Identifying the Harms Experienced by Married Women with Relationship Obsessive– Compulsive Disorder

Identifying the Harms Experienced by Married Women with Relationship Obsessive– Compulsive Disorder | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Identifying the Harms Experienced by Married Women with Relationship Obsessive– Compulsive Disorder Mozhdeh Zarifi, Marieh Dehghan Menashadi, Mohammad Hossein Fallah This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8407007/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Marriage can be significantly strained in the presence of Relationship Obsessive–Compulsive Disorder (ROCD), where intrusive doubts and compulsive cognitive patterns disrupt emotional security and marital functioning. Women with ROCD often experience chronic uncertainty, excessive comparison, and emotional dysregulation, leading to relational detachment, compensatory strategies, and maladaptive meaning-making. Examining these experiences qualitatively provides insight into how ROCD shapes marital difficulties within cultural contexts such as Iran. Therefore, this study aimed to explore the phenomenology of marital challenges among married women with ROCD in Bandar Abbas (2023–2024), within the framework of socio-cultural influences shaping cognitive-emotional experiences. This study employed a qualitative phenomenological approach to explore marital difficulties among married women with ROCD in Bandar Abbas (2023–2024). Eleven participants were purposefully selected from counseling centers based on inclusion and exclusion criteria and interviewed using semi-structured interviews until data saturation was reached. Interviews were audio-recorded, transcribed verbatim, and analyzed using interpretive phenomenological analysis. Credibility and trustworthiness were ensured through member checking, peer debriefing, and reflexive practices.The analysis identified eight main themes, twenty-three subthemes, and fifty-eight semantic units: (1) Intrapersonal Cognitive Experiences (chronic doubt and need for certainty, obsessive rumination, polarized thinking and negative bias, suspicious interpretations); (2) Emotional and Psychological Disturbance (helplessness and emotional deprivation, relational depression and psychological exhaustion, self-blame and worthlessness); (3) Marital Intimacy and Affectional Frustration (emotional rejection and coldness, chronic communicative failure, frustration in receiving affection and support); (4) Family and Environmental Pressures (spouse’s family interference, hasty decisions under pressure, social pressure and cultural judgment); (5) Interpersonal Conflicts and Dysfunctional Interactions (dominance and control, humiliation and chronic blame, lack of participation); (6) Maladaptive Coping Strategies and Emotion Regulation (psychological avoidance and suppression, compensatory behaviors, hope for external intervention); (7) Comparison and Regret Regarding Marital Choice (comparison with others, regret over marital choice); and (8) Searching for Alternative Sources of Meaning (meaning-making through the child, meaning-making through individual independence, meaning-making through adaptation). These themes illustrate how obsessive doubts, emotional dysregulation, familial and social pressures, and maladaptive coping strategies collectively erode relational trust, emotional security, and marital cohesion. The findings highlight the need for culturally sensitive interventions that address cognitive distortions, emotional regulation, communication, and meaning-making to improve marital functioning and relational resilience among women with ROCD. Relationship Obsessive–Compulsive Disorder marital difficulties women’s experiences qualitative phenomenology 1. Introduction Obsessive–Compulsive Disorder (OCD) is a debilitating psychological condition characterized by intrusive thoughts and repetitive, compulsive behaviors, encompassing dimensions such as fear of contamination, repeated checking, or an excessive need for order (1). In recent years, researchers have increasingly focused on a subtype known as Relationship Obsessive–Compulsive Disorder (ROCD), in which obsessive thoughts and compulsive behaviors are directed toward close interpersonal relationships, particularly romantic and marital relationships (2). ROCD has been studied as a distinct subgroup within OCD (3). Over the past decade, a growing body of empirical research has systematically examined intimate relationships as an additional focus of obsessive concerns in OCD (3, 4). Symptoms of ROCD often manifest as intrusive thoughts (e.g., “Is my partner the right person?”) and mental images (e.g., the partner’s face), but they can also appear as compulsive urges (e.g., the urge to leave one’s current partner) (5). ROCD may affect various types of intimate relationships, including romantic, parent–child, teacher–student, or even divine relationships (6). In ROCD, the focus of obsessive–compulsive symptoms may be either the relationship itself (relationship-centered) or the partner (partner-centered) (6). Relationship-centered ROCD may involve preoccupations with one’s own feelings toward the partner, the partner’s feelings, and, more broadly, concerns about the “rightness” of the relationship experience (7). A central feature of ROCD is persistent doubts and concerns about various aspects of the marital relationship, including the extent of love for the spouse, partner attractiveness or worthiness, marital compatibility, or even the appropriateness of the relationship choice itself (8, 9). These doubts frequently compel individuals to engage in compulsive behaviors aimed at reducing anxiety and resolving uncertainty. Such behaviors include repeated reassurance-seeking from the spouse, consulting multiple sources for validation, comparing one’s relationship with others, checking personal feelings toward the partner, or avoiding relationship-related situations (10). While these behaviors may provide temporary relief, they ultimately perpetuate and intensify the cycle of obsession and compulsion, eroding marital stability over time (11). Despite growing attention to ROCD in recent years, it has not yet been recognized as a distinct diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and may often be overlooked or misdiagnosed in clinical settings (5). Consequently, affected individuals—especially married women—may experience years of unmet intervention and struggle with the personal and relational consequences of the disorder. In societies where gender roles and cultural norms strongly structure marital relationships, married women with ROCD are exposed to multifaceted vulnerabilities. In many cultures, including Iran, women play central roles in maintaining family cohesion, managing emotional relationships, and ensuring family psychological security. In this context, the emergence of doubts and obsessive behaviors within marriage threatens not only individual mental health but also marital stability and family functioning. Social pressures to maintain the appearance of marriage, traditional expectations of spousal roles, and fear of stigma in conservative cultural settings may intensify these women’s psychological experiences. In the Iranian cultural context, where marital relationships are strongly associated with expectations of commitment, fidelity, and women’s role fulfillment, ROCD symptoms may be experienced more acutely, and women may hesitate to express concerns or seek specialized help. Previous research has shown that ROCD symptoms are associated with reduced emotional intimacy and marital satisfaction, increased marital conflict, and a heightened sense of relational inadequacy (8, 12). For example, perfectionism and catastrophic beliefs such as “being in the wrong relationship” or “never finding a better partner” are identified as factors contributing to the persistence of this disorder (3). However, most findings originate from quantitative studies in Western contexts, and qualitative investigations into the lived experiences of affected women—particularly in non-Western societies—remain limited. Existing research on ROCD is still sparse and primarily emphasizes psychological aspects related to its onset and consequences. Findings indicate that individuals with ROCD report higher levels of relational obsessions and depressive symptoms compared with those with general OCD (5). Doron et al. (13) also found that symptom severity—whether relationship-centered or partner-centered—was associated with reduced sexual satisfaction, increased self-reported worries, and intensified depressive symptoms, with relationship satisfaction mediating the link between symptoms and sexual satisfaction. Brandes et al. (4) showed that, in the partner-centered subtype, distrust of the partner is a key factor in maintaining the disorder. Moreover, unlike general OCD, ROCD is strongly associated with perfectionism and catastrophic beliefs regarding romantic relationships. Melli et al. (3) emphasized the role of such beliefs in the formation and persistence of the disorder, reporting that concerns about “being in the wrong relationship” or “never finding a better partner” significantly predict relationship-centered and partner-centered symptoms. Despite these findings, most studies have employed quantitative approaches in Western populations, with few qualitative studies exploring the lived experiences of affected individuals in different cultural contexts. Qualitative research can provide deeper insights into how cultural norms, values, and expectations influence the experience and maintenance of ROCD and inform the design of culturally sensitive interventions. In the Iranian cultural context, where marital relationships are strongly shaped by expectations of commitment, fidelity, and women’s role fulfillment, investigating the experiences of affected women is particularly important. Identifying the types and dimensions of marital harms experienced by these women can guide the development of more personalized and contextually appropriate therapeutic programs. Therefore, the present study adopts a qualitative approach to answer the following research question: What are the marital harms experienced by married women with Relationship Obsessive–Compulsive Disorder? 2. Method 2.1. Participants This study employed a qualitative research design using a thematic analysis approach to examine marital difficulties among married women with relationship obsessive–compulsive disorder (ROCD) in Bandar Abbas during 2023–2024. The research population included all married women diagnosed with ROCD in Bandar Abbas. Participants were purposefully selected from counseling and psychological centers that provide services to individuals and couples with obsessive–compulsive symptoms. Sampling continued until data saturation was reached, meaning that no new concepts or themes emerged from the interviews (14). Ultimately, 11 married women meeting the diagnostic criteria for ROCD were included. The inclusion criteria were: (a) being female and married for at least five years; (b) having at least a primary school education; (c) obtaining a score above the cutoff point (21.5) on the Relationship Obsessive–Compulsive Inventory (ROCI; (6); (d) meeting the DSM-5 diagnostic criteria for obsessive–compulsive disorder through a clinical interview; and (e) providing written informed consent to participate. Exclusion criteria included: (a) being divorced or in the process of separation; (b) suffering from severe psychiatric disorders (e.g., schizophrenia or bipolar disorder); (c) showing acute psychological symptoms (e.g., severe anxiety or depression) that interfered with participation; (d) currently taking psychiatric medications or undergoing psychotherapy; and (e) having severe physical disabilities or major changes in marital status during the research period. To ensure maximum diversity, participants were selected to represent variations in age, education, employment status, marriage duration, number of children, kinship with spouse, and prior psychotherapy experience. Sampling continued until data saturation was reached—that is, when no new concepts or themes emerged from subsequent interviews (14). Ultimately, 11 married women who met the diagnostic and inclusion criteria were included in the final sample. 2.2. Procedure The aim of this research was to examine the marital difficulties and relationship-related obsessive–compulsive symptoms experienced by married women. Following ethical approval and institutional permissions, the researcher visited selected counseling centers, introduced the study, and obtained written informed consent from eligible participants. Based on the inclusion and exclusion criteria qualified participants were invited to take part in semi-structured interviews. All interviews were conducted in private counseling rooms to ensure confidentiality and provide a comfortable, nonjudgmental environment. The interviews were conducted in Persian, the participants’ native language, without the need for a translator. A single researcher, a psychologist with specialized expertise in marital and obsessive–compulsive issues, conducted all interviews. Given the small sample size and the study’s focus on in-depth exploration of participants’ experiences, having one trained interviewer was appropriate. To ensure reliability and trustworthiness, the coding and theme development were independently reviewed by a qualitative research expert, thereby maintaining objectivity and methodological rigor. The first researcher, a psychologist with specialized experience in marital and obsessive–compulsive issues, conducted all interviews. Each interview lasted approximately 45–60 minutes and began with open-ended questions such as: “Can you describe your relationship with your spouse and how it has changed over time?” “What kinds of obsessive thoughts or doubts do you typically experience about your relationship?” “How do these thoughts affect your emotions and daily functioning?” “What strategies have you used to manage or control these thoughts?” Probing questions (e.g., “Can you explain more about that?”) were used to obtain more detailed responses. All interviews were audio-recorded with participants’ consent and transcribed verbatim immediately afterward. Field notes were also taken to document nonverbal cues and contextual details. To maintain objectivity and reduce potential bias, the researcher reflected on personal assumptions and theoretical preconceptions throughout the study. Peer discussions and reflective journaling were employed during data collection and analysis to enhance rigor and ensure the findings accurately represented participants’ reports. 2.3. Materials 2.3.1. Relationship Obsessive–Compulsive Inventory (ROCI; (6) : The ROCI is a 12-item instrument designed to assess the severity of ROCD symptoms across three domains: love for partner, rightness of relationship, and loving the partner. Items are rated on a 5-point Likert scale (0 = not at all to 4 = very much). The total score reflects the overall intensity of relationship-related obsessive–compulsive symptoms. Previous studies have reported excellent internal consistency (α = 0.81–0.93; (3). In the present study, Cronbach’s alpha was 0.88 based on a pilot sample of 70 individuals. The ROCI was used solely as a screening tool to determine participant eligibility rather than as a primary source of data. 2.4. Data Analysis Data analysis was conducted concurrently with data collection using Braun and Clarke’s (15) six-step framework for thematic analysis. All interview transcripts were read multiple times to achieve full familiarity with the content and ensure immersion in the data. Meaning units were identified, coded, and initially organized into preliminary categories. The interview transcripts were thoroughly reviewed by the single researcher who conducted the interviews. Meaning units were identified, coded, and initially organized into preliminary categories. To ensure reliability and trustworthiness, the coding and theme development were independently reviewed by a qualitative research expert, providing verification and feedback to maintain objectivity and methodological rigor. Through an iterative process of comparison and refinement, preliminary categories were grouped into subthemes and subsequently consolidated into overarching main themes that captured the central patterns of participants’ reports regarding marital difficulties and ROCD symptoms. As new data were collected, previously identified themes were refined and new insights were incorporated. To ensure coherence and robustness, the transcripts and codes were revisited multiple times, integrating the analytic summaries into a comprehensive framework that reflected shared patterns across participants. During the analysis, unrelated or redundant themes were discarded, while the relationships between categories were examined through continuous comparison and conceptual reasoning. 2.4.1 Validation and Coding Reliability To ensure trustworthiness, the study adhered to Lincoln and Guba’s (16) four criteria: Credibility: Achieved through prolonged engagement with participants, member checking (participant validation), and peer debriefing. Transferability: Ensured by providing detailed descriptions of participants, context, and data collection procedures to facilitate comparison across settings. Dependability: Maintained through transparent documentation of all analytic steps and external auditing by qualitative research experts. Confirmability: Secured by maintaining an audit trail, conducting independent code verification, and using reflexive journaling to minimize researcher bias. Follow-up interviews were also conducted with three participants to confirm the stability and accuracy of the extracted themes. 2.6. Ethical Considerations The study was approved by the Ethics Committee of Islamic Azad University, Yazd Branch (Approval Code: IR.IAU.YAZD.REC.1404.044). Participation was entirely voluntary, and participants were informed about the study’s objectives, confidentiality, and their right to withdraw at any stage. Pseudonyms were used in all transcripts and reports to protect identity and privacy. 3. Findings The study participants included 11 married women diagnosed with relationship obsessive–compulsive disorder (ROCD) in Bandar Abbas. Participants were selected based on the study’s inclusion and exclusion criteria and represented a diverse range of ages, education levels, employment statuses, marriage durations, number of children, kinship with spouse, and prior psychotherapy experiences, as detailed in Table 1. This diversity provided a broad spectrum of experiences, enriching the thematic analysis of marital difficulties and ROCD-related impairments. Table 1. Demographic Characteristics of the Participants In line with the research question—“What are the harms experienced by married women with relationship obsessive–compulsive disorder?”