It's a feeling that takes you back to those tender days of adolescence, when life itself seems to revolve around that one special person, when simply laying eyes on them, being anywhere near them is an indescribable rush that makes your palms sweat, your heart race, and brings your mind to a complete halt. Do they like me? What do they think of me? Do they even notice me? You take a sudden interest in their likes, the objects they touch become sacred, you have an uncanny knack for spotting their many doppelgängers when you're out and about.

Adolescence isn't forever, and those rushes fade, giving way to the complicated highs and lows of real adult relationships, of heartbreak and compromise and sticking it out. This isn't to say that those wonderful butterflies-in-the-stomach sensations at the start of a new relationship become unattainable, just that they're now tempered by growth and experience. Yet even in adulthood, unresolved personal issues can lead one to obsess over a love interest in an emotional state known as limerence1. The symptoms of relationship-centered obsessive-compulsive disorder, or ROCD, may also amplify those very normal doubts and fears and lead to relationships crippled by dysfunction and distress2,3.

Limerence Defined

In her book Love and Limerence: The Experience of Being in Love, psychologist Dorothy Tennov describes limerence. She coined the term, which refers to an unhealthy obsessive state in which an individual becomes all-consumed with securing or maintaining emotional reciprocation from their object of affection, known as the limerent object, or LO. Often this occurs despite being incapacitated by shyness in the LO's presence.

The obsessed person becomes overwhelmed by a fear of rejection, their moods dictated by whether their LO has paid attention to them and fixated on how that attention was paid. Indifference is often read as a secret passion, and feelings can intensify after rejection by the LO. Moreover, there is a remarkable ability to inflate the LO's admirable qualities, while ignoring and even reconstituting negative traits as strengths1.

And although limerence outwardly can resemble a normal state of being in love, in reality it is an involuntary negative state defined by invasive, obsessive, and compulsive thoughts and behaviors that can often have clinical implications4—as well as problematic physical manifestations: heart palpitations, sweating, dizziness, and changes in eating and sleeping patterns5.

Differences Between Limerence and ROCD

Limerence exists as a constant state of anxiety, which is focused solely upon the perceived reciprocity from the LO. This leads to ruminative and patterns of avoidance thinking (such as distraction as a coping strategy) that are similar to those of OCD.

However, one major difference between limerence and ROCD lies in how the partner is considered. The former is defined by an overwhelming fear of rejection, while the latter may lead to obsessing over not liking a partner enough5. A second major difference is that the goal of limerence is achieving emotional reciprocation, so compulsive behaviors are contingent on perceived feedback from the LO. In ROCD, the goal is to neutralize anxiety-provoking thoughts by repeating compulsive mental acts and behaviors. Noted psychologist Albert Wakin defines limerence as a combination of OCD and addiction, like living in a state of compulsory longing4.

Features of ROCD

While both disorders center on romantic bonds and exist at a relationship's outset, as well as negatively define the quality of a long-term commitment, the fears and compulsions of ROCD can dovetail and be in stark contrast to those of limerence. Fear of rejection and abandonment are common components, although with ROCD the fears can hobble a relationship's growth, fostering a climate of clinginess and dependency. Another hallmark of ROCD are the intense and pervasive feelings of doubt as to the "rightness" of the relationship or partner's compatibility, which can further destabilize a relationship.2

This preoccupation with the suitability and characteristics of a partner can also be taken to extremes. While ROCD dwells on the qualities of the relationship itself (e.g., "I am not in love because there is no passion in the relationship"), partner-focused obsessive-compulsive symptoms can exist as a standalone disorder and stoke existing compulsions. Persistent thoughts relating to a partner's perceived physical flaws (e.g., "They're not good looking enough!") or their personality shortcomings can lead to attempts to alleviate the distress through compulsive behaviors such as seeking outside reassurance, constantly checking in on one's partner, etc.3

Certain relationship-based cognitive biases, such as thinking that disaster is certain if one leaves a relationship ("I won't find anyone else and be alone for the rest of my life!") can in turn lead to even more obsessive thoughts and compulsive behaviors. Dwelling on personal flaws and deficits can also be turned inward ("I'm not good enough, and that's why I ended up with him."), further strengthening partner-focused obsessions and compulsive behaviors3. And when a partner brings intense vulnerability related to his or her self-worth and attachment anxiety into a relationship, an increased susceptibility to ROCD symptoms creates something of a loop: anxieties feed obsessive behaviors, which bring about additional feelings of incompetence into an individual's sense of self in the relationship.6

What Causes Limerence and ROCD?

