, for example, in borderline personality disorder. Cognitive behavioral therapies are the gold standard for talk therapy for OCD, although we usually also use medication. According to CBT models, we all have actually unwanted intrusive thoughts, images and urges, automatic negative thoughts ands. But individuals with OCD interpret these intrusive experiences as meaning something bad, as leading to something bad. The intrusive thoughts are perceived as self-critical. They prove to the person that he is, I don't know, crazy or bad or something wrong with his character. Or the intrusive thoughts predict, prognosticate some horrible future, a catastrophe is going to happen. So this is a process of catastrophizing. The core of OCD is not the intrusive thoughts, which, as I just said, all of us have, but the way the OCD person reacts to the intrusive thoughts. A mere occurrence, a mere happenstance of an unwanted thought about a loved one having an accident, for example. Take this. We all have this. We all worry whether a loved one could have an accident. But the obsessive person reacts to it in two ways. First of all, the mere thought of an accident renders the accident very probable, plausible. This is magical thinking. And the second reaction is the self-critical. I must be a bad person if I'm thinking of an accident. I must want the accident actually. It's a manifestation of an unconscious wish for something bad to happen to my partner. And these interpretations increase attention to these unwanted intrusive experiences, because then they are coupled with emotions, negative affectivity, and it makes them much more distressing. And the frequency becomes out of control. The thoughts proliferate. And so the individual tries to control these thoughts, tries to neutralize them, tries to repress the content. And so he develops rituals, like, I don't know, washing hands, counting every second tile on the floor, checking things all the time. Did I lock the door? Avoidance, suppression of these thoughts and mental and behavioral rituals, which are known as compulsions. These controls, these attempt to control, they don't work. That's the core issue in OCD. The solution that the OCD person comes with, these rituals, these compulsions, is a bad idea. It's a dysfunctional solution, because it actually enhances the anxiety. The very attempt to control the thought, of course, brings the thought to consciousness, amplifies the thought. If you have an intrusive thought and you pay no attention to it, it goes away. But if you then panic and try to control the thought, it metamorphosizes and takes over you, it becomes you. And so according to CBT models, the problem with people with OCD is that they give negative interpretations to these intrusive experiences, because they hold negative automatic thoughts, maladaptive beliefs about themselves and about the world in general. They perceive the world as hostile. The belief that if anything bad happens, it's their own fault. This is called inflated responsibility. And so people with OCD, when they have such a thought, they want to cleanse themselves, so they would wash their hands. And it translates. Very often there is a displacement of a thought. So there is a thought, my partner may have an accident and then, oh my God, I'm a bad person because I want my partner to have an accident. And then this is repressed because it's too much to cope with. And then there's a displaced substitute thought, I'm contaminated, I'm dirty, I should wash my hands. And they do this in order to avoid feeling the responsibility for hurting someone. It's very infantile, it's magical thinking. It's the underlying belief, the hidden assumption that your thoughts have effects, immediate effects on the environment and on others, physical effects. In relationship, obsessive-compulsive disorder, the intrusive thoughts, intrusions are about the rightness of the relationship, the suitability of the relationship partner. The partner is not smart, not moral, not good-looking enough, will cheat. This is very distressing. To reduce the distress, individuals with ROCD equally apply all kinds of ritual. They try to get reassurance from others that the partner or the relationship is good enough. They test the partner or they check the perceived flow. They may look for information on the internet. How do I know if I'm on the right relationship? They assess their physical reaction and feelings towards the partner. For example, during sex, they're constantly on the lookout. They're constantly supervising, monitoring, looking from above. It's like an out-of-body experience. They are, in other words, depersonalizing. And in this sense, obsessive-compulsion is dissociative. It's closely associated with dissociation. We're beginning to realize that only very, very recently, in the vast majority of universities in the world, they don't teach this, because this is very current knowledge. The connection between dissociation and OCD is cutting edge, is bleeding edge knowledge. There