—the interviews were analyzed using thematic analysis. This process resulted in the identification of 8 main codes and 24 sub-codes, as summarized in Table 2 . Table 2 Core Themes and Sub-Themes Related Main Themes Sub-Themes Semantic Units Individual Experiences Intrapersonal Cognitive Experiences Chronic doubt & need for certainty Persistent doubt about the continuation of the relationship, anxiety, and uncertainty in marital decision-making, chronic anxiety stemming from rumination and doubt “I constantly ask myself whether I made the right decision marrying him. I just wish someone could guarantee that our future will be okay so this anxiety would finally stop.” Obsessive rumination Negative revisiting of the past, intrusive thoughts, and obsessive thinking about the adequacy of the relationship “I keep replaying things he said in the past and overanalyzing them, as if they might prove the relationship was never right.” Polarized thinking & negative bias Polarized and black-and-white thinking, mental focus on negative evidence (negative bias), excessive cognitive sensitivity to partner’s flaws “If he seems distant, my mind immediately goes to extremes—either everything is perfect or our marriage is a complete failure.” Suspicious interpretations Need to understand others’ hidden motives, negative interpretation of neutral behaviors, reinforcement of cognitive doubt in the relationship “When he takes too long to respond to my messages, I start thinking he might be hiding something or someone else has become more important.” Emotional & Psychological Disturbance Helplessness & emotional deprivation Feelings of helplessness, psychological despair, chronic hopelessness regarding the future of the relationship “I feel emotionally abandoned in this marriage, as if no matter how hard I try, I can’t find a place of comfort or safety.” Relational depression & psychological exhaustion Reduced overall functioning, lack of motivation/willingness to engage in activities, and chronic emotional exhaustion “I’ve lost the motivation to even carry out daily tasks; it feels like the relationship has drained me completely.” Self-blame & worthlessness Self-blame, feelings of inadequacy, reduced self-confidence, and future-related anxiety stemming from self-blame “Whenever something goes wrong between us, I automatically blame myself and feel like I’m not good enough to sustain a healthy relationship.” Marital Intimacy & Affectional Frustration Emotional rejection & coldness Emotional rejection, persistent lack of care, emotional distancing, relational coldness, and failure to receive emotional responsiveness in situations requiring support “When I am upset, he doesn’t even acknowledge my feelings; the emotional coldness makes me feel invisible.” Chronic communicative failure Failure of verbal communication, avoidance of dialogue, suppression of conflict, mismatched communication styles between spouses, and inability to resolve conflicts “Whenever I try to talk about issues, the conversation shuts down or turns into an argument, and eventually I just stop talking.” Frustration in receiving affection & support Dissatisfaction with receiving emotional support from the spouse, failure to receive emotional support from the family of origin, failure to obtain emotional validation, and lack of responsiveness in critical situations “Even in moments when I desperately need emotional support, neither he nor his family offers any reassurance or validation.” Family & Environmental Pressures Spouse’s family interference Interference of the spouse’s family in marital life, family pressure on life decisions, lack of family boundary-setting, and involvement in child-rearing practices “His mother constantly interferes in our parenting decisions, and he always sides with her, which makes me feel undermined.” Hasty decisions under pressure Spousal choice under traditional pressure, hasty pre-marriage decisions, and decision-related anxiety in youth “Back then, everyone kept saying I was getting older and needed to marry quickly, so I rushed into it without fully thinking it through.” Social pressure & cultural judgment Compulsion to maintain marital appearances, social judgment, fear of judgment following divorce, cultural pressures, and enforced silence of women “Even though I’m unhappy, I continue the marriage out of fear of being judged by society if I were to divorce.” Interpersonal Conflicts & Dysfunctional Interactions Dominance & control Psychological control, pressure to comply, restriction of autonomy, and unilateral decision-making “He expects everything to be done his way and doesn’t allow me to make decisions, even about my personal life.” Humiliation & chronic blame Persistent blame, labeling, character humiliation, violation of respect, and invalidation of individual emotions “Whenever a problem arises, he immediately blames me and says I can’t do anything right.” Lack of participation Low participation in household affairs, lack of division of parental roles, pressure of traditional roles, imposition of caregiving burden on the woman, spousal behavioral indifference, and chronic fatigue of the woman in family responsibilities “I handle all household tasks and childcare alone; he shows no involvement and just assumes everything will be taken care of.” Maladaptive Coping Strategies & Emotion Regulation Psychological avoidance & suppression Emotional avoidance, self-censorship, suppression of emotional needs, and emotional silence “When I’m hurt, I stay silent to avoid conflict and keep everything bottled up inside.” Compensatory behaviors Avoidant and compensatory behaviors, such as excessive work, substitute hobbies, and solitary soothing activities “To escape from the emotional pain, I distract myself with work or mindless phone scrolling so I don’t have to feel it.” Hope for external intervention Hope for pharmacological treatment, psychotherapy, professional assistance, and seeking psychological help “Sometimes I think maybe a therapist or medication could fix things between us because I can’t do it alone anymore.” Comparison & Regret Regarding Marital Choice Comparison with others Repeated comparison with others, reduced marital satisfaction, and feelings of relative deprivation “Seeing other couples express affection and mutual care often leads me to feel that my own relationship is lacking, which strengthens my doubts about my marital choice.” Regret over marital choice Regret over marriage, sense of having made the wrong partner choice, and remorse over missed opportunities for a better marital match “There are times when I feel that if I had waited longer, I might have found someone who was a better match for me.” Searching for Alternative Sources of Meaning Meaning-making through the child Emotional reliance on the child, compensatory maternal role “I’ve started pouring all my emotional energy into my child—being a caring mother feels like the only place where I can still feel needed and emotionally connected.” Meaning-making through individual independence Individual empowerment outside the marital relationship, work, education, and personal growth to compensate for emotional void “I focus on my career and education because investing in myself gives me a sense of strength and purpose that I don’t find in my marriage.” Meaning-making through adaptation Efforts to justify the marriage, acceptance of existing conditions, and focusing on minimally positive aspects to continue the relationship “To keep going, I try to focus on the few stable or practical aspects of our life together and convince myself that staying is still better than starting over.” Table 2 . Main Codes and Sub-Codes Related to the Harms Experienced by Married Women with ROCD The findings are presented below, with each sub-code illustrated by participant statements to provide clarity and depth to the analysis of the participants’ experiences. Intrapersonal Cognitive Experiences in ROCD Intrapersonal cognitive factors play a crucial role in shaping the experiences of married women with Relationship Obsessive-Compulsive Disorder (ROCD). These factors encompass persistent doubts, rumination, cognitive biases, and obsessive interpretations that directly influence perceptions of the partner, relationship quality, and marital stability. One of the most prominent cognitive features is chronic doubt and the need for certainty . Individuals frequently engage in persistent questioning about the appropriateness of their partner, the correctness of marital decisions, and the sustainability of the relationship. Even when objective evidence indicates stability or satisfaction, the mind repeatedly returns to suspicion and uncertainty. As one participant reported: “Even after months together, I keep questioning if he truly loves me or if I just imagined it. I feel like I can’t trust my own judgment.” (Participant 4) A second central factor is obsessive rumination and negative revisiting of past experiences . This involves repetitive, involuntary review of previous interactions, perceived mistakes, or partner behaviors. Rumination is not problem-solving oriented; rather, it maintains and intensifies anxiety by keeping the individual cognitively stuck in the past. For example, a participant stated: “I go over every conversation we had last week, trying to spot mistakes I made. My mind won’t stop analyzing.” (Participant 7) The third key cognitive dimension is polarized thinking and negative bias . Participants often evaluate their partner and the relationship in black-and-white terms, exaggerating negative aspects while minimizing or ignoring positive traits. This cognitive distortion restricts flexibility and amplifies perceived relational failures. One participant described: "I tell myself it’s either perfect or it’s completely wrong. When he makes a mistake, I feel like the whole relationship is failing." (Participant 3) Finally, excessive and suspicious interpretations represent another critical theme. Individuals tend to interpret neutral or ambiguous partner behaviors as indicative of hidden motives or negative intentions, which reinforces cognitive doubt and distrust. As one participant explained: "When he does something neutral, I immediately wonder if he’s trying to upset me or hide something. I never feel sure about his intentions." (Participant 9) Overall, these intrapersonal cognitive experiences reflect a pattern of cognitive insecurity, hypervigilance to relational flaws, and obsessive need for control over thoughts related to the partner and marriage. These patterns not only maintain anxiety and rumination but also negatively impact marital functioning and emotional well-being. The findings are consistent with international research on ROCD, providing culturally relevant insights into the cognitive mechanisms underlying obsessive relational concerns in married women. Emotional and Psychological Disturbance Emotional and psychological disturbance refers to a pervasive state of affective instability, psychological tension, and impaired emotional regulation experienced by married women with ROCD. Within the marital context, this disturbance manifests through simultaneous and conflicting emotions such as love, anger, sadness, fear, and despair, accompanied by rapid mood fluctuations, frustration, and difficulty restoring emotional balance. Even minor relational issues may trigger disproportionate emotional reactions, leading to a persistent sense of internal chaos and psychological distress. Helplessness and emotional deprivation represent a psychological state in which individuals perceive themselves as trapped in an unchangeable relationship with minimal control over improving the situation. Participants expressed a sense of being caught in a relational dead end, where continuous conflicts and unresolved emotional tensions foster feelings of hopelessness and isolation. Over time, the perceived lack of supportive emotional resources from the partner or significant others deepens the experience of inner loneliness and deprivation, even in the physical presence of others. As one participant stated: “I feel trapped… like no matter what I do, nothing will change, and nobody truly understands me.” (Participant 6) Relational depression and psychological exhaustion reflect a progressive depletion of emotional, cognitive, and motivational resources due to prolonged exposure to unresolved relational distress and repetitive cognitive rumination. This experience extends beyond temporary sadness and evolves into chronic emotional fatigue, diminished motivation, and reduced overall functioning. Participants described difficulty engaging in everyday tasks and a pervasive sense of heaviness and mental burden. One participant explained: “Even making breakfast feels like a mountain I can’t climb. I have no energy for anything anymore.” (Participant 1) These experiences illustrate how ongoing conflict and repetitive emotional rumination progressively erode psychological energy, leading to chronic emotional burnout and reduced functioning. Self-blame and feelings of worthlessness emerge when individuals internalize relational problems and attribute conflicts, emotional distance, or perceived failures in the relationship to their own inadequacies. Participants reported engaging in continuous self-criticism, questioning their competence as a partner, and doubting their ability to maintain a healthy relationship. As one participant reflected: “ I keep thinking maybe I was too sensitive, too demanding… maybe I’m the reason everything went wrong .” (Participant 2) This internalized self-criticism fosters guilt, insecurity, and anxiety about the future, while gradually eroding self-esteem and self-confidence. Over time, this cognitive-emotional spiral leads to a stable sense of personal deficiency, reinforcing emotional vulnerability and diminishing resilience when facing relational challenges. Over time, this internalized self-blame evolves into a stable sense of unworthiness and incompetence, undermining both emotional well-being and the capacity to cope effectively with relational stress. Overall, emotional and psychological disturbance among married women with ROCD reflects a complex interplay of helplessness, exhaustion, and self-devaluation. These interconnected processes maintain a self-perpetuating cycle of emotional suffering, diminishing resilience and impairing marital functioning. The findings are consistent with international evidence emphasizing the central role of emotional dysregulation and self-critical cognition in sustaining obsessive relational distress, while offering culturally nuanced insight into the affective mechanisms underlying ROCD in married women. Marital Intimacy and Affectional Frustration Marital intimacy and affectional frustration in women with ROCD refer to a chronic emotional disconnection in marital life, where individuals consistently fail to achieve the desired psychological closeness, mutual empathy, and emotional responsiveness. In these relationships, although the marriage may appear outwardly intact, it is internally devoid of warmth, emotional security, and a sense of belonging. This deprivation of affection not only fosters loneliness but gradually undermines the individual’s perception of the relationship’s value and her self-worth, reinforcing negative cognitive appraisals about marriage and partner choice. Several emotional mechanisms operate within this process. First, emotional rejection and coldness emerge, manifesting as persistent neglect and lack of emotional responsiveness from the spouse, leading to a continuous experience of emotional invisibility. Second, chronic communicative failure occurs, characterized by blocked emotional dialogue and avoidance of meaningful conversation, causing unresolved conflicts to accumulate beneath the surface of the relationship. Third, frustration in receiving affection and support reflects insufficient emotional responsiveness from both the partner and the family of origin, intensifying the individual’s psychological loneliness and sense of helplessness. Together, these mechanisms gradually transform the relationship into a space dominated by silence, emotional coldness, and isolation. Emotional rejection and coldness refer to a persistent state in which one partner feels consistently ignored and deprived of necessary emotional and affectionate responses. While the marriage may continue physically, it becomes emotionally dry and disconnected. Over time, the individual experiences emotional vulnerability and gradually perceives herself as alone within the marital relationship. Even in situations requiring emotional support, such as illness, family crises, or psychological distress, the spouse’s responses are minimal or absent. This pattern is characterized by insufficient emotional responsiveness to expressed needs, emotional distancing that fosters avoidance, and heightened sensitivity to perceived neglect, where even minor lack of affection is interpreted as emotional abandonment. This negative feedback cycle gradually transforms the relationship into one marked by emotional coldness and insecurity. As one participant shared: “ He hugs me rarely, and when he does, it feels forced. I feel invisible even when he’s near.” (Participant 9) Such ongoing indifference created an emotional void that gradually turned intimacy into detachment and companionship into solitude. Over time, both partners became disengaged from attempts at repair, reinforcing a cycle of emotional withdrawal and perceived rejection. Chronic communicative failure in ROCD couples refers to a persistent pattern of blocked communication, avoidance of meaningful emotional interactions, and inability to manage emotional needs through dialogue. The relationship shifts toward silence, withdrawal, and communicative isolation. Attempts to express needs or resolve conflicts often evoke prior negative experiences, such as indifference, neglect, or perceived futility, leading to chronic avoidance of conversation. Attempts to express needs or resolve conflicts often evoke prior negative experiences, such as indifference, neglect, or perceived futility, which in turn lead to avoidance of dialogue, suppression of conflict to maintain superficial harmony, mismatched communication styles that cause misunderstandings, and a chronic inability to resolve daily conflicts. This pattern diminishes effective emotional exchange and trust, fostering obsessive doubts and mental rumination characteristic of ROCD. One woman explained: “I stopped sharing my feelings because he never listens. Silence feels safer than disappointment.” (Participant 2) This chronic silence eroded mutual understanding and trust, leaving conflicts unresolved and emotions unexpressed. Suppressed disagreements accumulated beneath the surface, creating an atmosphere of tension masked by routine stability. The inability to communicate emotional needs effectively reinforced feelings of disconnection and intensified the cognitive doubts characteristic of ROCD. Frustration in receiving affection and support Frustration in receiving affection and support refers to the experience of emotional deprivation, particularly in marital relationships affected by ROCD, where the individual feels unable to receive sufficient affectionate, caring, and validating responses from the partner or family of origin. This deprivation extends beyond lack of affection to include absence of support during psychological stress, inadequate assistance in marital pressures, and feelings of helplessness in crises. In such circumstances, the spouse’s chronic lack of emotional responsiveness during vulnerable moments, combined with inadequate support from the family of origin and a failure to receive emotional validation, leads to persistent feelings of invisibility and worthlessness. Repeated experiences of unmet emotional needs weaken the individual’s trust in the relational support system, fostering chronic emotional insecurity. One participant expressed: “Even when I’m upset, he ignores me. I feel alone in handling everything.” (Participant 8) Such dual deprivation—within the marital bond and from external sources—intensified participants’ sense of abandonment and helplessness. The absence of emotional refuge contributed to a deepening belief that no reliable source of comfort or understanding existed, further amplifying obsessive doubts about the relationship. Family and Environmental Pressures Family and environmental pressures encompass external factors beyond the marital relationship that significantly influence marital quality and the psychological experiences of individuals within the relationship. These pressures often manifest as interference from the spouse’s family, hasty decisions driven by expectations of the family of origin or traditional norms, and social or cultural judgments regarding the preservation of marital appearances. In such contexts, women experience not only the relational tensions inherent to their partnership but also the evaluative scrutiny of families and society, frequently compelling them to remain silent or tolerate difficult circumstances to avoid external blame. These external pressures elevate psychological stress and limit autonomous, rational decision-making within the marriage. Experiencing these pressures often constrains a woman’s sense of choice and independence, restricting realistic evaluation and assertive decision-making regarding the relationship. Women may feel solely responsible for maintaining the appearance of the marriage, with any attempt to modify or exit the relationship potentially resulting in social or familial censure. Interference from the spouse’s family undermines marital boundaries, reduces opportunities for relational repair, and, through favoritism or partiality, places additional psychological strain on the woman. Marriage decisions made under such external pressures often occur without sufficient opportunity for partner evaluation, leaving women vulnerable to regret and dissatisfaction when relational conflicts arise. Persistent exposure to these environmental pressures complicates conflict resolution processes and reinforces a cycle of marital tension. Spouse’s family interference reflects patterns in which marital boundaries are consistently violated by the spouse’s family, resulting in excessive influence over decisions, parenting practices, and private matters. Such interference diminishes the couple’s autonomy and transforms the marital space into one dominated by external control. Although often framed as “concern” or “advice,” these interventions undermine the marital structure. Husbands frequently remain passive or side with their families, rather than defending marital boundaries, leaving women without emotional support when needed. Consequently, women experience heightened vulnerability, diminished psychological security, and feelings of powerlessness. Women reported that major decisions, including finances, living arrangements, child-rearing, and conflict management, were frequently dictated by the spouse’s family. Husbands’ emotional dependence on their families or adherence to traditional norms often prevented them from intervening, intensifying women’s psychological burden. Participants described repeated experiences of judgment, criticism, imposition of opinions, and occasional overt or covert humiliation by the spouse’s family, which gradually eroded self-esteem and emotional security. Qualitative analysis revealed that key concepts, such as “spouse’s family interference in marital life,” “family pressure on life decisions,” “lack of family boundary setting,” and “interference in child-rearing,” were consistently reported. Illustrative statements include: “His family determines how the children are raised.” (Participant 4) Hasty decisions under pressure describe processes in which marriage is entered prematurely under external influence, without sufficient opportunity for partner evaluation, realistic assessment, or psychological preparedness. Traditional expectations, familial pressures, cultural norms, and fear of missed opportunities often lead women to commit without fully understanding relational compatibility. These rushed decisions can later generate regret, doubt, and a sense of erroneous choice as deeper relational and personal challenges emerge. Women described being subjected to explicit and implicit pressures during early marital decision-making, including expectations to marry at a socially acceptable age, comparisons with peers, and anxiety about future opportunities. Fear of parental disapproval or social labeling, coupled with hope that post-marriage problems could be resolved, contributed to premature commitment. Such choices often became sources of ongoing rumination, regret, and feelings of entrapment, forming a foundation for emotional and cognitive disturbances within the marriage. Participants highlighted repeated concepts such as “marital choice under traditional pressure,” “hasty pre-marriage decision,” and “decision anxiety in youth.” Illustrative statements include: “I decided too soon because my family was worried.” (Participant 9) Social pressure and cultural judgment refer to the psychological burden arising from societal norms, traditional expectations, and judgmental scrutiny, which compel women to conceal marital difficulties, remain silent, or project an image of a successful marriage. This pressure reduces