Relationship Obsessive-Compulsive Disorder (ROCD) involves intrusive thoughts and compulsive behaviors focused on doubts about one’s romantic relationship or partner.
Symptoms include constant questioning of love, relationship “rightness,” or partner’s flaws, often leading to significant distress and relationship dysfunction.
Existential concerns are fundamental human issues related to existence itself.
They encompass five main areas: isolation (feeling fundamentally separate from others), identity (struggling to define oneself), guilt (anxiety about life choices), meaninglessness (finding purpose in life), and death (grappling with mortality).
Menzies, R. E. (2024). Alone together: The role of existential concerns in symptoms of relationship obsessive-compulsive disorder. Clinical Psychologist, 28(2), 122–130. https://doi.org/10.1080/13284207.2024.2322936
Key Points
- All five existential concerns (isolation, identity, guilt, meaninglessness, death) were significantly associated with relationship obsessive-compulsive disorder (ROCD) symptoms
- Isolation and identity concerns showed the strongest associations with ROCD symptoms
- Existential concerns remained significant predictors of ROCD symptoms after controlling for relationship quality, catastrophic relationship beliefs, and neuroticism
- Findings suggest existential concerns may play an important role in ROCD and should be considered in conceptualization and treatment
Rationale
Relationship obsessive-compulsive disorder (ROCD) involves intrusive thoughts and compulsive behaviors focused on romantic relationships, causing significant distress and relationship dysfunction (Doron et al., 2014).
While research has identified some predictors of ROCD, such as maladaptive beliefs and personality traits (Doron et al., 2016; Tinella et al., 2023), the role of existential concerns remains unexplored.
Existential psychology’s “five givens” of existence (isolation, meaning, identity, guilt, and death) have been linked to various psychopathologies (Iverach et al., 2014).
Some existential concerns have shown associations with OCD symptoms more broadly (Chawla et al., 2022), but their specific relevance to ROCD is unknown.
This study aimed to address this gap by examining relationships between existential concerns and ROCD symptoms.
Understanding these associations could provide new insights into ROCD etiology and inform treatment approaches.
Based on theoretical considerations and previous findings, isolation, identity, and guilt were hypothesized to show the strongest relationships with ROCD symptoms.
Method
Procedure
Cross-sectional survey study design
- Participants recruited from undergraduate psychology students
- Completed online questionnaires measuring existential concerns, ROCD symptoms, relationship quality, catastrophic relationship beliefs, and neuroticism
Sample
- 353 undergraduate students (77.6% female, 20.7% male, 1.7% non-binary)
- Mean age: 20.95 years (SD = 5.38)
- Ethnicity: 49.1% Asian, 41.7% White, 0.9% Middle Eastern, 0.8% Aboriginal/Torres Strait Islander, 0.3% African
- 52.7% currently in a relationship, 41.9% single, 3.1% married, 2.0% de facto, 0.3% divorced, 0.6% widowed
Measures
- Existential Concerns Questionnaire (ECQ)
- Relationship Obsessive-Compulsive Inventory (ROCI)
- Relationship Catastrophization Scale (ReCats)
- Relationship Quality (RQ) scale
- Big Five Aspects Scales – Neuroticism subscale (BFAS)
Statistical measures
- Pearson correlations
- Fisher r-to-z transformations to compare correlation strengths
- Hierarchical multiple regression analyses
Results
Hypothesis 1: Existential concerns will predict ROCD symptoms.
- Supported. All five existential concerns (isolation, identity, guilt, meaninglessness, death) were significantly positively correlated with ROCD symptoms.
Hypothesis 2: Isolation, identity, and guilt will demonstrate the strongest relationships with ROCD symptoms.
- Partially supported. Isolation and identity showed the strongest correlations with ROCD symptoms. The correlation for guilt was not significantly different from meaninglessness or death.
Additional findings:
- All five existential concerns remained significant predictors of ROCD symptoms after controlling for relationship quality, catastrophic relationship beliefs, and neuroticism.
- This pattern held true for both participants currently in relationships and the overall sample including single participants.
Insight
This study provides the first evidence linking existential concerns to relationship obsessive-compulsive disorder (ROCD) symptoms.
The finding that all five existential concerns – isolation, identity, guilt, meaninglessness, and death anxiety – were associated with ROCD symptoms highlights the potential importance of existential issues in this disorder.
The particularly strong relationships found for isolation and identity concerns suggest these may be especially relevant to ROCD.
These results extend previous research on existential concerns in OCD by demonstrating their relevance to relationship-focused symptoms specifically.
The robust nature of the associations, persisting even after controlling for other relevant variables, further emphasizes their potential significance.