are similar behaviors that increase the attention given to the intrusion. They give it more importance. They make it more frequent. In a way we could perceive of OCD, obsessive-compulsive disorder, as a way to cope with dissociation. The intrusive thoughts are very terrifying, they're very threatening, they're ominous. The immediate reaction is dissociation to forget these thoughts, amnesia. And then there's the ritual, and the ritual is intended to actually restore the attention given to the intrusive thoughts in order to eradicate and eliminate it. So there's a battle between dissociative repressive mechanisms on the one hand, and a desperate attempt to eliminate or eradicate the negative thought via behaviors. Individuals with relationship-obsessive-compulsive disorder also give catastrophic meanings to intrusions. These are maladaptive beliefs. For example, they can develop the belief that being in a relationship, they're not absolutely sure about, always would lead to an extreme disaster. For example, cheating, and these beliefs lead individuals to interpret common relationship doubts in a catastrophic way, provoking compulsive mental acts and behaviors. Focusing on the partner, like a laser beam, but the opposite of love-bombing, I would call it flow-bombing, or negative-bombing, or shortcomings-bombing. The repeated assessment of the strength and quality of one's feelings towards the partner in a negative light. The treatment of these symptoms, of course, requires psychoeducation about the disorder, CBT, exposure, therapy, response prevention, and so on and so forth. And so people have bought into this clinical entity, new clinical entity. There are even apps developed to assist therapies coping with these maladaptive beliefs. Okay, that's the overview of the relationship-obsessive-compulsive disorder, and here some of you may check out. For those of you who are interested in deeper clinical, in a deeper clinical picture, stay tuned for the following. So, relationship-obsessive-compulsive disorder, ROCD, are obsessive-compulsive symptoms that focus on intimate relationships. I said it before. I would refer you to two articles, which are an excellent introduction. The one, the first one is by Doron, G, Doron Guy, Derby D, and Zwebssenwold, Jesus Christ, Zwebssenwold or something. It was published in 2014. It's titled Relationship-obsessive-compulsive disorder, a conceptual framework. It was published in the Journal of Obsessive-compulsive and related disorders, Volume 3. The same guy, Guy Doron, and the same guys actually, Guy Doron and Danny Derby, wrote something a lot more popular and published it in the OCD Journal, in the fall edition of the OCD newsletter, I'm sorry, the fall edition of the OCD newsletter, and the article is simply titled Relationship OCD. So everything I would say now is based on their excellent work, groundbreaking work. So as we said, relationship OCD focuses on relationships, could be child-parent, could be intimate relationships. And when you go to OCD forums and health groups, it's a very common topic, and it's beginning to infiltrate somehow the media. This form of OCD is especially distressing, because it's personal and interpersonal in relationships. It impairs functioning in interpersonal relationships at work, study, family, but also with oneself. People have doubts about suitability of partners. People have doubts about relationships. It's totally normal, there's ups and downs. There is always ambivalence, changeable or opposing feelings towards a romantic partner. That's completely natural. It's actually part of developing intimacy. Overcoming this ambivalence is a very crucial part of developing attachment, bonding and intimacy. We all pay more attention to our partner's real or imagined flaws as intimate relationships progress, because naturally the more time we spend with a partner, the more we are exposed to the negative aspects of his existence. At the beginning he puts his best food for it. There's a lot of play-acting in initial dating. But intimacy means that you're free to show your vulnerabilities and your less positive sides to your partner. But with some people, the minute they're exposed to the shortcomings and frailties and vulnerabilities and brokenness of the partner, the minute they're exposed, they begin to catastrophize. Their doubts and concerns, their worries become impairing, time-consuming, distressing, intrusive, they overtake everything else. People presenting with ROCD notice these symptoms early on, in early adulthood, even adolescence, because that's when they begin to develop intimacy in relationships. And it's a lifelong thing and it affects all relationships, especially romantic relationships. The first time this kind of person faces important romantic decisions, become girlfriend with someone, getting married, having children, these critical junctures, these passages as she he called them, they provoke anxiety. And this anxiety is all pervasive and all permeating. And it gives