opportunities for open communication with family, friends, or professionals and forces women into adaptive behaviors aimed at avoiding social stigma. Divorce is frequently perceived as failure, causing women to feel threatened even when expressing needs or complaints. This judgmental context limits psychological recovery, transforming distress into a silent, internalized experience. Women reported encountering responses emphasizing the continuation of the marriage regardless of personal suffering, such as “You must endure,” “All men are the same,” or “Don’t separate because of the children.” Such responses invalidate the woman’s experiences and restrict independent decision-making. Fear of social judgment following separation or complaints promotes emotional self-censorship, denial of feelings, acceptance of imposed roles, and chronic concealment. Many participants emphasized that, even during severe marital distress, fear of familial or societal condemnation prevented disclosure or help-seeking. Illustrative statements include: “No one understands my pain; they just want me to preserve my life.” (Participant 5) These narratives reveal how cultural and social pressures systematically silence women, maintaining marital appearances at the cost of psychological well-being and sustaining prolonged relational distress. Interpersonal Conflicts and Dysfunctional Marital Interactions Interpersonal conflicts and dysfunctional marital interactions reflect entrenched patterns of maladaptive and unequal exchanges within the daily lives of couples in which dominance, psychological control, criticism, and chronic blame become defining features of the relationship. Unlike emotional withdrawal or communicative silence—where disconnection occurs passively—these interactions involve active, damaging dynamics that expose one or both partners to persistent power imbalance, disrespect, and emotional invalidation. Among married women with Relationship Obsessive-Compulsive Disorder (ROCD), such maladaptive cycles frequently manifest through recurring episodes of control, humiliation, avoidance of cooperation, and neglect of emotional needs. Within these relationships, couples fail to engage in mutual emotional regulation, resorting instead to defensive interpersonal mechanisms such as angry outbursts, unilateral decision-making, imposition of rigid traditional roles, and the withdrawal of behavioral support. These maladaptive exchanges not only obstruct constructive dialogue but gradually foster feelings of helplessness, emotional fatigue, and chronic rejection in the female partner. Over time, the relationship evolves into a chronically dysfunctional interpersonal environment characterized by low cooperation, indifference, and recurrent violations of emotional and psychological boundaries. Dominance and Control emerged as a central interpersonal mechanism within these dynamics. Participants described how their husbands sought to exert control over emotional, behavioral, and even social domains of their lives, progressively eroding their autonomy and sense of agency. Control manifested both overtly—through direct restrictions, unilateral decisions, or explicit behavioral monitoring—and covertly, through psychological pressure, subtle coercion, and emotional withdrawal in response to noncompliance. As one participant explained: “He decides all family plans without asking me. I feel like I don’t exist in our own home.” (Participant 2) Such dynamics fostered a relationship climate governed by authority rather than collaboration. Over time, women internalized the belief that resisting control would lead to conflict, resulting in emotional resignation and silent compliance. The cumulative loss of personal freedom produced a sense of psychological exhaustion and diminished ownership over one’s own life. Humiliation and Chronic Blame represented another pervasive interactional pattern, where emotional communication became dominated by criticism, belittlement, and character-based attacks. Instead of receiving validation or empathy, participants reported being repeatedly discredited and emotionally devalued. Spouses often exaggerated minor mistakes, framed disagreements as personal failures, and employed sarcasm or public mockery to undermine the woman’s confidence. As one participant stated: “He criticizes me in front of friends for small mistakes, making me feel worthless.” (Participant 3) This persistent invalidation gradually transformed the marital environment into a psychologically unsafe space, where the woman’s emotional expressions were dismissed as irrational or exaggerated. The erosion of respect replaced emotional support with criticism, leading to chronic self-doubt, internalized guilt, and an enduring sense of unworthiness. Lack of Participation in the Relationship formed the third recurrent interpersonal pattern, encompassing unequal distribution of domestic, parental, and emotional responsibilities. Participants consistently described feeling solely responsible for the maintenance of household routines, childcare, and relational management, while their husbands remained passive or disengaged. One participant expressed: “I do all the cooking, cleaning, and managing the children. He doesn’t help at all.” (Participant 11) The absence of active participation reinforced structural inequality within the relationship, as women bore the full weight of domestic and emotional labor. Simultaneously, the persistence of rigid traditional roles restricted the woman’s capacity for rest, self-care, and personal growth. The cumulative burden of unshared responsibilities contributed to psychological depletion and a growing perception of relational inequity and loneliness. Overall, interpersonal conflicts and dysfunctional marital interactions among married women with ROCD illustrate a complex system of relational pathology in which dominance, emotional degradation, and unilateral engagement intersect to sustain a cycle of distress. These intertwined dynamics diminish psychological safety, undermine emotional reciprocity, and perpetuate the obsessive doubts characteristic of ROCD. The findings highlight how enduring power imbalances and communication failures not only impair marital satisfaction but also exacerbate obsessive relational cognitions. From a therapeutic standpoint, interventions that address power asymmetry, promote assertive communication, and rebuild mutual emotional responsiveness are essential for restoring balance and psychological well-being in these relationships. Maladaptive Coping Strategies and Emotion Regulation Maladaptive coping strategies and emotion regulation patterns describe habitual ways of responding to psychological distress and marital difficulties that, rather than reducing tension or fostering relational repair, maintain or even intensify psychological harm. In these situations, individuals often avoid directly addressing problems or expressing emotions in healthy ways, instead relying on psychological avoidance, self-censorship, emotional suppression, or compensatory behaviors. At times, they relinquish responsibility for change to external sources, hoping for outside intervention. These strategies typically develop as a consequence of repeated relational failures, frustration over a spouse’s lack of change, and limited capacity for emotion regulation within a safe relational context. Although such strategies may provide temporary relief, they ultimately perpetuate distress and reduce psychological flexibility. Women living under these conditions frequently adopt strategies that, although psychologically “less stressful,” are profoundly exhausting. Emotional avoidance and psychological withdrawal often manifest as self-censorship, emotional distancing, and disengagement from relational conflicts. Some turn to compensatory activities, such as shopping, hobbies, child-focused tasks, or excessive housework, to temporarily alleviate distress. Others, hoping for external intervention, delegate responsibility for relational improvement to medication, therapy, or professional help without altering internal or relational patterns. These behaviors function to reduce anxiety and maintain apparent functionality, yet leave the root of relational distress unaddressed. Psychological avoidance and suppression involve internal reactions in which individuals suppress their needs and emotions, avoiding direct engagement with relational challenges. This mechanism usually arises in response to repeated relational failures, emotional unresponsiveness from the spouse, and prior negative experiences, teaching the individual that expressing emotions or needs may be met with neglect, rejection, or blame. To protect themselves from further conflict, emotions and needs are relegated to the background, producing short-term conflict reduction but long-term accumulation of hidden dissatisfaction and psychological distancing. Over time, women internalize the belief that expressing needs or emotions will not elicit a response and may even exacerbate relational tension. Consequently, they refrain from discussing emotions, desires, or grievances, resulting in emotional self-censorship. Even during intense internal suffering, they may present a calm, tension-free exterior to prevent interpersonal escalation. Prolonged cycles of suppression push emotions into deeper layers of consciousness, gradually leading to emotional numbness or psychological withdrawal, impairing both expression and awareness of internal emotional needs. Qualitative data repeatedly highlighted concepts such as emotional avoidance, self-censorship, suppression of emotional needs, and emotional withdrawal. Participants often reported withholding emotional expression to maintain household calm or avoid repeated conflict. Illustrative statements include: “I prefer not to say anything to avoid arguments ” (Participant 8) Compensatory behaviors refer to alternative activities undertaken to temporarily relieve psychological tension, emotional frustration, and suppressed emotions. These actions are not aimed at problem-solving or relational change but serve to manage internal distress, deny crises, or fill emotional voids. Common compensatory behaviors include individual hobbies, excessive work, or overcommitment to household responsibilities. By keeping themselves occupied, women avoid direct engagement with relational conflicts while maintaining an appearance of functional performance, though unresolved emotional pain remains active beneath the surface. When emotional needs remain unmet and opportunities for constructive dialogue are absent, women often seek activities that divert attention from unresolved tension. These may include intensive work, obsessive engagement with household chores, or solitary leisure activities such as reading, cooking, exercising, or social media use. While these behaviors provide temporary distraction and a sense of productivity, they function defensively, preventing confrontation with the underlying issue or expression of genuine needs. Qualitative findings revealed recurring concepts such as alternative activities, soothing solitary activities, and avoidant and compensatory behaviors such as excessive work. Illustrative statements include: “I read or use my phone to avoid thinking about it” (Participant 10). Hope for external intervention refers to a psychological mechanism whereby individuals rely on external sources, such as medication, psychotherapy, or professional support, to cope with relational or emotional difficulties rather than fostering internal change or effective communication. Women in this situation often turn to therapy not necessarily to change their spouse, but to find a safe space for understanding, internal regulation, and guidance for decision-making. In many cases, therapy or consultation emerges as a last resort after repeated relational failures and personal attempts at problem-solving. Following experiences of emotional coldness, rejection, or chronic blame, women seek external sources where they can express themselves without judgment. Some participants hope that therapy or medication will help them manage anxiety or relational stress. Illustrative statements include: “I felt calmer with medication so I could continue” (Participant 11) Comparison and Regret Regarding Marital Choice Comparison and regret regarding marital choice represent a cognitive–emotional pattern through which married women with ROCD retrospectively question the correctness of their marital decision. This theme reflects the pervasive presence of ruminative comparison , idealized counterfactual thinking , and feelings of regret or disappointment about perceived missed opportunities. As dissatisfaction accumulates within the relationship, women tend to reexamine their choice of partner through a lens of self-doubt and imagined alternatives. These cognitive processes intensify emotional ambivalence, weaken attachment, and sustain a cyclical pattern of relational uncertainty. One of the most salient components of this experience involves comparison and negative evaluation of the spouse . Women often engage in continuous evaluations of their partners, contrasting them with other men—such as friends’ or relatives’ husbands—or with an internalized ideal of the “perfect partner.” This comparison is rarely neutral; it is charged with emotional dissatisfaction and a sense of deprivation. Over time, the spouse becomes increasingly perceived as inadequate, emotionally distant, or inferior to these idealized standards. Such evaluations erode admiration, respect, and emotional closeness—the essential foundations of marital satisfaction. As participants described: “Seeing my friends’ husbands care more for their wives makes me feel my marriage is lacking.” (Participant 5) These reflections highlight how persistent comparison fosters a cognitive bias toward partner inadequacy, reinforcing relational disappointment and deepening emotional distance. A second prominent process relates to regret over marital choice . Many women expressed a lingering sense of remorse for having chosen their current partner, often accompanied by self-blame and feelings of entrapment. This regret is typically not momentary; it becomes a chronic mental state marked by counterfactual rumination—replaying “what if” scenarios and imagining better life outcomes had a different decision been made. The emotional tone of these reflections is often heavy with disillusionment, guilt, and sadness. As participants explained: “Sometimes I think I should have chosen differently. I keep imagining life if I married someone else.” (Participant 6) These expressions reveal how regret functions as both a cognitive and emotional burden, eroding self-confidence and contributing to psychological exhaustion. Overall, comparison and regret regarding marital choice reflect an intricate dynamic of relational dissatisfaction, idealized thinking, and self-critical rumination. The interplay between these processes maintains doubt and emotional disconnection, perpetuating the obsessive cycle of reassessment and regret characteristic of ROCD. Consistent with international literature, these findings underscore how maladaptive cognitive comparison and counterfactual rumination serve as central mechanisms that sustain relational distress and undermine marital satisfaction, while offering culturally grounded insight into the lived experience of married women struggling with obsessive relational doubts. Searching for Alternative Sources of Meaning in Life The search for alternative sources of meaning in life refers to a psychological process in which married women with Relationship Obsessive-Compulsive Disorder (ROCD), when faced with marital failures and the inability to receive love, security, or satisfaction, seek new resources to reconstruct meaning, purpose, and hope in their lives. In this process, the marital relationship, which was expected to serve as the primary source of attachment, emotional security, and identity, is replaced by alternative elements that compensate for relational voids. Alternative sources of meaning may emerge through motherhood, individual independence and self-redefinition, or through realistic acceptance of limitations and constructing adaptive meaning from the damaged situation. Women engaged in this process attempt to cope with the emotional strain of marital failure by focusing on aspects of life that remain meaningful. For some, the child becomes the primary reason for continuing life, and the maternal role substitutes for the spousal role in providing existential meaning. Others, instead of investing in the marital relationship, work to reconstruct their psychological and social independence, defining themselves through occupational, educational, or personal roles. In other cases, women create adaptive meaning for the damaged situation by realistically accepting limitations, ensuring psychological endurance. Across all these pathways, the central mechanism is the “shift of psychological reliance from the marital relationship to an alternative source.” The first pattern, meaning-making through the child , involved women directing their emotional and psychological focus toward their children, using the maternal role as a substitute for the lack of support and affection in the marital relationship. The child became a central source of meaning, motivating the woman to continue life despite relational setbacks. Participants described this as essential for coping, for example, stating, “My child gives me reason to keep going; without them, I wouldn’t know what to do.” (Participant 7) The second pattern, meaning-making through individual independence , emerged as women sought to restore personal identity, self-esteem, and a sense of control by focusing on personal growth, work, education, or other non-marital roles. This pathway allowed women to generate alternative sources of meaning and self-worth in the absence of relational support. One participant noted, “ Only when I am at work do I feel alive ,” highlighting the role of independence in sustaining psychological resilience (Participant 1). The third pattern, meaning-making through psychological adaptation to a failed relationship , involved women cognitively and emotionally reconstructing their marital situation to find a tolerable way to continue. Through realistic acceptance and focus on minimally positive aspects, they balanced hopelessness with the need to maintain life, using strategies such as justifying the marriage or highlighting small positive traits. For instance, one participant expressed, “ When I think about his small good qualities, I can tolerate it better ,” illustrating how adaptation served as a tool for emotional survival (Participant 6). Overall, these patterns demonstrate that, in the absence of supportive relationships, women actively seek alternative resources for meaning and purpose, maintaining psychological resilience through children, personal independence, or adaptive cognitive strategies. Discussion The thematic analysis of the interviews led to the identification of eight overarching themes that capture the main harms experienced by married women with Relationship Obsessive–Compulsive Disorder (ROCD). These themes include Intrapersonal Cognitive Experiences, Emotional and Psychological Disturbance, Marital Intimacy and Affectional Frustration, Interpersonal Conflicts and Dysfunctional Marital Interactions, Family and Environmental Pressures, Maladaptive Coping and Emotion Regulation Strategies, Comparison and Regret Regarding Marital Choice, and Searching for Alternative Sources of Meaning in Life. Collectively, these themes provide a comprehensive understanding of the multidimensional impact of ROCD on women’s cognitive, emotional, relational, and existential domains. Each theme and its related subthemes are elaborated in the following sections. Consistent with prior research (e.g., (3, 5, 17), the participants’ narratives revealed that ROCD is sustained by maladaptive intrapersonal cognitive processes—particularly chronic doubt, rumination, polarized thinking, and suspicious interpretations—that amplify uncertainty and undermine trust in personal judgment. This need for absolute certainty and low tolerance for ambiguity reflects a rigid cognitive style linked to maladaptive schemas and anxious attachment patterns. According to metacognitive and intolerance-of-uncertainty models (18, 19), such rigidity fosters repetitive checking and reassurance-seeking as a means to control uncertainty, paradoxically reinforcing anxiety and preoccupation in a self-perpetuating cycle of cognitive insecurity and emotional distress. Marital intimacy emerged as another critical domain affected by ROCD. Participants frequently described emotional rejection, lack of empathy, and chronic communicative failure, all of which deepened their sense of isolation and relational insecurity. This absence of emotional reciprocity sustains obsessive questioning about the relationship’s value and the partner’s feelings. These findings echo previous research showing reduced intimacy and satisfaction among individuals with relationship-centered obsessions (20, 21). Extending cross-cultural perspectives, the present results illustrate how chronic affectional deprivation interacts with obsessive doubt in collectivist contexts (22), where relational harmony and emotional restraint are highly valued. Interpersonal conflict and dysfunctional marital interactions further compound these difficulties. Power imbalance, psychological control, chronic criticism, and low participation in emotional responsibilities emerged as dominant relational dynamics. Such patterns deprive women of autonomy and psychological safety, reinforcing perceptions of inadequacy and entrapment. These findings are consistent with systemic and interactional perspectives, as prior research has shown that relationship-centered obsessive symptoms are intertwined with relational dissatisfaction and are maintained through maladaptive interaction patterns within the dyad (e.g., (13). Cultural and social contexts played a salient role in shaping these experiences. In-law interference, traditional gender