Do perfectionism and maladaptive beliefs contribute to the maintenance of symptoms in the relationship DOC?
Obsessive-Compulsive Disorder can occur according to a wide range of clinical types. Among these there is the Obsessive-Compulsive Disorder; RDOC which occurs in the context of intimate relationships.
Advertising message Obsessive-compulsive disorder (DOC) is characterized by the presence of obsessions, that is, recurring and intrusive thoughts, impulses or images, which the individual tries to counter or neutralize through compulsions, that is, repetitive behaviors or mental rituals. Compulsions would serve to prevent or reduce anxiety, or the unwanted consequences that would occur if such rituals were not implemented. The connection between obsessive concern and compulsion tends to be unrealistic or illogical (American Psychiatric Association, 2013).
DOC can be presented according to a wide range of clinical types. Among these, there is the relationship obsessive-compulsive disorder; RDOC, an expression of the DOC in which the symptoms manifest themselves in the context of intimate relationships (Doron, Derby, & Szepsenwol, 2014). In particular, the symptoms can be relationship-centered or partner-focused. These two symptomatic manifestations of DOC can coexist and reinforce each other.
In the relationship-centered ROCD, the person questions how “right” their relationship is and has doubts about their feelings towards the partner or vice versa, about the partner’s feelings towards themselves (Doron, Derby, Szepsenwol, & Talmor, 2012a) . Compulsions consist in continuously monitoring one’s internal states (“Do I really love him? How much am I really attracted?”), Formulating neutralizing thoughts (eg imagining oneself happy together), seeking reassurance or repeatedly checking the quality of one’s relationship (Doron & Derby, 2017; Doron, Derby, Szepsenwol, & Talmor, 2012b).
In the partner-centered DOC, the obsessions consist of excessive worries about perceived flaws in one’s partner in various areas: intelligence, morality, sociability and appearance (Doron and colleagues, 2012a). Compulsions, on the other hand, concern continuous comparisons of the characteristics of one’s partner with those of other hypothetical partners, checking the partner’s behavior or skills and repeatedly analyzing his / her qualities and defects.
Melli, Bulli, Doron and Carraresi (2018) carried out a study to verify the relative contribution of some maladaptive beliefs on the maintenance of symptoms in the DOC relationship. In particular, the authors considered the effects of beliefs relating to DOC, perfectionism and beliefs regarding relationships, assessing separately the effects on the two DOC subtypes of relationship.
The study involved 124 participants diagnosed with RDOC, who were given a battery of questionnaires online. These include: the Italian version of the Relationship Obsessive-Compulsive Inventory (ROCI; Melli and colleagues), to measure the presence of relationship-oriented RDOC symptoms, and the Italian version of the Partner-Related Obsessive-Compulsive Symptoms Inventory (PROCSI; Melli and colleagues), to measure the symptoms of partner-centered RDOC.
The Italian version of the Frost Multidimensional Perfectionism Scale (FMPS; Lombardo, 2008) was administered, which measures six aspects of perfectionism: 1) high personal standards, 2) concern for errors, 3) doubts about actions, 4) high parental expectations , 5) parental criticism, 6) tendency towards organization and order.
Advertising message In the battery of questionnaires there is also the Obsessive Beliefs Questionnaire-20 (OBQ-20; Italian version of Melli, Ghisi, Bottesi. & Sica, 2014), which measures beliefs related to the DOC including overestimation of the threat and its own responsibility, intolerance to the uncertainty and importance of thoughts and to be able to control them.
Finally, the participants responded to the Relationship Catastrophization Scale (RECATS; Doron et al., 2016), which measures the overestimation of the negative consequences of being alone, ending a relationship and being in a wrong relationship; and the reduced version of Depression Anxiety Stress Scales-21 (DASS; Clara et al., 2001), which measures depression, anxiety and stress.
The results indicate that perfectionism, in particular continually worrying about one’s mistakes and constantly doubting one’s actions, are factors that help keep the symptoms of ROCD centered on relationships. A person with ROCD for example could interpret a fight not as a normal aspect of a relationship, but as an unacceptable mistake, a failure. The catastrophic beliefs of being in a wrong relationship or being alone are also related to relationship-oriented ROCD. In this case, the person on the one hand continually worries about not being with the right partner, on the other he thinks it would be terrible to be alone. As a result, she feels trapped in the relationship.
The fear of being in the wrong relationship is associated with partner-focused ROCD. In this case, the person wonders obsessively (beyond a normal doubt) if the partner he is with is really “the love of his life” or if there is no better partner out there than he is today. The fear is that each of the two options may lead to regret.
The maladaptive beliefs that unite the thinking of those who suffer from DOC in general, on the other hand, would seem to indirectly influence the ROCD, increasing stress, anxiety and depression.
Although these results are interesting and useful at a clinical level, in order to draw more solid conclusions the authors suggest that the predictive factors of relationship-oriented and partner-centered ROCD are studied through longitudinal studies, with an inclusion criterion of patients diagnosed with ROCD more rigid and with a control group of healthy individuals.
Research on ROCD is in fact necessary to identify specific factors on which to act at the clinical level when meeting patients with DOC from relationships.