This study bridges existential psychology with clinical research on ROCD, offering a new perspective on factors that may contribute to or maintain these symptoms.
The findings open up several avenues for future research. Studies could explore whether interventions targeting existential concerns, particularly isolation and identity issues, may be beneficial for individuals with ROCD.
Longitudinal research could examine whether existential concerns predict the development or exacerbation of ROCD symptoms over time.
Additionally, investigating how existential concerns might interact with other known risk factors for ROCD could provide a more comprehensive understanding of the disorder’s etiology.
Implications
The findings suggest that clinicians working with individuals experiencing ROCD symptoms should consider assessing and addressing existential concerns, particularly feelings of isolation and identity issues.
Treatment approaches for ROCD may benefit from incorporating elements that target these existential themes.
For example, interventions could focus on helping clients build meaningful connections to address isolation or explore and strengthen their sense of identity outside of romantic relationships.
Policymakers in mental health could consider incorporating education about existential concerns into training programs for therapists working with OCD and relationship issues.
This could help ensure that clinicians are equipped to recognize and address these concerns in treatment.
Implementing these findings may lead to more holistic and effective treatments for ROCD.
However, challenges may include the need for additional training for clinicians and potential resistance to incorporating existential themes into more traditional cognitive-behavioral approaches.
Careful integration and evaluation of existential-focused interventions would be necessary to ensure their effectiveness and acceptability to clients.
Strengths
This study had several methodological strengths, including:
- First study to examine existential concerns in relation to ROCD
- Large, adequately powered sample
- Controlled for potential confounding variables (neuroticism, relationship quality, catastrophic beliefs)
- Used validated measures
Limitations
This study had several methodological limitations, including:
- Cross-sectional design limits causal inferences
- Student sample may limit generalizability
- Reliance on self-report measures
- Did not assess for formal OCD diagnoses
- Did not include a general measure of OCD symptoms for comparison
References
Primary reference
Menzies, R. E. (2024). Alone together: The role of existential concerns in symptoms of relationship obsessive-compulsive disorder. Clinical Psychologist, 28(2), 122–130. https://doi.org/10.1080/13284207.2024.2322936
Other references
Chawla, S., Menzies, R. E., & Menzies, R. G. (2022). Existential concerns in OCD with aggressive and sexual obsessions. Journal of Obsessive-Compulsive and Related Disorders, 32, 100710. https://doi.org/10.1016/j.jocrd.2022.100710
Doron, G., Derby, D. S., & Szepsenwol, O. (2014). Relationship obsessive compulsive disorder (ROCD): A conceptual framework. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 169-180. https://doi.org/10.1016/j.jocrd.2013.12.005
Doron, G., Derby, D., Szepsenwol, O., Nahaloni, E., & Moulding, R. (2016). Relationship Obsessive–Compulsive Disorder: Interference, Symptoms, and Maladaptive Beliefs. Frontiers in Psychiatry, 7, 182385. https://doi.org/10.3389/fpsyt.2016.00058
Iverach, L., Menzies, R. G., & Menzies, R. E. (2014). Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clinical Psychology Review, 34(7), 580-593. https://doi.org/10.1016/j.cpr.2014.09.002
Tinella, L., Lunardi, L., Rigobello, L., Bosco, A., & Mancini, F. (2023). Relationship Obsessive Compulsive Disorder (R-OCD): The role of relationship duration, fear of guilt, and personality traits. Journal of Obsessive-Compulsive and Related Disorders, 37, 100801. https://doi.org/10.1016/j.jocrd.2023.100801
Socratic Questions
- How might the relationship between existential concerns and ROCD symptoms be bidirectional? What implications would this have for treatment approaches?
- The study found associations between death anxiety and ROCD symptoms. How might concerns about mortality relate to obsessions and compulsions focused on romantic relationships?
- What alternative explanations might account for the strong associations found between existential concerns and ROCD symptoms?
- How might cultural factors influence the relationship between existential concerns and ROCD symptoms? How could future research address this?
- The study used a non-clinical student sample. How might the results differ if replicated with a clinical sample of individuals diagnosed with ROCD?
- What ethical considerations should be taken into account when incorporating existential themes into treatment for ROCD?
- How might addressing existential concerns in ROCD treatment impact other areas of an individual’s life beyond their romantic relationships?
- The study controlled for neuroticism, relationship quality, and catastrophic beliefs. What other potential confounding variables might be important to consider in future research?
- How might the findings of this study apply to other types of relationship-focused OCD, such as parent-child ROCD?
- What are the potential risks and benefits of explicitly addressing existential concerns in ROCD treatment, particularly for younger individuals or those in early stages of romantic relationships?