expectations, and emphasis on maintaining social reputation limited women’s emotional expression and autonomy. The internalization of these cultural scripts created tension between conformity and self-expression, sustaining emotional suppression and cognitive ambivalence. These findings support research that highlight how collectivist norms and gendered expectations shape mental distress and relational functioning (23). The Iranian context thus offers a unique framework for understanding how sociocultural pressures amplify obsessive relational cognition and emotional withdrawal. Comparison and regret regarding marital choice emerged as a distinct cognitive–emotional pattern. Women often evaluated their partners against imagined ideals or others’ relationships, resulting in chronic regret and dissatisfaction. This pattern reflects counterfactual thinking processes known to intensify negative affect and relational insecurity (24, 25). Persistent comparison and idealization reinforce cognitive rigidity and emotional ambivalence, sustaining a self-perpetuating loop of obsessive doubt and reduced commitment. Participants also relied on maladaptive coping strategies such as reassurance-seeking, thought suppression, and avoidance, which provided short-term relief but reinforced obsessive preoccupation. These findings correspond with coping-focused and cognitive models of OCD maintenance, suggesting that maladaptive coping responses—such as reassurance-seeking, thought suppression, and avoidance—serve as key maintaining factors of obsessive–compulsive symptoms and affective distress (26–28). Over time, such strategies diminished confidence in coping capacity and increased interpersonal tension, highlighting the cyclical relationship between maladaptive emotion regulation and obsessive thinking. Social withdrawal and isolation frequently emerged as women attempted to protect themselves from perceived judgment and relational strain. By avoiding social engagement, participants reduced opportunities for support and validation, amplifying loneliness and preoccupation with their partners. This finding is consistent with studies linking social isolation to heightened OCD severity and diminished quality of life (29–31). Social withdrawal thus functions as an avoidance-based coping mechanism that perpetuates cognitive and emotional dysfunction. Despite these challenges, participants demonstrated adaptive efforts to preserve resilience by redirecting emotional energy toward parenting, work, or personal independence. Such meaning-making strategies, while partially adaptive, provided short-term stability without resolving core relational needs. These findings align with the conceptualization of meaning-making as a coping resource in the face of distress (32–34). However, reliance on compensatory roles may represent defensive adaptation that further reduces intimacy and authentic emotional connection. Taken together, these findings reveal that ROCD among married women in this context is sustained by an interconnected network of cognitive rigidity, emotional dysregulation, relational power imbalance, sociocultural constraint, maladaptive coping, chronic comparison, social withdrawal, and efforts to construct alternative meaning. The constant interplay between obsessive thought patterns, emotional exhaustion, relational dysfunction, and compensatory adaptations produces a self-reinforcing cycle of distress. These mechanisms illustrate how personal vulnerabilities and contextual stressors jointly maintain psychological suffering and relational dissatisfaction. Conclusion The findings of this study illuminate the psychological and relational dynamics of married women experiencing ROCD. ROCD extends beyond obsessive doubts to involve cognitive rigidity, emotional dysregulation, and maladaptive interpersonal patterns that sustain marital distress. Cognitive insecurities such as polarized thinking and excessive need for certainty interacted with helplessness and self-blame, reducing resilience and intensifying relational anxiety. Marital intimacy was often replaced by emotional withdrawal and unmet validation needs, while power imbalances and chronic criticism further eroded psychological safety. Cultural norms regarding loyalty, endurance, and emotional restraint contributed to the persistence of these anxieties. Participants’ efforts to find alternative sources of meaning (e.g., parenting or adaptive acceptance) reflected resilience, although sometimes at the cost of emotional detachment. Clinically, these results highlight the importance of culturally sensitive interventions integrating cognitive restructuring, emotional regulation, and relational therapy. Future research should explore these dynamics longitudinally and across diverse populations, incorporating perspectives of both partners to better understand reciprocal influences in ROCD. Limitations This study provided an in-depth understanding of marital difficulties among married women with ROCD through thematic analysis of interviews conducted in Bandar Abbas (2023–2024). However, several limitations should be considered. Participants were recruited exclusively from counseling centers in a single city, limiting generalizability. Exclusion of women undergoing psychotherapy or pharmacotherapy may have reduced sample representativeness. All interviews were conducted by a single researcher, which could introduce interpretive bias despite peer review and reflexive journaling. The cross-sectional design and reliance on self-reports restrict causal inferences and longitudinal insights. Additionally, sociocultural and gender norms specific to Iran may limit applicability to other cultural contexts. Implications and Future Research Future studies should include larger, more diverse samples from multiple regions, employ longitudinal and mixed-methods designs, and integrate partners’ perspectives to capture dyadic dynamics. Experimental and intervention-based studies, including randomized controlled trials, are recommended to evaluate targeted therapies combining cognitive restructuring, emotion regulation, and attachment-based interventions. Clinically, findings highlight the need for specialized therapist training, culturally informed psychoeducational programs, and integration of cognitive, emotional, and relational components in treatment to enhance marital functioning among women with ROCD. Declarations Ethics approval and consent to participate The research was conducted in accordance with Declaration of Helsinki and was approved by the ethics committee of University under the research code. Prior to each interview, participants were given detailed explanations about the study's objectives, the purpose of recording the interview, and assurances regarding the confidentiality of their information. Written consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding There was no funding. Consent for Publication Not applicable. Disclosure statement No potential conflict of interest was reported by the author(s). References Bloch MH, Landeros-Weisenberger A, Rosario MC, Pittenger C, Leckman JF. Meta-analysis of the symptom structure of obsessive-compulsive disorder. American Journal of Psychiatry. 2008;165(12):1532–42. Doron G, Szepsenwol O, Karp E, Gal N. Obsessing about intimate-relationships: Testing the double relationship-vulnerability hypothesis. Journal of behavior therapy and experimental psychiatry. 2013;44(4):433–40. Melli G, Bulli F, Doron G, Carraresi C. Maladaptive beliefs in relationship obsessive compulsive disorder (ROCD): Replication and extension in a clinical sample. Journal of Obsessive-Compulsive and Related Disorders. 2018;18:47–53. Brandes O, Stern A, Doron G. “I just can't trust my partner”: Evaluating associations between untrustworthiness obsessions, relationship obsessions and couples violence. Journal of Obsessive-Compulsive and Related Disorders. 2020;24:100500. Doron G, Derby D, Szepsenwol O, Nahaloni E, Moulding R. Relationship obsessive–compulsive disorder: Interference, symptoms, and maladaptive beliefs. Frontiers in Psychiatry. 2016;7:58. Doron G, Derby DS, Szepsenwol O. Relationship obsessive compulsive disorder (ROCD): A conceptual framework. Journal of Obsessive-Compulsive and Related Disorders. 2014;3(2):169–80. Doron G, Derby DS, Szepsenwol O, Talmor D. Flaws and all: Exploring partner-focused obsessive-compulsive symptoms. Journal of Obsessive-Compulsive and Related Disorders. 2012;1(4):234–43. Pozza A, Casale S, Dèttore D. Therapists’ emotional reactions to patients with obsessive–compulsive disorder: the role of therapists’ orientation and perfectionism. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2022;40(4):879–904. Prasko J, Ociskova M, Krone I, Burkauskas J, Gecaite-Stonciene J, Hodny F, et al. A narrative review of relationship obsessive-compulsive disorder: Characteristics, causes and cognitive-behavioural interventions. Neuroendocrinology Letters. 2024;45(4):262–80. Mısırlı M, Kaynak GK. Relationship obsessive compulsive disorder: A systematic review. Psikiyatride Güncel Yaklaşımlar. 2023;15(4):549–61. Lombardi A, Rodriguez C. Enhancing Exposure and Response Prevention Treatment in an Individual With Relationship Obsessive-Compulsive Disorder: A Case Report. Journal of Cognitive Psychotherapy. 2019;33(3):185–95. Aardema F, Moulding R, Melli G, Radomsky AS, Doron G, Audet JS, et al. The role of feared possible selves in obsessive–compulsive and related disorders: A comparative analysis of a core cognitive self‐construct in clinical samples. Clinical psychology & psychotherapy. 2018;25(1):19–29. Doron G, Mizrahi M, Szepsenwol O, Derby D. Right or flawed: Relationship obsessions and sexual satisfaction. The journal of sexual medicine. 2014;11(9):2218–24. Corbin J, Strauss A. Basics of qualitative research: Techniques and procedures for developing grounded theory: Sage publications; 2014. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2008;3(2):77–101. Guba EG, Lincoln YS. Competing paradigms in qualitative research. Handbook of qualitative research. 1994;2(163-194):105. Trak E, Inozu M. Developmental and self-related vulnerability factors in relationship-centered obsessive compulsive disorder symptoms: A moderated mediation model. Journal of Obsessive-Compulsive and Related Disorders. 2019;21:121–8. Wells A. Advances in metacognitive therapy. International Journal of Cognitive Therapy. 2013;6(2):186–201. Buhr K, Dugas MJ. Fear of emotions, experiential avoidance, and intolerance of uncertainty in worry and generalized anxiety disorder. International Journal of Cognitive Therapy. 2012;5(1):1–17. Doron G, Derby DS, Szepsenwol O, Talmor D. Tainted love: Exploring relationship-centered obsessive compulsive symptoms in two non-clinical cohorts. Journal of Obsessive-Compulsive and Related Disorders. 2012;1(1):16–24. Kılıç N, Altınok A. Obsession and relationship satisfaction through the lens of jealousy and rumination. Personality and Individual Differences. 2021;179:110959. Su JC, Lee RM, Park IJ, Soto JA, Chang J, Zamboanga BL, et al. Differential links between expressive suppression and well-being among Chinese and Mexican American college students. Asian American Journal of Psychology. 2015;6(1):15–24. Rajkumar RP. Cultural collectivism, intimate partner violence, and women's mental health: An analysis of data from 151 countries. Frontiers in sociology. 2023;8:1125771. Horgos P. Rewriting Reality: Cognitive and Affective Relationships of Counterfactual Thought. RANGE: Undergraduate Research Journal (2025). 2025. Studer LE. If I had never met you: Counterfactual thinking and romantic relationships 2016. Spencer SD, Stiede JT, Wiese AD, Goodman WK, Guzick AG, Storch EA. Cognitive-behavioral therapy for obsessive-compulsive disorder. The Psychiatric clinics of North America. 2022;46(1):167–80. Chessell C, Halldorsson B, Harvey K, Guzman-Holst C, Creswell C. Cognitive, behavioural and familial maintenance mechanisms in childhood obsessive compulsive disorders: A systematic review. Journal of Experimental Psychopathology. 2021;12(3):20438087211036581. Fatima A, Gul A. The COGNITIVE BIASES, COPING MECHANISMS AND SYMPTOM SEVERITY AMONG INDIVIDUALS WITH OCD TENDENCIES. Journal of Arts & Social Sciences. 2025;12(1):64–74. Żerdziński M, Burdzik M, Żmuda R, Witkowska-Berek A, Dȩbski P, Flajszok-Macierzyńska N, et al. Sense of happiness and other aspects of quality of life in patients with obsessive-compulsive disorder. Frontiers in Psychiatry. 2022;13:1077337. Kılıç A, Görmez A, Elbay RY, Özer BU. Internalized stigma in obsessive compulsive disorder: Correlates and associations with quality of life. Archives of Psychiatric Nursing. 2022;39:37–45. Manzoor R, Shah SAR, Kamal A, Nazir N. Investigating the Effects of OCD Traits on the Quality of Life among Adults: The moderating role of Social Support. Remittances Review 2024;9(24):3101–11. Yang Z, Ji L-J, Yang Y, Wang Y, Zhu L, Cai H. Meaning making helps cope with COVID-19: A longitudinal study. Personality and Individual Differences. 2021;174:110670. Park CL. Meaning Making Following Trauma. Frontiers in Psychology. 2022;Volume 13 - 2022. Karbainova D, Fang S, Barker ET. Meaning making in the context of the COVID-19 pandemic: effects of purpose in life, positive reframing, acceptance, and event appraisal. Applied Developmental Science. 2025:1–15. Table 1 Table 1 is not available with this version. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 09 Mar, 2026 Reviews received at journal 08 Mar, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviews received at journal 09 Feb, 2026 Reviewers agreed at journal 27 Jan, 2026 Reviewers invited by journal 26 Jan, 2026 Editor invited by journal 16 Jan, 2026 Editor assigned by journal 14 Jan, 2026 Submission checks completed at journal 14 Jan, 2026 First submitted to journal 19 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8407007","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":581174050,"identity":"21a8934a-02f9-456e-b53c-7cd09ed96aeb","order_by":0,"name":"Mozhdeh Zarifi","email":"","orcid":"","institution":"Islamic Azad University, Yazd","correspondingAuthor":false,"prefix":"","firstName":"Mozhdeh","middleName":"","lastName":"Zarifi","suffix":""},{"id":581174051,"identity":"d73c9329-5986-4d05-9f0c-33cfa445de98","order_by":1,"name":"Marieh Dehghan Menashadi","email":"data:image/png;base64,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","orcid":"","institution":"Islamic Azad University, Yazd","correspondingAuthor":true,"prefix":"","firstName":"Marieh","middleName":"Dehghan","lastName":"Menashadi","suffix":""},{"id":581174052,"identity":"9fe073d3-7447-4cd2-b263-1967d5313644","order_by":2,"name":"Mohammad Hossein Fallah","email":"","orcid":"","institution":"Islamic Azad University, Yazd","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Hossein","lastName":"Fallah","suffix":""}],"badges":[],"createdAt":"2025-12-19 17:20:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8407007/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8407007/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101727162,"identity":"fdec0c8e-c5eb-4dd4-bb89-f8c244d405b7","added_by":"auto","created_at":"2026-02-03 04:59:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1376020,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8407007/v1/ad325a14-647b-4ef8-8bcc-f93641904f9c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Identifying the Harms Experienced by Married Women with Relationship Obsessive– Compulsive Disorder","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eObsessive\u0026ndash;Compulsive Disorder (OCD) is a debilitating psychological condition characterized by intrusive thoughts and repetitive, compulsive behaviors, encompassing dimensions such as fear of contamination, repeated checking, or an excessive need for order (1). In recent years, researchers have increasingly focused on a subtype known as Relationship Obsessive\u0026ndash;Compulsive Disorder (ROCD), in which obsessive thoughts and compulsive behaviors are directed toward close interpersonal relationships, particularly romantic and marital relationships (2).\u003c/p\u003e \u003cp\u003eROCD has been studied as a distinct subgroup within OCD (3). Over the past decade, a growing body of empirical research has systematically examined intimate relationships as an additional focus of obsessive concerns in OCD (3, 4). Symptoms of ROCD often manifest as intrusive thoughts (e.g., \u0026ldquo;Is my partner the right person?\u0026rdquo;) and mental images (e.g., the partner\u0026rsquo;s face), but they can also appear as compulsive urges (e.g., the urge to leave one\u0026rsquo;s current partner) (5). ROCD may affect various types of intimate relationships, including romantic, parent\u0026ndash;child, teacher\u0026ndash;student, or even divine relationships (6). In ROCD, the focus of obsessive\u0026ndash;compulsive symptoms may be either the relationship itself (relationship-centered) or the partner (partner-centered) (6). Relationship-centered ROCD may involve preoccupations with one\u0026rsquo;s own feelings toward the partner, the partner\u0026rsquo;s feelings, and, more broadly, concerns about the \u0026ldquo;rightness\u0026rdquo; of the relationship experience (7).\u003c/p\u003e \u003cp\u003eA central feature of ROCD is persistent doubts and concerns about various aspects of the marital relationship, including the extent of love for the spouse, partner attractiveness or worthiness, marital compatibility, or even the appropriateness of the relationship choice itself (8, 9). These doubts frequently compel individuals to engage in compulsive behaviors aimed at reducing anxiety and resolving uncertainty. Such behaviors include repeated reassurance-seeking from the spouse, consulting multiple sources for validation, comparing one\u0026rsquo;s relationship with others, checking personal feelings toward the partner, or avoiding relationship-related situations (10). While these behaviors may provide temporary relief, they ultimately perpetuate and intensify the cycle of obsession and compulsion, eroding marital stability over time (11).\u003c/p\u003e \u003cp\u003eDespite growing attention to ROCD in recent years, it has not yet been recognized as a distinct diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and may often be overlooked or misdiagnosed in clinical settings (5). Consequently, affected individuals\u0026mdash;especially married women\u0026mdash;may experience years of unmet intervention and struggle with the personal and relational consequences of the disorder. In societies where gender roles and cultural norms strongly structure marital relationships, married women with ROCD are exposed to multifaceted vulnerabilities. In many cultures, including Iran, women play central roles in maintaining family cohesion, managing emotional relationships, and ensuring family psychological security. In this context, the emergence of doubts and obsessive behaviors within marriage threatens not only individual mental health but also marital stability and family functioning. Social pressures to maintain the appearance of marriage, traditional expectations of spousal roles, and fear of stigma in conservative cultural settings may intensify these women\u0026rsquo;s psychological experiences.\u003c/p\u003e \u003cp\u003eIn the Iranian cultural context, where marital relationships are strongly associated with expectations of commitment, fidelity, and women\u0026rsquo;s role fulfillment, ROCD symptoms may be experienced more acutely, and women may hesitate to express concerns or seek specialized help. Previous research has shown that ROCD symptoms are associated with reduced emotional intimacy and marital satisfaction, increased marital conflict, and a heightened sense of relational inadequacy (8, 12). For example, perfectionism and catastrophic beliefs such as \u0026ldquo;being in the wrong relationship\u0026rdquo; or \u0026ldquo;never finding a better partner\u0026rdquo; are identified as factors contributing to the persistence of this disorder (3). However, most findings originate from quantitative studies in Western contexts, and qualitative investigations into the lived experiences of affected women\u0026mdash;particularly in non-Western societies\u0026mdash;remain limited.\u003c/p\u003e \u003cp\u003eExisting research on ROCD is still sparse and primarily emphasizes psychological aspects related to its onset and consequences. Findings indicate that individuals with ROCD report higher levels of relational obsessions and depressive symptoms compared with those with general OCD (5). Doron et al. (13) also found that symptom severity\u0026mdash;whether relationship-centered or partner-centered\u0026mdash;was associated with reduced sexual satisfaction, increased self-reported worries, and intensified depressive symptoms, with relationship satisfaction mediating the link between symptoms and sexual satisfaction. Brandes et al. (4) showed that, in the partner-centered subtype, distrust of the partner is a key factor in maintaining the disorder. Moreover, unlike general OCD, ROCD is strongly associated with perfectionism and catastrophic beliefs regarding romantic relationships. Melli et al. (3) emphasized the role of such beliefs in the formation and persistence of the disorder, reporting that concerns about \u0026ldquo;being in the wrong relationship\u0026rdquo; or \u0026ldquo;never finding a better partner\u0026rdquo; significantly predict relationship-centered and partner-centered symptoms.\u003c/p\u003e \u003cp\u003eDespite these findings, most studies have employed quantitative approaches in Western populations, with few qualitative studies exploring the lived experiences of affected individuals in different cultural contexts. Qualitative research can provide deeper insights into how cultural norms, values, and expectations influence the experience and maintenance of ROCD and inform the design of culturally sensitive interventions. In the Iranian cultural context, where marital relationships are strongly shaped by expectations of commitment, fidelity, and women\u0026rsquo;s role fulfillment, investigating the experiences of affected women is particularly important. Identifying the types and dimensions of marital harms experienced by these women can guide the development of more personalized and contextually appropriate therapeutic programs. Therefore, the present study adopts a qualitative approach to answer the following research question: What are the marital harms experienced by married women with Relationship Obsessive\u0026ndash;Compulsive Disorder?