rise in an attempt to rationalize the anxiety, in an attempt to make sense of this anxiety. The person develops these intrusive thoughts and the dysfunctional rituals, the behaviors which are intended to neutralize and suppress these thoughts. ROCD symptoms are not limited to ongoing romantic relationships. There could be an obsession about the past. I think that retroactive jealousy is a form of ROCD. It causes people to avoid entering relationships because of the anxiety and pain associated with past relationships. ROCD symptoms are not related to relationship length or even to gender. It's gender neutral. They've been linked to other significant personal difficulties. For example, people with mood disorders, anxiety disorders, and of course other ROCD symptoms not relationship related. They tend to develop ROCD relationship related, OCD. When there are difficulties in the couple, sexual dissatisfaction, extramarital affairs, problems with the relationship, in some people this triggers an OCD response. ROCD is not linked to other forms of OCD. A person can have multiple forms of OCD, including ROCD. People with other forms of OCD and people with no known OCD diagnosis show similar levels of interference in functioning, distress, resistance attempts, and degree of perceived control due to symptoms of ROCD. So ROCD can attack anyone. You don't need to have OCD in order to have ROCD. You can be a victim of ROCD. ROCD is as disabling as other types of OCD. It's a really bad thing. And as Doron and allies Derby and others say, ROCD has two common presentations. Relationship center and partner focused. The symptoms are grouped, coalesce into these two groups. And so people with relationship centered obsession feel overwhelmed by doubts and worries focused on their own feelings towards the partner, their partner's feelings towards them, and their rightness of the relationship experience. They ask themselves, is this the right relationship for me? This is not real love. Do I feel right? Does my partner really love me, etc., etc. So they are relationship focused. They are systemic. They have systemic OCD. The OCD is about the system, not about a specific individual or occurrence or event or behavior. What about generally about whether I should be with this person? And the people who are partner focused, they have partner focused obsession. They focus on the partner's physical features. They could say his nose is too big. Her boobs are too small or whatever. They focus on the partner's social qualities. He is not sociable. She doesn't have what it takes to succeed in life, etc. Or they focus on personality attributes. She is immoral. She can't be trusted. She is not intelligent enough or she is not emotionally stable. So relationship centered and partner focused symptoms can happen at the same time and very often reinforce each other. Many people describe being preoccupied with a perceived flaw or problem with a partner, for example body proportions, but then much later they begin to doubt the whole relationship. They are plagued by skepticism about the whole thing. Some people start with doubts about the relationship and end up preoccupied with the flaws of the partner, but that's more real. So what does it look like? What are the presenting symptoms and signs in clinical settings? But this is of course obsessive preoccupation. Doubts. A variety of compulsive behaviors intended to reduce feelings of uncertainty, anxiety and distress or reduce the frequency of such thoughts. But the compulsions in ROCD are idiosyncratic. They are special to ROCD. They are not common to other ROCD manifestations. So for example monitoring and checking their own feelings. These people keep asking themselves, do I feel love? Do I want this partner? Do I want to be with her? Did I ever love her? Am I going to love her? Given the opportunity or time, should I invest in her? And then there's doubts about behaviors. Am I looking at others? Do I have a wandering eye? And then the obsessive thoughts, intrusive thoughts, do I have critical thoughts about her? Do I have doubts about him? These people are immersed in their own mind constantly trying to ascertain what is the level of doubt and suspicion regarding the partner. They keep comparing their relationships with other people's relationships. Friends, colleagues, characters in romantic films, TV sitcoms and celebrities. They make desperate attempts, these people. People with relationship and obsessive-compassive disorder. They make desperate attempts to recall good experiences with the partner. Times when they felt sure about the partner. And they keep consulting. And I mean like daily and hours every day. Friends, family, therapists, fortune tellers, psychics, you name it, about the relationship. They keep buttonholing. Everyone who passes asking questions about the relationship. People with ROCD try to avoid situations that trigger unwanted thoughts and doubts. They may avoid specific social situations such as friends they consider to