Interpersonal ambivalence in obsessive-compulsive disorder

Background: The social attitudes and interpersonal relationships of patients with obsessive-compulsive disorder (OCD) are subject to a longstanding controversy. Whereas cognitive-behavioural researchers emphasize exaggerated pro-social attitudes in OCD like inflated responsibility and worry for other people (especially significant others), dynamic theories traditionally focus on anti-social attitudes such as latent aggression and hostility. In two recent studies, we gathered support not only for a co-existence of these seemingly opposing attitudes in OCD, but also for a functional connection: inflated responsibility in part appears to serve as a coping strategy (or defense) against negative interpersonal feelings. Aims: In the present study, we tested a shortened version of the Responsibility and Interpersonal Behaviours and Attitudes Questionnaire (RIBAQ-R). Method: The scale was administered to 34 participants with OCD and 34 healthy controls. The questionnaire concurrently measures pro-social and anti-social interpersonal attitudes across three subscales. Results: In line with our prior studies, patients displayed higher scores on both exaggerated pro-social attitudes (e.g. I suffer from a strict conscience concerning my relatives) as well as latent aggression (e.g. Sometimes I would like to harm strangers on the street) and suspiciousness/distrust (e.g. I cannot even trust my own family). A total of 59% of the patients but only 12% of the healthy controls showed marked interpersonal ambivalence (defined as scores higher than one standard deviation from the mean of the nonclinical controls on both the pro-social and at least one of the two anti-social subscales). Conclusions: The study asserts high interpersonal ambivalence in OCD. Further research is required to pinpoint both the dynamic and causal links between opposing interpersonal styles. Normalization and social competence training may prove beneficial to resolve the apparent problems of patients with OCD regarding anger expression and social conflict management.