\u003c/p\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Participants\u003c/h2\u003e \u003cp\u003eThis study employed a qualitative research design using a thematic analysis approach to examine marital difficulties among married women with relationship obsessive\u0026ndash;compulsive disorder (ROCD) in Bandar Abbas during 2023\u0026ndash;2024. The research population included all married women diagnosed with ROCD in Bandar Abbas. Participants were purposefully selected from counseling and psychological centers that provide services to individuals and couples with obsessive\u0026ndash;compulsive symptoms. Sampling continued until data saturation was reached, meaning that no new concepts or themes emerged from the interviews (14). Ultimately, 11 married women meeting the diagnostic criteria for ROCD were included.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were: (a) being female and married for at least five years; (b) having at least a primary school education; (c) obtaining a score above the cutoff point (21.5) on the Relationship Obsessive\u0026ndash;Compulsive Inventory (ROCI; (6); (d) meeting the DSM-5 diagnostic criteria for obsessive\u0026ndash;compulsive disorder through a clinical interview; and (e) providing written informed consent to participate.\u003c/p\u003e \u003cp\u003eExclusion criteria included: (a) being divorced or in the process of separation; (b) suffering from severe psychiatric disorders (e.g., schizophrenia or bipolar disorder); (c) showing acute psychological symptoms (e.g., severe anxiety or depression) that interfered with participation; (d) currently taking psychiatric medications or undergoing psychotherapy; and (e) having severe physical disabilities or major changes in marital status during the research period.\u003c/p\u003e \u003cp\u003eTo ensure maximum diversity, participants were selected to represent variations in age, education, employment status, marriage duration, number of children, kinship with spouse, and prior psychotherapy experience.\u003c/p\u003e \u003cp\u003eSampling continued until data saturation was reached\u0026mdash;that is, when no new concepts or themes emerged from subsequent interviews (14). Ultimately, 11 married women who met the diagnostic and inclusion criteria were included in the final sample.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Procedure\u003c/h2\u003e \u003cp\u003eThe aim of this research was to examine the marital difficulties and relationship-related obsessive\u0026ndash;compulsive symptoms experienced by married women. Following ethical approval and institutional permissions, the researcher visited selected counseling centers, introduced the study, and obtained written informed consent from eligible participants.\u003c/p\u003e \u003cp\u003eBased on the inclusion and exclusion criteria qualified participants were invited to take part in semi-structured interviews. All interviews were conducted in private counseling rooms to ensure confidentiality and provide a comfortable, nonjudgmental environment. The interviews were conducted in Persian, the participants\u0026rsquo; native language, without the need for a translator. A single researcher, a psychologist with specialized expertise in marital and obsessive\u0026ndash;compulsive issues, conducted all interviews. Given the small sample size and the study\u0026rsquo;s focus on in-depth exploration of participants\u0026rsquo; experiences, having one trained interviewer was appropriate. To ensure reliability and trustworthiness, the coding and theme development were independently reviewed by a qualitative research expert, thereby maintaining objectivity and methodological rigor.\u003c/p\u003e \u003cp\u003eThe first researcher, a psychologist with specialized experience in marital and obsessive\u0026ndash;compulsive issues, conducted all interviews. Each interview lasted approximately 45\u0026ndash;60 minutes and began with open-ended questions such as:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e\u0026ldquo;Can you describe your relationship with your spouse and how it has changed over time?\u0026rdquo;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e\u0026ldquo;What kinds of obsessive thoughts or doubts do you typically experience about your relationship?\u0026rdquo;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e\u0026ldquo;How do these thoughts affect your emotions and daily functioning?\u0026rdquo;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e\u0026ldquo;What strategies have you used to manage or control these thoughts?\u0026rdquo;\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eProbing questions (e.g., \u0026ldquo;Can you explain more about that?\u0026rdquo;) were used to obtain more detailed responses. All interviews were audio-recorded with participants\u0026rsquo; consent and transcribed verbatim immediately afterward. Field notes were also taken to document nonverbal cues and contextual details.\u003c/p\u003e \u003cp\u003eTo maintain objectivity and reduce potential bias, the researcher reflected on personal assumptions and theoretical preconceptions throughout the study. Peer discussions and reflective journaling were employed during data collection and analysis to enhance rigor and ensure the findings accurately represented participants\u0026rsquo; reports.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Materials\u003c/h2\u003e \u003cp\u003e\u003cem\u003e2.3.1. Relationship Obsessive\u0026ndash;Compulsive Inventory (ROCI; (6)\u003c/em\u003e: The ROCI is a 12-item instrument designed to assess the severity of ROCD symptoms across three domains: love for partner, rightness of relationship, and loving the partner. Items are rated on a 5-point Likert scale (0\u0026thinsp;=\u0026thinsp;not at all to 4\u0026thinsp;=\u0026thinsp;very much). The total score reflects the overall intensity of relationship-related obsessive\u0026ndash;compulsive symptoms. Previous studies have reported excellent internal consistency (α\u0026thinsp;=\u0026thinsp;0.81\u0026ndash;0.93; (3). In the present study, Cronbach\u0026rsquo;s alpha was 0.88 based on a pilot sample of 70 individuals. The ROCI was used solely as a screening tool to determine participant eligibility rather than as a primary source of data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Data Analysis\u003c/h2\u003e \u003cp\u003eData analysis was conducted concurrently with data collection using Braun and Clarke\u0026rsquo;s (15) six-step framework for thematic analysis. All interview transcripts were read multiple times to achieve full familiarity with the content and ensure immersion in the data. Meaning units were identified, coded, and initially organized into preliminary categories.\u003c/p\u003e \u003cp\u003eThe interview transcripts were thoroughly reviewed by the single researcher who conducted the interviews. Meaning units were identified, coded, and initially organized into preliminary categories. To ensure reliability and trustworthiness, the coding and theme development were independently reviewed by a qualitative research expert, providing verification and feedback to maintain objectivity and methodological rigor.\u003c/p\u003e \u003cp\u003eThrough an iterative process of comparison and refinement, preliminary categories were grouped into subthemes and subsequently consolidated into overarching main themes that captured the central patterns of participants\u0026rsquo; reports regarding marital difficulties and ROCD symptoms. As new data were collected, previously identified themes were refined and new insights were incorporated. To ensure coherence and robustness, the transcripts and codes were revisited multiple times, integrating the analytic summaries into a comprehensive framework that reflected shared patterns across participants. During the analysis, unrelated or redundant themes were discarded, while the relationships between categories were examined through continuous comparison and conceptual reasoning.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Validation and Coding Reliability\u003c/h2\u003e \u003cp\u003eTo ensure trustworthiness, the study adhered to Lincoln and Guba\u0026rsquo;s (16) four criteria:\u003c/p\u003e \u003cp\u003e Credibility: Achieved through prolonged engagement with participants, member checking (participant validation), and peer debriefing.\u003c/p\u003e \u003cp\u003eTransferability: Ensured by providing detailed descriptions of participants, context, and data collection procedures to facilitate comparison across settings.\u003c/p\u003e \u003cp\u003eDependability: Maintained through transparent documentation of all analytic steps and external auditing by qualitative research experts.\u003c/p\u003e \u003cp\u003eConfirmability: Secured by maintaining an audit trail, conducting independent code verification, and using reflexive journaling to minimize researcher bias.\u003c/p\u003e \u003cp\u003eFollow-up interviews were also conducted with three participants to confirm the stability and accuracy of the extracted themes.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Ethical Considerations\u003c/h2\u003e \u003cp\u003e The study was approved by the Ethics Committee of Islamic Azad University, Yazd Branch (Approval Code: IR.IAU.YAZD.REC.1404.044). Participation was entirely voluntary, and participants were informed about the study\u0026rsquo;s objectives, confidentiality, and their right to withdraw at any stage. Pseudonyms were used in all transcripts and reports to protect identity and privacy.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Findings","content":"\u003cp\u003eThe study participants included 11 married women diagnosed with relationship obsessive\u0026ndash;compulsive disorder (ROCD) in Bandar Abbas. Participants were selected based on the study\u0026rsquo;s inclusion and exclusion criteria and represented a diverse range of ages, education levels, employment statuses, marriage durations, number of children, kinship with spouse, and prior psychotherapy experiences, as detailed in Table\u0026nbsp;1. This diversity provided a broad spectrum of experiences, enriching the thematic analysis of marital difficulties and ROCD-related impairments.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;1. Demographic Characteristics of the Participants\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn line with the research question\u0026mdash;\u0026ldquo;What are the harms experienced by married women with relationship obsessive\u0026ndash;compulsive disorder?\u0026rdquo;\u0026mdash;the interviews were analyzed using thematic analysis. This process resulted in the identification of 8 main codes and 24 sub-codes, as summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eCore Themes and Sub-Themes Related\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain Themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-Themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSemantic Units\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndividual Experiences\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eIntrapersonal Cognitive Experiences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic doubt \u0026amp; need for certainty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePersistent doubt about the continuation of the relationship, anxiety, and uncertainty in marital decision-making, chronic anxiety stemming from rumination and doubt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I constantly ask myself whether I made the right decision marrying him. I just wish someone could guarantee that our future will be okay so this anxiety would finally stop.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObsessive rumination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNegative revisiting of the past, intrusive thoughts, and obsessive thinking about the adequacy of the relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I keep replaying things he said in the past and overanalyzing them, as if they might prove the relationship was never right.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolarized thinking \u0026amp; negative bias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePolarized and black-and-white thinking, mental focus on negative evidence (negative bias), excessive cognitive sensitivity to partner\u0026rsquo;s flaws\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;If he seems distant, my mind immediately goes to extremes\u0026mdash;either everything is perfect or our marriage is a complete failure.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuspicious interpretations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeed to understand others\u0026rsquo; hidden motives, negative interpretation of neutral behaviors, reinforcement of cognitive doubt in the relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;When he takes too long to respond to my messages, I start thinking he might be hiding something or someone else has become more important.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEmotional \u0026amp; Psychological Disturbance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHelplessness \u0026amp; emotional deprivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFeelings of helplessness, psychological despair, chronic hopelessness regarding the future of the relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I feel emotionally abandoned in this marriage, as if no matter how hard I try, I can\u0026rsquo;t find a place of comfort or safety.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelational depression \u0026amp; psychological exhaustion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReduced overall functioning, lack of motivation/willingness to engage in activities, and chronic emotional exhaustion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;ve lost the motivation to even carry out daily tasks; it feels like the relationship has drained me completely.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-blame \u0026amp; worthlessness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSelf-blame, feelings of inadequacy, reduced self-confidence, and future-related anxiety stemming from self-blame\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Whenever something goes wrong between us, I automatically blame myself and feel like I\u0026rsquo;m not good enough to sustain a healthy relationship.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMarital Intimacy \u0026amp; Affectional Frustration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmotional rejection \u0026amp; coldness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmotional rejection, persistent lack of care, emotional distancing, relational coldness, and failure to receive emotional responsiveness in situations requiring support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;When I am upset, he doesn\u0026rsquo;t even acknowledge my feelings; the emotional coldness makes me feel invisible.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic communicative failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFailure of verbal communication, avoidance of dialogue, suppression of conflict, mismatched communication styles between spouses, and inability to resolve conflicts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Whenever I try to talk about issues, the conversation shuts down or turns into an argument, and eventually I just stop talking.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrustration in receiving affection \u0026amp; support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDissatisfaction with receiving emotional support from the spouse, failure to receive emotional support from the family of origin, failure to obtain emotional validation, and lack of responsiveness in critical situations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Even in moments when I desperately need emotional support, neither he nor his family offers any reassurance or validation.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily \u0026amp; Environmental Pressures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpouse\u0026rsquo;s family interference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInterference of the spouse\u0026rsquo;s family in marital life, family pressure on life decisions, lack of family boundary-setting, and involvement in child-rearing practices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;His mother constantly interferes in our parenting decisions, and he always sides with her, which makes me feel undermined.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHasty decisions under pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpousal choice under traditional pressure, hasty pre-marriage decisions, and decision-related anxiety in youth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Back then, everyone kept saying I was getting older and needed to marry quickly, so I rushed into it without fully thinking it through.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial pressure \u0026amp; cultural judgment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCompulsion to maintain marital appearances, social judgment, fear of judgment following divorce, cultural pressures, and enforced silence of women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Even though I\u0026rsquo;m unhappy, I continue the marriage out of fear of being judged by society if I were to divorce.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterpersonal Conflicts \u0026amp; Dysfunctional Interactions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDominance \u0026amp; control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePsychological control, pressure to comply, restriction of autonomy, and unilateral decision-making\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;He expects everything to be done his way and doesn\u0026rsquo;t allow me to make decisions, even about my personal life.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHumiliation \u0026amp; chronic blame\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePersistent blame, labeling, character humiliation, violation of respect, and invalidation of individual emotions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Whenever a problem arises, he immediately blames me and says I can\u0026rsquo;t do anything right.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLack of participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow participation in household affairs, lack of division of parental roles, pressure of traditional roles, imposition of caregiving burden on the woman, spousal behavioral indifference, and chronic fatigue of the woman in family responsibilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I handle all household tasks and childcare alone; he shows no involvement and just assumes everything will be taken care of.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaladaptive Coping Strategies \u0026amp; Emotion Regulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological avoidance \u0026amp; suppression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmotional avoidance, self-censorship, suppression of emotional needs, and emotional silence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;When I\u0026rsquo;m hurt, I stay silent to avoid conflict and keep everything bottled up inside.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompensatory behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvoidant and compensatory behaviors, such as excessive work, substitute hobbies, and solitary soothing activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;To escape from the emotional pain, I distract myself with work or mindless phone scrolling so I don\u0026rsquo;t have to feel it.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHope for external intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHope for pharmacological treatment, psychotherapy, professional assistance, and seeking psychological help\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes I think maybe a therapist or medication could fix things between us because I can\u0026rsquo;t do it alone anymore.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComparison \u0026amp; Regret Regarding Marital Choice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComparison with others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRepeated comparison with others, reduced marital satisfaction, and feelings of relative deprivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Seeing other couples express affection and mutual care often leads me to feel that my own relationship is lacking, which strengthens my doubts about my marital choice.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegret over marital choice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRegret over marriage, sense of having made the wrong partner choice, and remorse over missed opportunities for a better marital match\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;There are times when I feel that if I had waited longer, I might have found someone who was a better match for me.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSearching for Alternative Sources of Meaning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeaning-making through the child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmotional reliance on the child, compensatory maternal role\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;ve started pouring all my emotional energy into my child\u0026mdash;being a caring mother feels like the only place where I can still feel needed and emotionally connected.