be very much in love or having a perfect relationship. So if they have friends whose relationships are good or who are in the throes of a love affair with someone, infatuation or limerence, they would avoid these friends. Because these friends trigger, remind them of what they are missing and may provoke a cycle of obsession and compulsion. They avoid particular leisure activities such as seeing romantic movies because they are afraid that they would not be able to feel strong or passionate love as the characters in the movie do. People with ROCD may give great importance to romantic relationships. In a way, ROCD reflects an overinvestment, overcathesis in romantic relationships because the functions of the romantic relationship in people with ROCD are not the same as in healthy people. The romantic relationship with people with ROCD is an anxiolytic mechanism or device. The idea is that a romantic relationship can reduce your anxiety and depression. It's a self-medication. They self-medicate with intimate partners and they outsource internal ego-boundary functions and regulatory functions to the intimate partners. The romantic relationship has an inordinate importance in the life of the person with ROCD. Negative events relating to these relationships cause significant distress, make them doubt their own self-worth and go into panic mode because they are about to lose regulation, functions. The landscape is at risk of disintegrating and people with partner-focused obsessions are particularly sensitive to the way the partner compares them with others and to the way others look at the partner. The romantic relationship with a partner is viewed unfavorably or when encountering alternative potential partners causes intense distress and triggers this obsessive preoccupation. People with ROCD have extreme beliefs about relationships. They have a very unrealistic perception of intimacy, of relationships and what they should and could get from them. It makes them more responsive and emotionally reactive to relationship concerns and doubts. These beliefs are counterfactual and some of them are catastrophized beliefs, the terrible irreversible consequences of being in the wrong relationship, the hurt. This is a form of hurt aversion. So a belief like romantic relationship that doesn't always feel right is probably a destructive relationship. Or I think breaking up with my partner is one of the worst things that can happen to me. Or the thought of going through life without a partner scares me to death. These are all dysfunctional negative beliefs. Of course, they're all wrong. Extreme beliefs about love make people with ROCD more vulnerable to negative relationship thoughts or emotions. So this kind of beliefs, if the relationship is not completely perfect, it is unlikely to be true love. If you doubt your love for your partner, it is likely it is not the right relationship and not the right partner and probably not love. If you don't think about your partner all the time, she is probably not the one. And similar to other forms of ROCD, beliefs about the importance of thoughts, generally the importance of these thoughts. If I think about it, it must mean something. Or even if I think about it, it will come true, magical thinking. There's a difficulty with certainty, inability to handle uncertainty, I'm sorry. An inflated sense of responsibility. It's like if I fail to prevent something bad from happening, I might as well have caused it. I made it happen. And this also increases sensitivity to ROCD. Now we treat ROCD the way we treat OCD with CBT and so on and so forth. But it's at its infancy. People with OCD in general and relationship OCD in particular find great relief in reading or hearing about someone going through what they are experiencing. So joining forums may be a good idea. And reading or even listening to this video may be a good idea. And definitely CBT would be a good idea. The treatment includes assessment, information gathering, mapping the symptoms and understanding forming between therapist and client about beliefs and views of the self and others which may be affected by the symptoms. Wrong thinking. And exposure and response prevention therapies, ERP therapies are also very, very good. There's also new techniques like imagination based exposures and so on. So there are treatments and there are treatment gains. There are effective strategies. There are relapse prevention plans. OCD is amenable to treatment unlike, for example, narcissistic personality disorder, let alone psychopathy. So go for it. Go treat yourself. The worst case you will be given medication, antidepressants and xeolytics. In the worst case, even some stimulants, amphetamines, maybe of health. Just go and take care of this. Every relationship, obsessive-compulsive disorders has taken over your mind, is disabling you, paralyzing you and ruining your relationship. You may wish to take care of it. You may wish to have yourself treated because it can be different and it can be better.