The intrusive thinking involved in limerence and OCD and has been associated with low levels of serotonin and elevated levels of dopamine and norepinephrine—all neurotransmitters, or chemicals that act as messengers between brain cells. Partner-focused heightened attention, motivation and goal-directed behaviors are related to elevation of dopamine concentrations in the central nervous system. Dopamine is also related to feelings of exhilaration, elevated energy, reduced appetite, sleeplessness, and anxiety. Elevated levels of norepinephrine are associated with increased memory for new stimuli7.

Recommended Treatments

Based on the practice guidelines of the American Psychiatric Association, the best evidence-based OCD treatments include the combination of serotonin-reuptake inhibitors (SRIs) and cognitive-behavioral therapy (CBT), particularly the technique of exposure and response prevention(ERP)8. CBT also has particularly beneficial results with individuals who have ROCD; some of the most widely used cognitive-behavioral techniques include cognitive restructuring and ERP. Experiential techniques such as imagery rescripting have also been incorporated into CBT programs to challenge fears related to attachment- and commitment-related behaviors9.

Exposure and response prevention (ERP) may be used to break the connection between obsessional triggers and the urge to perform compulsive rituals. For example, an individual who has ROCD may be asked to trigger her doubts and preoccupations by repeating the sentence, "I have doubts about the relationship." Instead of compulsively looking for reassurance from others when experiencing the distress associated with this thought, she would be encouraged to sit with her anxiety and notice how it will dissipate eventually9.

It is important for those who have ROCD to become aware that when their maladaptive beliefs are prominent, even naturally occurring thoughts may be interpreted as catastrophic and negative. This may lead to dysfunctional responses and increased distress. For example, if a man has specific beliefs about how he should feel and think in an ideal relationship ("thinking about his partner all the time" or "never being critical of his partner"), but does not experience them in his relationship, he interprets this as not being in love. Although when encouraged to look at these beliefs, he may recognize that they might be considered extreme and if they were to materialize they wouldn't be practical or desirable: Thinking about his partner all the time would not be productive while at work9.

Meditation and practicing mindfulness may also prove useful to stay present and centered, rather than ruminating about the past or future romantic fantasies. Also beneficial is joining a 12-step program to find support among others who are struggling with similar issues. In addition, it is helpful to read about limerence and ROCD to gain insight into how family dynamics and attachment patterns may have influenced maladaptive patterns10.

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Sources

1. Tennov, D. (1998). Love and limerence: The experience of being in love. Chelsea, MI: Scarborough House.

2. Doron, G., Derby, D. S., Szepsenwol, O., & Talmor, D. (2012a). Tainted love: Exploring relationship-centered obsessive-compulsive symptoms in two non-clinical cohorts. Journal of Obsessive-Compulsive and Related Disorders, 1(1), 16-24.

3. Doron, G., Derby, D. S., Szepsenwol, O., & Talmor, D. (2012b). Flaws and all: Exploring partner-focused obsessive-compulsive symptoms. Journal of Obsessive-Compulsive and Related Disorders, 1(4), 234-243.

4. Wakin, A., & Vo, D. B. (2008). Love-variant: The Wakin-Vo I.D.R. Model of Limerence. In Interdisciplinary–Net. 2nd Global Conference; Challenging Intimate Boundaries.

5. Willmott, L., & Bentley, E. (2015). Exploring the lived-experience of limerence: a journey toward authenticity. The Qualitative Report, 20(1), 20-38.

6. Doron, G., Szepsenwol, O., Karp, E., & Gal, N. (2013). Obsessing about intimate-relationships: Testing the double relationship-vulnerability hypothesis. Journal of behavior therapy and experimental psychiatry, 44(4), 433-440.

7. Fisher, H. (2000). Lust, attraction, attachment: Biology and evolution of the three primary emotion systems for mating, reproduction, and parenting. Journal of Sex Education and Therapy, 25(1), 96-104.

8. Koran, L. M., Hanna, G. L., Hollander, E., Nestadt, G., & Simpson, H. B. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. The American Journal of Psychiatry, 164(7), 1.

9. Doron, G., & Derby, D. (2017). Assessment and treatment of relationship-related OCD symptoms (ROCD): a modular approach. In J. Abramowitz, D. McKay, & E. Storch (Eds.), The Wiley Handbook of Obsessive Compulsive Disorders (pp 547-564). Hoboken, NJ: Wiley-Blackwell.

10. http://limerence.net/limerence-faq/limerence-treatment.html

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