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeaning-making through individual independence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndividual empowerment outside the marital relationship, work, education, and personal growth to compensate for emotional void\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I focus on my career and education because investing in myself gives me a sense of strength and purpose that I don\u0026rsquo;t find in my marriage.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeaning-making through adaptation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEfforts to justify the marriage, acceptance of existing conditions, and focusing on minimally positive aspects to continue the relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;To keep going, I try to focus on the few stable or practical aspects of our life together and convince myself that staying is still better than starting over.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e. \u003cb\u003eMain Codes and Sub-Codes Related to the Harms Experienced by Married Women with ROCD\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe findings are presented below, with each sub-code illustrated by participant statements to provide clarity and depth to the analysis of the participants\u0026rsquo; experiences.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIntrapersonal Cognitive Experiences in ROCD\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIntrapersonal cognitive factors play a crucial role in shaping the experiences of married women with Relationship Obsessive-Compulsive Disorder (ROCD). These factors encompass persistent doubts, rumination, cognitive biases, and obsessive interpretations that directly influence perceptions of the partner, relationship quality, and marital stability. One of the most prominent cognitive features is \u003cb\u003echronic doubt and the need for certainty\u003c/b\u003e. Individuals frequently engage in persistent questioning about the appropriateness of their partner, the correctness of marital decisions, and the sustainability of the relationship. Even when objective evidence indicates stability or satisfaction, the mind repeatedly returns to suspicion and uncertainty. As one participant reported:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Even after months together, I keep questioning if he truly loves me or if I just imagined it. I feel like I can\u0026rsquo;t trust my own judgment.\u0026rdquo; (Participant 4)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA second central factor is \u003cb\u003eobsessive rumination and negative revisiting of past experiences\u003c/b\u003e. This involves repetitive, involuntary review of previous interactions, perceived mistakes, or partner behaviors. Rumination is not problem-solving oriented; rather, it maintains and intensifies anxiety by keeping the individual cognitively stuck in the past. For example, a participant stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I go over every conversation we had last week, trying to spot mistakes I made. My mind won\u0026rsquo;t stop analyzing.\u0026rdquo; (Participant 7)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe third key cognitive dimension is \u003cb\u003epolarized thinking and negative bias\u003c/b\u003e. Participants often evaluate their partner and the relationship in black-and-white terms, exaggerating negative aspects while minimizing or ignoring positive traits. This cognitive distortion restricts flexibility and amplifies perceived relational failures. One participant described:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I tell myself it\u0026rsquo;s either perfect or it\u0026rsquo;s completely wrong. When he makes a mistake, I feel like the whole relationship is failing.\" (Participant 3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFinally, \u003cb\u003eexcessive and suspicious interpretations\u003c/b\u003e represent another critical theme. Individuals tend to interpret neutral or ambiguous partner behaviors as indicative of hidden motives or negative intentions, which reinforces cognitive doubt and distrust. As one participant explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When he does something neutral, I immediately wonder if he\u0026rsquo;s trying to upset me or hide something. I never feel sure about his intentions.\" (Participant 9)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOverall, these intrapersonal cognitive experiences reflect a pattern of cognitive insecurity, hypervigilance to relational flaws, and obsessive need for control over thoughts related to the partner and marriage. These patterns not only maintain anxiety and rumination but also negatively impact marital functioning and emotional well-being. The findings are consistent with international research on ROCD, providing culturally relevant insights into the cognitive mechanisms underlying obsessive relational concerns in married women.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEmotional and Psychological Disturbance\u003c/b\u003e \u003c/p\u003e \u003cp\u003eEmotional and psychological disturbance refers to a pervasive state of affective instability, psychological tension, and impaired emotional regulation experienced by married women with ROCD. Within the marital context, this disturbance manifests through simultaneous and conflicting emotions such as love, anger, sadness, fear, and despair, accompanied by rapid mood fluctuations, frustration, and difficulty restoring emotional balance. Even minor relational issues may trigger disproportionate emotional reactions, leading to a persistent sense of internal chaos and psychological distress.\u003c/p\u003e \u003cp\u003e\u003cb\u003eHelplessness and emotional deprivation\u003c/b\u003e represent a psychological state in which individuals perceive themselves as trapped in an unchangeable relationship with minimal control over improving the situation. Participants expressed a sense of being caught in a relational dead end, where continuous conflicts and unresolved emotional tensions foster feelings of hopelessness and isolation. Over time, the perceived lack of supportive emotional resources from the partner or significant others deepens the experience of inner loneliness and deprivation, even in the physical presence of others. As one participant stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I feel trapped\u0026hellip; like no matter what I do, nothing will change, and nobody truly understands me.\u0026rdquo; (Participant 6)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eRelational depression and psychological exhaustion\u003c/b\u003e reflect a progressive depletion of emotional, cognitive, and motivational resources due to prolonged exposure to unresolved relational distress and repetitive cognitive rumination. This experience extends beyond temporary sadness and evolves into chronic emotional fatigue, diminished motivation, and reduced overall functioning. Participants described difficulty engaging in everyday tasks and a pervasive sense of heaviness and mental burden. One participant explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Even making breakfast feels like a mountain I can\u0026rsquo;t climb. I have no energy for anything anymore.\u0026rdquo; (Participant 1)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThese experiences illustrate how ongoing conflict and repetitive emotional rumination progressively erode psychological energy, leading to chronic emotional burnout and reduced functioning.\u003c/p\u003e \u003cp\u003e\u003cb\u003eSelf-blame and feelings of worthlessness\u003c/b\u003e emerge when individuals internalize relational problems and attribute conflicts, emotional distance, or perceived failures in the relationship to their own inadequacies. Participants reported engaging in continuous self-criticism, questioning their competence as a partner, and doubting their ability to maintain a healthy relationship. As one participant reflected:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI keep thinking maybe I was too sensitive, too demanding\u0026hellip; maybe I\u0026rsquo;m the reason everything went wrong\u003c/em\u003e.\u0026rdquo; \u003cem\u003e(Participant 2)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThis internalized self-criticism fosters guilt, insecurity, and anxiety about the future, while gradually eroding self-esteem and self-confidence. Over time, this cognitive-emotional spiral leads to a stable sense of personal deficiency, reinforcing emotional vulnerability and diminishing resilience when facing relational challenges. Over time, this internalized self-blame evolves into a stable sense of unworthiness and incompetence, undermining both emotional well-being and the capacity to cope effectively with relational stress.\u003c/p\u003e \u003cp\u003eOverall, emotional and psychological disturbance among married women with ROCD reflects a complex interplay of helplessness, exhaustion, and self-devaluation. These interconnected processes maintain a self-perpetuating cycle of emotional suffering, diminishing resilience and impairing marital functioning. The findings are consistent with international evidence emphasizing the central role of emotional dysregulation and self-critical cognition in sustaining obsessive relational distress, while offering culturally nuanced insight into the affective mechanisms underlying ROCD in married women.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMarital Intimacy and Affectional Frustration\u003c/b\u003e \u003c/p\u003e \u003cp\u003eMarital intimacy and affectional frustration in women with ROCD refer to a chronic emotional disconnection in marital life, where individuals consistently fail to achieve the desired psychological closeness, mutual empathy, and emotional responsiveness. In these relationships, although the marriage may appear outwardly intact, it is internally devoid of warmth, emotional security, and a sense of belonging. This deprivation of affection not only fosters loneliness but gradually undermines the individual\u0026rsquo;s perception of the relationship\u0026rsquo;s value and her self-worth, reinforcing negative cognitive appraisals about marriage and partner choice. Several emotional mechanisms operate within this process. First, emotional rejection and coldness emerge, manifesting as persistent neglect and lack of emotional responsiveness from the spouse, leading to a continuous experience of emotional invisibility. Second, chronic communicative failure occurs, characterized by blocked emotional dialogue and avoidance of meaningful conversation, causing unresolved conflicts to accumulate beneath the surface of the relationship. Third, frustration in receiving affection and support reflects insufficient emotional responsiveness from both the partner and the family of origin, intensifying the individual\u0026rsquo;s psychological loneliness and sense of helplessness. Together, these mechanisms gradually transform the relationship into a space dominated by silence, emotional coldness, and isolation.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEmotional rejection and coldness\u003c/b\u003e refer to a persistent state in which one partner feels consistently ignored and deprived of necessary emotional and affectionate responses. While the marriage may continue physically, it becomes emotionally dry and disconnected. Over time, the individual experiences emotional vulnerability and gradually perceives herself as alone within the marital relationship. Even in situations requiring emotional support, such as illness, family crises, or psychological distress, the spouse\u0026rsquo;s responses are minimal or absent. This pattern is characterized by insufficient emotional responsiveness to expressed needs, emotional distancing that fosters avoidance, and heightened sensitivity to perceived neglect, where even minor lack of affection is interpreted as emotional abandonment. This negative feedback cycle gradually transforms the relationship into one marked by emotional coldness and insecurity. As one participant shared:\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eHe hugs me rarely, and when he does, it feels forced. I feel invisible even when he\u0026rsquo;s near.\u0026rdquo; (Participant 9)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSuch ongoing indifference created an emotional void that gradually turned intimacy into detachment and companionship into solitude. Over time, both partners became disengaged from attempts at repair, reinforcing a cycle of emotional withdrawal and perceived rejection.\u003c/p\u003e \u003cp\u003e \u003cb\u003eChronic communicative failure\u003c/b\u003e in ROCD couples refers to a persistent pattern of blocked communication, avoidance of meaningful emotional interactions, and inability to manage emotional needs through dialogue. The relationship shifts toward silence, withdrawal, and communicative isolation. Attempts to express needs or resolve conflicts often evoke prior negative experiences, such as indifference, neglect, or perceived futility, leading to chronic avoidance of conversation. Attempts to express needs or resolve conflicts often evoke prior negative experiences, such as indifference, neglect, or perceived futility, which in turn lead to avoidance of dialogue, suppression of conflict to maintain superficial harmony, mismatched communication styles that cause misunderstandings, and a chronic inability to resolve daily conflicts. This pattern diminishes effective emotional exchange and trust, fostering obsessive doubts and mental rumination characteristic of ROCD. One woman explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I stopped sharing my feelings because he never listens. Silence feels safer than disappointment.\u0026rdquo; (Participant 2)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThis chronic silence eroded mutual understanding and trust, leaving conflicts unresolved and emotions unexpressed. Suppressed disagreements accumulated beneath the surface, creating an atmosphere of tension masked by routine stability. The inability to communicate emotional needs effectively reinforced feelings of disconnection and intensified the cognitive doubts characteristic of ROCD.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFrustration in receiving affection and support\u003c/b\u003e Frustration in receiving affection and support refers to the experience of emotional deprivation, particularly in marital relationships affected by ROCD, where the individual feels unable to receive sufficient affectionate, caring, and validating responses from the partner or family of origin. This deprivation extends beyond lack of affection to include absence of support during psychological stress, inadequate assistance in marital pressures, and feelings of helplessness in crises. In such circumstances, the spouse\u0026rsquo;s chronic lack of emotional responsiveness during vulnerable moments, combined with inadequate support from the family of origin and a failure to receive emotional validation, leads to persistent feelings of invisibility and worthlessness. Repeated experiences of unmet emotional needs weaken the individual\u0026rsquo;s trust in the relational support system, fostering chronic emotional insecurity. One participant expressed:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Even when I\u0026rsquo;m upset, he ignores me. I feel alone in handling everything.\u0026rdquo; (Participant 8)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSuch dual deprivation\u0026mdash;within the marital bond and from external sources\u0026mdash;intensified participants\u0026rsquo; sense of abandonment and helplessness. The absence of emotional refuge contributed to a deepening belief that no reliable source of comfort or understanding existed, further amplifying obsessive doubts about the relationship.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFamily and Environmental Pressures\u003c/b\u003e \u003c/p\u003e \u003cp\u003eFamily and environmental pressures encompass external factors beyond the marital relationship that significantly influence marital quality and the psychological experiences of individuals within the relationship. These pressures often manifest as interference from the spouse\u0026rsquo;s family, hasty decisions driven by expectations of the family of origin or traditional norms, and social or cultural judgments regarding the preservation of marital appearances. In such contexts, women experience not only the relational tensions inherent to their partnership but also the evaluative scrutiny of families and society, frequently compelling them to remain silent or tolerate difficult circumstances to avoid external blame. These external pressures elevate psychological stress and limit autonomous, rational decision-making within the marriage.\u003c/p\u003e \u003cp\u003eExperiencing these pressures often constrains a woman\u0026rsquo;s sense of choice and independence, restricting realistic evaluation and assertive decision-making regarding the relationship. Women may feel solely responsible for maintaining the appearance of the marriage, with any attempt to modify or exit the relationship potentially resulting in social or familial censure. Interference from the spouse\u0026rsquo;s family undermines marital boundaries, reduces opportunities for relational repair, and, through favoritism or partiality, places additional psychological strain on the woman. Marriage decisions made under such external pressures often occur without sufficient opportunity for partner evaluation, leaving women vulnerable to regret and dissatisfaction when relational conflicts arise. Persistent exposure to these environmental pressures complicates conflict resolution processes and reinforces a cycle of marital tension.\u003c/p\u003e \u003cp\u003e\u003cb\u003eSpouse\u0026rsquo;s family\u003c/b\u003e interference reflects patterns in which marital boundaries are consistently violated by the spouse\u0026rsquo;s family, resulting in excessive influence over decisions, parenting practices, and private matters. Such interference diminishes the couple\u0026rsquo;s autonomy and transforms the marital space into one dominated by external control. Although often framed as \u0026ldquo;concern\u0026rdquo; or \u0026ldquo;advice,\u0026rdquo; these interventions undermine the marital structure. Husbands frequently remain passive or side with their families, rather than defending marital boundaries, leaving women without emotional support when needed. Consequently, women experience heightened vulnerability, diminished psychological security, and feelings of powerlessness. Women reported that major decisions, including finances, living arrangements, child-rearing, and conflict management, were frequently dictated by the spouse\u0026rsquo;s family. Husbands\u0026rsquo; emotional dependence on their families or adherence to traditional norms often prevented them from intervening, intensifying women\u0026rsquo;s psychological burden. Participants described repeated experiences of judgment, criticism, imposition of opinions, and occasional overt or covert humiliation by the spouse\u0026rsquo;s family, which gradually eroded self-esteem and emotional security. Qualitative analysis revealed that key concepts, such as \u0026ldquo;spouse\u0026rsquo;s family interference in marital life,\u0026rdquo; \u0026ldquo;family pressure on life decisions,\u0026rdquo; \u0026ldquo;lack of family boundary setting,\u0026rdquo; and \u0026ldquo;interference in child-rearing,\u0026rdquo; were consistently reported. Illustrative statements include:\u003c/p\u003e \u003cp\u003e\u003cem\u003e \u0026ldquo;His family determines how the children are raised.\u0026rdquo; (Participant 4)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eHasty decisions under pressure\u003c/b\u003e describe processes in which marriage is entered prematurely under external influence, without sufficient opportunity for partner evaluation, realistic assessment, or psychological preparedness. Traditional expectations, familial pressures, cultural norms, and fear of missed opportunities often lead women to commit without fully understanding relational compatibility. These rushed decisions can later generate regret, doubt, and a sense of erroneous choice as deeper relational and personal challenges emerge. Women described being subjected to explicit and implicit pressures during early marital decision-making, including expectations to marry at a socially acceptable age, comparisons with peers, and anxiety about future opportunities. Fear of parental disapproval or social labeling, coupled with hope that post-marriage problems could be resolved, contributed to premature commitment. Such choices often became sources of ongoing rumination, regret, and feelings of entrapment, forming a foundation for emotional and cognitive disturbances within the marriage. Participants highlighted repeated concepts such as \u0026ldquo;marital choice under traditional pressure,\u0026rdquo; \u0026ldquo;hasty pre-marriage decision,\u0026rdquo; and \u0026ldquo;decision anxiety in youth.\u0026rdquo; Illustrative statements include:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I decided too soon because my family was worried.\u0026rdquo; (Participant 9)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSocial pressure and cultural judgment\u003c/b\u003e refer to the psychological burden arising from societal norms, traditional expectations, and judgmental scrutiny, which compel women to conceal marital difficulties, remain silent, or project an image of a successful marriage. This pressure reduces opportunities for open communication with family, friends, or professionals and forces women into adaptive behaviors aimed at avoiding social stigma. Divorce is frequently perceived as failure, causing women to feel threatened even when expressing needs or complaints. This judgmental context limits psychological recovery, transforming distress into a silent, internalized experience. Women reported encountering responses emphasizing the continuation of the marriage regardless of personal suffering, such as \u0026ldquo;You must endure,\u0026rdquo; \u0026ldquo;All men are the same,\u0026rdquo; or \u0026ldquo;Don\u0026rsquo;t separate because of the children.\u0026rdquo; Such responses invalidate the woman\u0026rsquo;s experiences and restrict independent decision-making. Fear of social judgment following separation or complaints promotes emotional self-censorship, denial of feelings, acceptance of imposed roles, and chronic concealment. Many participants emphasized that, even during severe marital distress, fear of familial or societal condemnation prevented disclosure or help-seeking. Illustrative statements include:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;No one understands my pain; they just want me to preserve my life.\u0026rdquo; (Participant 5)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThese narratives reveal how cultural and social pressures systematically silence women, maintaining marital appearances at the cost of psychological well-being and sustaining prolonged relational distress.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInterpersonal Conflicts and Dysfunctional Marital Interactions\u003c/b\u003e \u003c/p\u003e \u003cp\u003eInterpersonal conflicts and dysfunctional marital interactions reflect entrenched patterns of maladaptive and unequal exchanges within the daily lives of couples in which dominance, psychological control, criticism, and chronic blame become defining features of the relationship. Unlike emotional withdrawal or communicative silence\u0026mdash;where disconnection occurs passively\u0026mdash;these interactions involve active, damaging dynamics that expose one or both partners to persistent power imbalance, disrespect, and emotional invalidation. Among married women with Relationship Obsessive-Compulsive Disorder (ROCD), such maladaptive cycles frequently manifest through recurring episodes of control, humiliation, avoidance of cooperation, and neglect of emotional needs.\u003c/p\u003e \u003cp\u003eWithin these relationships, couples fail to engage in mutual emotional regulation, resorting instead to defensive interpersonal mechanisms such as angry outbursts, unilateral decision-making, imposition of rigid traditional roles, and the withdrawal of behavioral support. These maladaptive exchanges not only obstruct constructive dialogue but gradually foster feelings of helplessness, emotional fatigue, and chronic rejection in the female partner. Over time, the relationship evolves into a chronically dysfunctional interpersonal environment characterized by low cooperation, indifference, and recurrent violations of emotional and psychological boundaries.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDominance and Control\u003c/b\u003e emerged as a central interpersonal mechanism within these dynamics. Participants described how their husbands sought to exert control over emotional, behavioral, and even social domains of their lives, progressively eroding their autonomy and sense of agency. Control manifested both overtly\u0026mdash;through direct restrictions, unilateral decisions, or explicit behavioral monitoring\u0026mdash;and covertly, through psychological pressure, subtle coercion, and emotional withdrawal in response to noncompliance. As one participant explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;He decides all family plans without asking me. I feel like I don\u0026rsquo;t exist in our own home.\u0026rdquo; (Participant 2)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSuch dynamics fostered a relationship climate governed by authority rather than collaboration. Over time, women internalized the belief that resisting control would lead to conflict, resulting in emotional resignation and silent compliance. The cumulative loss of personal freedom produced a sense of psychological exhaustion and diminished ownership over one\u0026rsquo;s own life.\u003c/p\u003e \u003cp\u003e \u003cb\u003eHumiliation and Chronic Blame\u003c/b\u003e represented another pervasive interactional pattern, where emotional communication became dominated by criticism, belittlement, and character-based attacks. Instead of receiving validation or empathy, participants reported being repeatedly discredited and emotionally devalued. Spouses often exaggerated minor mistakes, framed disagreements as personal failures, and employed sarcasm or public mockery to undermine the woman\u0026rsquo;s confidence. As one participant stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;He criticizes me in front of friends for small mistakes, making me feel worthless.\u0026rdquo; (Participant 3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThis persistent invalidation gradually transformed the marital environment into a psychologically unsafe space, where the woman\u0026rsquo;s emotional expressions were dismissed as irrational or exaggerated. The erosion of respect replaced emotional support with criticism, leading to chronic self-doubt, internalized guilt, and an enduring sense of unworthiness.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLack of Participation in the Relationship\u003c/b\u003e formed the third recurrent interpersonal pattern, encompassing unequal distribution of domestic, parental, and emotional responsibilities. Participants consistently described feeling solely responsible for the maintenance of household routines, childcare, and relational management, while their husbands remained passive or disengaged. One participant expressed:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I do all the cooking, cleaning, and managing the children. He doesn\u0026rsquo;t help at all.\u0026rdquo; (Participant 11)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe absence of active participation reinforced structural inequality within the relationship, as women bore the full weight of domestic and emotional labor. Simultaneously, the persistence of rigid traditional roles restricted the woman\u0026rsquo;s capacity for rest, self-care, and personal growth. The cumulative burden of unshared responsibilities contributed to psychological depletion and a growing perception of relational inequity and loneliness.\u003c/p\u003e \u003cp\u003eOverall, interpersonal conflicts and dysfunctional marital interactions among married women with ROCD illustrate a complex system of relational pathology in which dominance, emotional degradation, and unilateral engagement intersect to sustain a cycle of distress. These intertwined dynamics diminish psychological safety, undermine emotional reciprocity, and perpetuate the obsessive doubts characteristic of ROCD. The findings highlight how enduring power imbalances and communication failures not only impair marital satisfaction but also exacerbate obsessive relational cognitions. From a therapeutic standpoint, interventions that address power asymmetry, promote assertive communication, and rebuild mutual emotional responsiveness are essential for restoring balance and psychological well-being in these relationships.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMaladaptive Coping Strategies and Emotion Regulation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eMaladaptive coping strategies and emotion regulation patterns describe habitual ways of responding to psychological distress and marital difficulties that, rather than reducing tension or fostering relational repair, maintain or even intensify psychological harm. In these situations, individuals often avoid directly addressing problems or expressing emotions in healthy ways, instead relying on psychological avoidance, self-censorship, emotional suppression, or compensatory behaviors. At times, they relinquish responsibility for change to external sources, hoping for outside intervention. These strategies typically develop as a consequence of repeated relational failures, frustration over a spouse\u0026rsquo;s lack of change, and limited capacity for emotion regulation within a safe relational context. Although such strategies may provide temporary relief, they ultimately perpetuate distress and reduce psychological flexibility.\u003c/p\u003e \u003cp\u003eWomen living under these conditions frequently adopt strategies that, although psychologically \u0026ldquo;less stressful,\u0026rdquo; are profoundly exhausting. Emotional avoidance and psychological withdrawal often manifest as self-censorship, emotional distancing, and disengagement from relational conflicts. Some turn to compensatory activities, such as shopping, hobbies, child-focused tasks, or excessive housework, to temporarily alleviate distress. Others, hoping for external intervention, delegate responsibility for relational improvement to medication, therapy, or professional help without altering internal or relational patterns. These behaviors function to reduce anxiety and maintain apparent functionality, yet leave the root of relational distress unaddressed.\u003c/p\u003e \u003cp\u003e\u003cb\u003ePsychological avoidance and suppression\u003c/b\u003e involve internal reactions in which individuals suppress their needs and emotions, avoiding direct engagement with relational challenges. This mechanism usually arises in response to repeated relational failures, emotional unresponsiveness from the spouse, and prior negative experiences, teaching the individual that expressing emotions or needs may be met with neglect, rejection, or blame. To protect themselves from further conflict, emotions and needs are relegated to the background, producing short-term conflict reduction but long-term accumulation of hidden dissatisfaction and psychological distancing. Over time, women internalize the belief that expressing needs or emotions will not elicit a response and may even exacerbate relational tension. Consequently, they refrain from discussing emotions, desires, or grievances, resulting in emotional self-censorship. Even during intense internal suffering, they may present a calm, tension-free exterior to prevent interpersonal escalation. Prolonged cycles of suppression push emotions into deeper layers of consciousness, gradually leading to emotional numbness or psychological withdrawal, impairing both expression and awareness of internal emotional needs. Qualitative data repeatedly highlighted concepts such as emotional avoidance, self-censorship, suppression of emotional needs, and emotional withdrawal. Participants often reported withholding emotional expression to maintain household calm or avoid repeated conflict. Illustrative statements include:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I prefer not to say anything to avoid arguments\u003c/em\u003e\u0026rdquo; (Participant 8)\u003c/p\u003e \u003cp\u003e \u003cb\u003eCompensatory behaviors\u003c/b\u003e refer to alternative activities undertaken to temporarily relieve psychological tension, emotional frustration, and suppressed emotions. These actions are not aimed at problem-solving or relational change but serve to manage internal distress, deny crises, or fill emotional voids. Common compensatory behaviors include individual hobbies, excessive work, or overcommitment to household responsibilities. By keeping themselves occupied, women avoid direct engagement with relational conflicts while maintaining an appearance of functional performance, though unresolved emotional pain remains active beneath the surface. When emotional needs remain unmet and opportunities for constructive dialogue are absent, women often seek activities that divert attention from unresolved tension. These may include intensive work, obsessive engagement with household chores, or solitary leisure activities such as reading, cooking, exercising, or social media use. While these behaviors provide temporary distraction and a sense of productivity, they function defensively, preventing confrontation with the underlying issue or expression of genuine needs. Qualitative findings revealed recurring concepts such as alternative activities, soothing solitary activities, and avoidant and compensatory behaviors such as excessive work. Illustrative statements include:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I read or use my phone to avoid thinking about it\u0026rdquo;\u003c/em\u003e (Participant 10).\u003c/p\u003e \u003cp\u003e \u003cb\u003eHope for external intervention\u003c/b\u003e refers to a psychological mechanism whereby individuals rely on external sources, such as medication, psychotherapy, or professional support, to cope with relational or emotional difficulties rather than fostering internal change or effective communication. Women in this situation often turn to therapy not necessarily to change their spouse, but to find a safe space for understanding, internal regulation, and guidance for decision-making. In many cases, therapy or consultation emerges as a last resort after repeated relational failures and personal attempts at problem-solving. Following experiences of emotional coldness, rejection, or chronic blame, women seek external sources where they can express themselves without judgment. Some participants hope that therapy or medication will help them manage anxiety or relational stress. Illustrative statements include:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I felt calmer with medication so I could continue\u0026rdquo;\u003c/em\u003e (Participant 11)\u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison and Regret Regarding Marital Choice\u003c/b\u003e \u003c/p\u003e \u003cp\u003eComparison and regret regarding marital choice represent a cognitive\u0026ndash;emotional pattern through which married women with ROCD retrospectively question the correctness of their marital decision. This theme reflects the pervasive presence of \u003cb\u003eruminative comparison\u003c/b\u003e, \u003cb\u003eidealized counterfactual thinking\u003c/b\u003e, and \u003cb\u003efeelings of regret or disappointment\u003c/b\u003e about perceived missed opportunities. As dissatisfaction accumulates within the relationship, women tend to reexamine their choice of partner through a lens of self-doubt and imagined alternatives. These cognitive processes intensify emotional ambivalence, weaken attachment, and sustain a cyclical pattern of relational uncertainty.\u003c/p\u003e \u003cp\u003eOne of the most salient components of this experience involves \u003cb\u003ecomparison and negative evaluation of the spouse\u003c/b\u003e. Women often engage in continuous evaluations of their partners, contrasting them with other men\u0026mdash;such as friends\u0026rsquo; or relatives\u0026rsquo; husbands\u0026mdash;or with an internalized ideal of the \u0026ldquo;perfect partner.\u0026rdquo; This comparison is rarely neutral; it is charged with emotional dissatisfaction and a sense of deprivation. Over time, the spouse becomes increasingly perceived as inadequate, emotionally distant, or inferior to these idealized standards. Such evaluations erode admiration, respect, and emotional closeness\u0026mdash;the essential foundations of marital satisfaction. As participants described:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Seeing my friends\u0026rsquo; husbands care more for their wives makes me feel my marriage is lacking.\u0026rdquo; (Participant 5)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThese reflections highlight how persistent comparison fosters a cognitive bias toward partner inadequacy, reinforcing relational disappointment and deepening emotional distance.\u003c/p\u003e \u003cp\u003eA second prominent process relates to \u003cb\u003eregret over marital choice\u003c/b\u003e. Many women expressed a lingering sense of remorse for having chosen their current partner, often accompanied by self-blame and feelings of entrapment. This regret is typically not momentary; it becomes a chronic mental state marked by counterfactual rumination\u0026mdash;replaying \u0026ldquo;what if\u0026rdquo; scenarios and imagining better life outcomes had a different decision been made. The emotional tone of these reflections is often heavy with disillusionment, guilt, and sadness. As participants explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Sometimes I think I should have chosen differently. I keep imagining life if I married someone else.\u0026rdquo; (Participant 6)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThese expressions reveal how regret functions as both a cognitive and emotional burden, eroding self-confidence and contributing to psychological exhaustion.\u003c/p\u003e \u003cp\u003eOverall, comparison and regret regarding marital choice reflect an intricate dynamic of relational dissatisfaction, idealized thinking, and self-critical rumination. The interplay between these processes maintains doubt and emotional disconnection, perpetuating the obsessive cycle of reassessment and regret characteristic of ROCD. Consistent with international literature, these findings underscore how maladaptive cognitive comparison and counterfactual rumination serve as central mechanisms that sustain relational distress and undermine marital satisfaction, while offering culturally grounded insight into the lived experience of married women struggling with obsessive relational doubts.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSearching for Alternative Sources of Meaning in Life\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe search for alternative sources of meaning in life refers to a psychological process in which married women with Relationship Obsessive-Compulsive Disorder (ROCD), when faced with marital failures and the inability to receive love, security, or satisfaction, seek new resources to reconstruct meaning, purpose, and hope in their lives. In this process, the marital relationship, which was expected to serve as the primary source of attachment, emotional security, and identity, is replaced by alternative elements that compensate for relational voids. Alternative sources of meaning may emerge through motherhood, individual independence and self-redefinition, or through realistic acceptance of limitations and constructing adaptive meaning from the damaged situation. Women engaged in this process attempt to cope with the emotional strain of marital failure by focusing on aspects of life that remain meaningful. For some, the child becomes the primary reason for continuing life, and the maternal role substitutes for the spousal role in providing existential meaning. Others, instead of investing in the marital relationship, work to reconstruct their psychological and social independence, defining themselves through occupational, educational, or personal roles. In other cases, women create adaptive meaning for the damaged situation by realistically accepting limitations, ensuring psychological endurance. Across all these pathways, the central mechanism is the \u0026ldquo;shift of psychological reliance from the marital relationship to an alternative source.\u0026rdquo;\u003c/p\u003e \u003cp\u003eThe first pattern, \u003cb\u003emeaning-making through the child\u003c/b\u003e, involved women directing their emotional and psychological focus toward their children, using the maternal role as a substitute for the lack of support and affection in the marital relationship. The child became a central source of meaning, motivating the woman to continue life despite relational setbacks. Participants described this as essential for coping, for example, stating, \u003cem\u003e\u0026ldquo;My child gives me reason to keep going; without them, I wouldn\u0026rsquo;t know what to do.\u0026rdquo; (Participant 7)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe second pattern, \u003cb\u003emeaning-making through individual independence\u003c/b\u003e, emerged as women sought to restore personal identity, self-esteem, and a sense of control by focusing on personal growth, work, education, or other non-marital roles. This pathway allowed women to generate alternative sources of meaning and self-worth in the absence of relational support. One participant noted, \u0026ldquo;\u003cem\u003eOnly when I am at work do I feel alive\u003c/em\u003e,\u0026rdquo; highlighting the role of independence in sustaining psychological resilience (Participant 1).\u003c/p\u003e \u003cp\u003eThe third pattern, \u003cb\u003emeaning-making through psychological adaptation to a failed relationship\u003c/b\u003e, involved women cognitively and emotionally reconstructing their marital situation to find a tolerable way to continue. Through realistic acceptance and focus on minimally positive aspects, they balanced hopelessness with the need to maintain life, using strategies such as justifying the marriage or highlighting small positive traits. For instance, one participant expressed, \u0026ldquo;\u003cem\u003eWhen I think about his small good qualities, I can tolerate it better\u003c/em\u003e,\u0026rdquo; illustrating how adaptation served as a tool for emotional survival (Participant 6).\u003c/p\u003e \u003cp\u003eOverall, these patterns demonstrate that, in the absence of supportive relationships, women actively seek alternative resources for meaning and purpose, maintaining psychological resilience through children, personal independence, or adaptive cognitive strategies.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe thematic analysis of the interviews led to the identification of eight overarching themes that capture the main harms experienced by married women with Relationship Obsessive\u0026ndash;Compulsive Disorder (ROCD). These themes include Intrapersonal Cognitive Experiences, Emotional and Psychological Disturbance, Marital Intimacy and Affectional Frustration, Interpersonal Conflicts and Dysfunctional Marital Interactions, Family and Environmental Pressures, Maladaptive Coping and Emotion Regulation Strategies, Comparison and Regret Regarding Marital Choice, and Searching for Alternative Sources of Meaning in Life. Collectively, these themes provide a comprehensive understanding of the multidimensional impact of ROCD on women\u0026rsquo;s cognitive, emotional, relational, and existential domains. Each theme and its related subthemes are elaborated in the following sections.\u003c/p\u003e \u003cp\u003eConsistent with prior research (e.g., (3, 5, 17), the participants\u0026rsquo; narratives revealed that ROCD is sustained by maladaptive intrapersonal cognitive processes\u0026mdash;particularly chronic doubt, rumination, polarized thinking, and suspicious interpretations\u0026mdash;that amplify uncertainty and undermine trust in personal judgment. This need for absolute certainty and low tolerance for ambiguity reflects a rigid cognitive style linked to maladaptive schemas and anxious attachment patterns. According to metacognitive and intolerance-of-uncertainty models (18, 19), such rigidity fosters repetitive checking and reassurance-seeking as a means to control uncertainty, paradoxically reinforcing anxiety and preoccupation in a self-perpetuating cycle of cognitive insecurity and emotional distress.\u003c/p\u003e \u003cp\u003eMarital intimacy emerged as another critical domain affected by ROCD. Participants frequently described emotional rejection, lack of empathy, and chronic communicative failure, all of which deepened their sense of isolation and relational insecurity. This absence of emotional reciprocity sustains obsessive questioning about the relationship\u0026rsquo;s value and the partner\u0026rsquo;s feelings. These findings echo previous research showing reduced intimacy and satisfaction among individuals with relationship-centered obsessions (20, 21). Extending cross-cultural perspectives, the present results illustrate how chronic affectional deprivation interacts with obsessive doubt in collectivist contexts (22), where relational harmony and emotional restraint are highly valued.\u003c/p\u003e \u003cp\u003eInterpersonal conflict and dysfunctional marital interactions further compound these difficulties. Power imbalance, psychological control, chronic criticism, and low participation in emotional responsibilities emerged as dominant relational dynamics. Such patterns deprive women of autonomy and psychological safety, reinforcing perceptions of inadequacy and entrapment. These findings are consistent with systemic and interactional perspectives, as prior research has shown that relationship-centered obsessive symptoms are intertwined with relational dissatisfaction and are maintained through maladaptive interaction patterns within the dyad (e.g., (13).\u003c/p\u003e \u003cp\u003eCultural and social contexts played a salient role in shaping these experiences. In-law interference, traditional gender expectations, and emphasis on maintaining social reputation limited women\u0026rsquo;s emotional expression and autonomy. The internalization of these cultural scripts created tension between conformity and self-expression, sustaining emotional suppression and cognitive ambivalence. These findings support research that highlight how collectivist norms and gendered expectations shape mental distress and relational functioning (23). The Iranian context thus offers a unique framework for understanding how sociocultural pressures amplify obsessive relational cognition and emotional withdrawal.\u003c/p\u003e \u003cp\u003eComparison and regret regarding marital choice emerged as a distinct cognitive\u0026ndash;emotional pattern. Women often evaluated their partners against imagined ideals or others\u0026rsquo; relationships, resulting in chronic regret and dissatisfaction. This pattern reflects counterfactual thinking processes known to intensify negative affect and relational insecurity (24, 25). Persistent comparison and idealization reinforce cognitive rigidity and emotional ambivalence, sustaining a self-perpetuating loop of obsessive doubt and reduced commitment.\u003c/p\u003e \u003cp\u003eParticipants also relied on maladaptive coping strategies such as reassurance-seeking, thought suppression, and avoidance, which provided short-term relief but reinforced obsessive preoccupation. These findings correspond with coping-focused and cognitive models of OCD maintenance, suggesting that maladaptive coping responses\u0026mdash;such as reassurance-seeking, thought suppression, and avoidance\u0026mdash;serve as key maintaining factors of obsessive\u0026ndash;compulsive symptoms and affective distress (26\u0026ndash;28). Over time, such strategies diminished confidence in coping capacity and increased interpersonal tension, highlighting the cyclical relationship between maladaptive emotion regulation and obsessive thinking.\u003c/p\u003e \u003cp\u003eSocial withdrawal and isolation frequently emerged as women attempted to protect themselves from perceived judgment and relational strain. By avoiding social engagement, participants reduced opportunities for support and validation, amplifying loneliness and preoccupation with their partners. This finding is consistent with studies linking social isolation to heightened OCD severity and diminished quality of life (29\u0026ndash;31). Social withdrawal thus functions as an avoidance-based coping mechanism that perpetuates cognitive and emotional dysfunction.\u003c/p\u003e \u003cp\u003eDespite these challenges, participants demonstrated adaptive efforts to preserve resilience by redirecting emotional energy toward parenting, work, or personal independence. Such meaning-making strategies, while partially adaptive, provided short-term stability without resolving core relational needs. These findings align with the conceptualization of meaning-making as a coping resource in the face of distress (32\u0026ndash;34). However, reliance on compensatory roles may represent defensive adaptation that further reduces intimacy and authentic emotional connection.\u003c/p\u003e \u003cp\u003eTaken together, these findings reveal that ROCD among married women in this context is sustained by an interconnected network of cognitive rigidity, emotional dysregulation, relational power imbalance, sociocultural constraint, maladaptive coping, chronic comparison, social withdrawal, and efforts to construct alternative meaning. The constant interplay between obsessive thought patterns, emotional exhaustion, relational dysfunction, and compensatory adaptations produces a self-reinforcing cycle of distress. These mechanisms illustrate how personal vulnerabilities and contextual stressors jointly maintain psychological suffering and relational dissatisfaction.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study illuminate the psychological and relational dynamics of married women experiencing ROCD. ROCD extends beyond obsessive doubts to involve cognitive rigidity, emotional dysregulation, and maladaptive interpersonal patterns that sustain marital distress. Cognitive insecurities such as polarized thinking and excessive need for certainty interacted with helplessness and self-blame, reducing resilience and intensifying relational anxiety. Marital intimacy was often replaced by emotional withdrawal and unmet validation needs, while power imbalances and chronic criticism further eroded psychological safety. Cultural norms regarding loyalty, endurance, and emotional restraint contributed to the persistence of these anxieties. Participants\u0026rsquo; efforts to find alternative sources of meaning (e.g., parenting or adaptive acceptance) reflected resilience, although sometimes at the cost of emotional detachment. Clinically, these results highlight the importance of culturally sensitive interventions integrating cognitive restructuring, emotional regulation, and relational therapy. Future research should explore these dynamics longitudinally and across diverse populations, incorporating perspectives of both partners to better understand reciprocal influences in ROCD.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study provided an in-depth understanding of marital difficulties among married women with ROCD through thematic analysis of interviews conducted in Bandar Abbas (2023\u0026ndash;2024). However, several limitations should be considered. Participants were recruited exclusively from counseling centers in a single city, limiting generalizability. Exclusion of women undergoing psychotherapy or pharmacotherapy may have reduced sample representativeness. All interviews were conducted by a single researcher, which could introduce interpretive bias despite peer review and reflexive journaling. The cross-sectional design and reliance on self-reports restrict causal inferences and longitudinal insights. Additionally, sociocultural and gender norms specific to Iran may limit applicability to other cultural contexts.\u003c/p\u003e\n\u003ch3\u003eImplications and Future Research\u003c/h3\u003e\n\u003cp\u003eFuture studies should include larger, more diverse samples from multiple regions, employ longitudinal and mixed-methods designs, and integrate partners\u0026rsquo; perspectives to capture dyadic dynamics. Experimental and intervention-based studies, including randomized controlled trials, are recommended to evaluate targeted therapies combining cognitive restructuring, emotion regulation, and attachment-based interventions. Clinically, findings highlight the need for specialized therapist training, culturally informed psychoeducational programs, and integration of cognitive, emotional, and relational components in treatment to enhance marital functioning among women with ROCD.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted in accordance with Declaration of Helsinki and was approved by the ethics committee of University under the research code. Prior to each interview, participants were given detailed explanations about the study's objectives, the purpose of recording the interview, and assurances regarding the confidentiality of their information. Written consent was obtained from all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflict of interest was reported by the author(s).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBloch MH, Landeros-Weisenberger A, Rosario MC, Pittenger C, Leckman JF. Meta-analysis of the symptom structure of obsessive-compulsive disorder. American Journal of Psychiatry. 2008;165(12):1532\u0026ndash;42.\u003c/li\u003e\n \u003cli\u003eDoron G, Szepsenwol O, Karp E, Gal N. Obsessing about intimate-relationships: Testing the double relationship-vulnerability hypothesis. Journal of behavior therapy and experimental psychiatry. 2013;44(4):433\u0026ndash;40.\u003c/li\u003e\n \u003cli\u003eMelli G, Bulli F, Doron G, Carraresi C. Maladaptive beliefs in relationship obsessive compulsive disorder (ROCD): Replication and extension in a clinical sample. Journal of Obsessive-Compulsive and Related Disorders. 2018;18:47\u0026ndash;53.\u003c/li\u003e\n \u003cli\u003eBrandes O, Stern A, Doron G. \u0026ldquo;I just can\u0026apos;t trust my partner\u0026rdquo;: Evaluating associations between untrustworthiness obsessions, relationship obsessions and couples violence. Journal of Obsessive-Compulsive and Related Disorders. 2020;24:100500.\u003c/li\u003e\n \u003cli\u003eDoron G, Derby D, Szepsenwol O, Nahaloni E, Moulding R. Relationship obsessive\u0026ndash;compulsive disorder: Interference, symptoms, and maladaptive beliefs. Frontiers in Psychiatry. 2016;7:58.\u003c/li\u003e\n \u003cli\u003eDoron G, Derby DS, Szepsenwol O. Relationship obsessive compulsive disorder (ROCD): A conceptual framework. Journal of Obsessive-Compulsive and Related Disorders. 2014;3(2):169\u0026ndash;80.\u003c/li\u003e\n \u003cli\u003eDoron G, Derby DS, Szepsenwol O, Talmor D. Flaws and all: Exploring partner-focused obsessive-compulsive symptoms. Journal of Obsessive-Compulsive and Related Disorders. 2012;1(4):234\u0026ndash;43.\u003c/li\u003e\n \u003cli\u003ePozza A, Casale S, D\u0026egrave;ttore D. Therapists\u0026rsquo; emotional reactions to patients with obsessive\u0026ndash;compulsive disorder: the role of therapists\u0026rsquo; orientation and perfectionism. Journal of Rational-Emotive \u0026amp; Cognitive-Behavior Therapy. 2022;40(4):879\u0026ndash;904.\u003c/li\u003e\n \u003cli\u003ePrasko J, Ociskova M, Krone I, Burkauskas J, Gecaite-Stonciene J, Hodny F, et al. A narrative review of relationship obsessive-compulsive disorder: Characteristics, causes and cognitive-behavioural interventions. Neuroendocrinology Letters. 2024;45(4):262\u0026ndash;80.\u003c/li\u003e\n \u003cli\u003eMısırlı M, Kaynak GK. Relationship obsessive compulsive disorder: A systematic review. Psikiyatride G\u0026uuml;ncel Yaklaşımlar. 2023;15(4):549\u0026ndash;61.\u003c/li\u003e\n \u003cli\u003eLombardi A, Rodriguez C. Enhancing Exposure and Response Prevention Treatment in an Individual With Relationship Obsessive-Compulsive Disorder: A Case Report. Journal of Cognitive Psychotherapy. 2019;33(3):185\u0026ndash;95.\u003c/li\u003e\n \u003cli\u003eAardema F, Moulding R, Melli G, Radomsky AS, Doron G, Audet JS, et al. The role of feared possible selves in obsessive\u0026ndash;compulsive and related disorders: A comparative analysis of a core cognitive self‐construct in clinical samples. Clinical psychology \u0026amp; psychotherapy. 2018;25(1):19\u0026ndash;29.\u003c/li\u003e\n \u003cli\u003eDoron G, Mizrahi M, Szepsenwol O, Derby D. Right or flawed: Relationship obsessions and sexual satisfaction. The journal of sexual medicine. 2014;11(9):2218\u0026ndash;24.\u003c/li\u003e\n \u003cli\u003eCorbin J, Strauss A. Basics of qualitative research: Techniques and procedures for developing grounded theory: Sage publications; 2014.\u003c/li\u003e\n \u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2008;3(2):77\u0026ndash;101.\u003c/li\u003e\n \u003cli\u003eGuba EG, Lincoln YS. Competing paradigms in qualitative research. Handbook of qualitative research. 1994;2(163-194):105.\u003c/li\u003e\n \u003cli\u003eTrak E, Inozu M. Developmental and self-related vulnerability factors in relationship-centered obsessive compulsive disorder symptoms: A moderated mediation model. Journal of Obsessive-Compulsive and Related Disorders. 2019;21:121\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eWells A. Advances in metacognitive therapy. International Journal of Cognitive Therapy. 2013;6(2):186\u0026ndash;201.\u003c/li\u003e\n \u003cli\u003eBuhr K, Dugas MJ. Fear of emotions, experiential avoidance, and intolerance of uncertainty in worry and generalized anxiety disorder. International Journal of Cognitive Therapy. 2012;5(1):1\u0026ndash;17.\u003c/li\u003e\n \u003cli\u003eDoron G, Derby DS, Szepsenwol O, Talmor D. Tainted love: Exploring relationship-centered obsessive compulsive symptoms in two non-clinical cohorts. Journal of Obsessive-Compulsive and Related Disorders. 2012;1(1):16\u0026ndash;24.\u003c/li\u003e\n \u003cli\u003eKılı\u0026ccedil; N, Altınok A. Obsession and relationship satisfaction through the lens of jealousy and rumination. Personality and Individual Differences. 2021;179:110959.\u003c/li\u003e\n \u003cli\u003eSu JC, Lee RM, Park IJ, Soto JA, Chang J, Zamboanga BL, et al. Differential links between expressive suppression and well-being among Chinese and Mexican American college students. Asian American Journal of Psychology. 2015;6(1):15\u0026ndash;24.\u003c/li\u003e\n \u003cli\u003eRajkumar RP. Cultural collectivism, intimate partner violence, and women\u0026apos;s mental health: An analysis of data from 151 countries. Frontiers in sociology. 2023;8:1125771.\u003c/li\u003e\n \u003cli\u003eHorgos P. Rewriting Reality: Cognitive and Affective Relationships of Counterfactual Thought. RANGE: Undergraduate Research Journal (2025). 2025.\u003c/li\u003e\n \u003cli\u003eStuder LE. If I had never met you: Counterfactual thinking and romantic relationships 2016.\u003c/li\u003e\n \u003cli\u003eSpencer SD, Stiede JT, Wiese AD, Goodman WK, Guzick AG, Storch EA. Cognitive-behavioral therapy for obsessive-compulsive disorder. The Psychiatric clinics of North America. 2022;46(1):167\u0026ndash;80.\u003c/li\u003e\n \u003cli\u003eChessell C, Halldorsson B, Harvey K, Guzman-Holst C, Creswell C. Cognitive, behavioural and familial maintenance mechanisms in childhood obsessive compulsive disorders: A systematic review. Journal of Experimental Psychopathology. 2021;12(3):20438087211036581.\u003c/li\u003e\n \u003cli\u003eFatima A, Gul A. The COGNITIVE BIASES, COPING MECHANISMS AND SYMPTOM SEVERITY AMONG INDIVIDUALS WITH OCD TENDENCIES. Journal of Arts \u0026amp; Social Sciences. 2025;12(1):64\u0026ndash;74.\u003c/li\u003e\n \u003cli\u003eŻerdziński M, Burdzik M, Żmuda R, Witkowska-Berek A, Dȩbski P, Flajszok-Macierzyńska N, et al. Sense of happiness and other aspects of quality of life in patients with obsessive-compulsive disorder. Frontiers in Psychiatry. 2022;13:1077337.\u003c/li\u003e\n \u003cli\u003eKılı\u0026ccedil; A, G\u0026ouml;rmez A, Elbay RY, \u0026Ouml;zer BU. Internalized stigma in obsessive compulsive disorder: Correlates and associations with quality of life. Archives of Psychiatric Nursing. 2022;39:37\u0026ndash;45.\u003c/li\u003e\n \u003cli\u003eManzoor R, Shah SAR, Kamal A, Nazir N. Investigating the Effects of OCD Traits on the Quality of Life among Adults: The moderating role of Social Support. Remittances Review 2024;9(24):3101\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eYang Z, Ji L-J, Yang Y, Wang Y, Zhu L, Cai H. Meaning making helps cope with COVID-19: A longitudinal study. Personality and Individual Differences. 2021;174:110670.\u003c/li\u003e\n \u003cli\u003ePark CL. Meaning Making Following Trauma. Frontiers in Psychology. 2022;Volume 13 - 2022.\u003c/li\u003e\n \u003cli\u003eKarbainova D, Fang S, Barker ET. Meaning making in the context of the COVID-19 pandemic: effects of purpose in life, positive reframing, acceptance, and event appraisal. Applied Developmental Science. 2025:1\u0026ndash;15.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Relationship Obsessive–Compulsive Disorder, marital difficulties, women’s experiences, qualitative phenomenology","lastPublishedDoi":"10.21203/rs.3.rs-8407007/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8407007/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMarriage can be significantly strained in the presence of Relationship Obsessive\u0026ndash;Compulsive Disorder (ROCD), where intrusive doubts and compulsive cognitive patterns disrupt emotional security and marital functioning. Women with ROCD often experience chronic uncertainty, excessive comparison, and emotional dysregulation, leading to relational detachment, compensatory strategies, and maladaptive meaning-making. Examining these experiences qualitatively provides insight into how ROCD shapes marital difficulties within cultural contexts such as Iran. Therefore, this study aimed to explore the phenomenology of marital challenges among married women with ROCD in Bandar Abbas (2023\u0026ndash;2024), within the framework of socio-cultural influences shaping cognitive-emotional experiences. This study employed a qualitative phenomenological approach to explore marital difficulties among married women with ROCD in Bandar Abbas (2023\u0026ndash;2024). Eleven participants were purposefully selected from counseling centers based on inclusion and exclusion criteria and interviewed using semi-structured interviews until data saturation was reached. Interviews were audio-recorded, transcribed verbatim, and analyzed using interpretive phenomenological analysis. Credibility and trustworthiness were ensured through member checking, peer debriefing, and reflexive practices.The analysis identified eight main themes, twenty-three subthemes, and fifty-eight semantic units: (1) Intrapersonal Cognitive Experiences (chronic doubt and need for certainty, obsessive rumination, polarized thinking and negative bias, suspicious interpretations); (2) Emotional and Psychological Disturbance (helplessness and emotional deprivation, relational depression and psychological exhaustion, self-blame and worthlessness); (3) Marital Intimacy and Affectional Frustration (emotional rejection and coldness, chronic communicative failure, frustration in receiving affection and support); (4) Family and Environmental Pressures (spouse\u0026rsquo;s family interference, hasty decisions under pressure, social pressure and cultural judgment); (5) Interpersonal Conflicts and Dysfunctional Interactions (dominance and control, humiliation and chronic blame, lack of participation); (6) Maladaptive Coping Strategies and Emotion Regulation (psychological avoidance and suppression, compensatory behaviors, hope for external intervention); (7) Comparison and Regret Regarding Marital Choice (comparison with others, regret over marital choice); and (8) Searching for Alternative Sources of Meaning (meaning-making through the child, meaning-making through individual independence, meaning-making through adaptation). These themes illustrate how obsessive doubts, emotional dysregulation, familial and social pressures, and maladaptive coping strategies collectively erode relational trust, emotional security, and marital cohesion. The findings highlight the need for culturally sensitive interventions that address cognitive distortions, emotional regulation, communication, and meaning-making to improve marital functioning and relational resilience among women with ROCD.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e","manuscriptTitle":"Identifying the Harms Experienced by Married Women with Relationship Obsessive– Compulsive Disorder","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 04:59:28","doi":"10.21203/rs.3.rs-8407007/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-09T08:14:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-08T20:50:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198348599278473738138620245677925607735","date":"2026-02-10T13:36:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-09T19:13:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334514920938225189637965990187018925250","date":"2026-01-27T09:12:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-27T04:28:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-16T17:04:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-15T04:31:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-15T04:30:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-12-19T16:48:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7d30b89f-77c9-4409-88ba-9702a32ca855","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T08:25:46+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 04:59:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8407007","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8407007","identity":"rs-8407007","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}