As a clinical psychologist who has treated countless clients with relationship-themed obsessive-compulsive disorder (OCD), known as relationship OCD or ROCD, I have witnessed firsthand the profound distress and damage this lesser-understood condition can cause. My aim today is to share insights that can spur compassion and understanding about ROCD.
The Core of Relationship OCD
Like other manifestations of OCD, ROCD consists of intrusive, unwanted thoughts that trigger deep distress anxiety, which leads to repetitive acts aimed at temporarily alleviating that distress. The difference lies in the content - in ROCD these obsessions and compulsions revolve around intimate relationships.
ROCD obsessions generally fall into two main categories:
Obsessing about the “rightness” of the relationship (e.g. questioning feelings towards partner, the future viability of the relationship)
Obsessing about perceived flaws in one’s partner (e.g. appearance, habits and traits)
Compulsions can be behavioral or purely mental and include:
Monitoring of feelings/ attractions / sexual arousal and other internal states
Compulsively seeking reassurance about the relationship or partner rightness
Mental reviewing and analyzing past interactions to figure out if this is the right relationship or the right partner
Checking social media and comparing attractiveness of other people and other relationships
On the surface these symptoms can seem similar to normal doubts or concerns in relationships. What tips it over into ROCD is the extent of time spent and the distress and suffering they cause. ROCD can completely hijack attention and impair daily functioning.
The Devastating Impact of ROCD
ROCD extracts a painful toll on those afflicted, often causing tremendous damage to the relationship itself. Partners feel hurt and rejected by the constant doubts and criticism. The individual’s suffering also negatively impacts partners empathetically. ROCD prevents both members of a couple from being fully present and finding joy within the relationship.
The disorder breeds shame and isolation. Seeing happy couples triggers further self-loathing. As I often tell my clients - ROCD makes you feel like a prisoner watching others enjoy freedom. Temporarily avoiding relationships to escape the pain often seems the only choice.
Demystifying the Causes
The development of OCD, including ROCD, involves complex interactions between biological and environmental factors. Both Genetics and environmental influences influence the development of the disorder.
OCD highjacks normal thought processes. Typically it starts with an initial normal thought or trigger. For example, if you are a bit board when spending time with your partner on a date night. Rather than dismissing it as no big deal, the inclination in ROCD is to perceive it as important and requiring analysis. This sparks endless mental review of the date, whay you felt board and what it means that you felt board - searching for the deeper meaning – "does feeling board reflect waning interest in the relationship?"
Overimportance of thoughts plus intolerance of uncertainty create a self-perpetuating cycle of obsessing and compulsively trying to achieve certainty to relieve the anxiety. Of course, definitive certainty about the future of a relationship or guarantee of a partner’s perpetual affection is impossible. And so the obsessions continue.
Treatment Options Offer Hope
We now have well-established, effective treatments for ROCD. First-line treatment is cognitive behavioral therapy (CBT) consisting of exposure and response prevention (ERP) and cognitive therapy.
ERP involves gradually confronting triggers of obsessions without performing compulsions. Feared situations are approached gradually and consistently. For example, an individual afraid of seeing attractive people could start by looking at less-threatening images and work their way up to real-life exposure. The goal is to demonstrate anxiety naturally peaks and fades without performing compulsions.
Cognitive therapy addresses the dysfunctional beliefs, thought patterns and biases underlying ROCD such as:
Black-and-white thinking (e.g. a partner is either perfect or inadequate)
Overimportance of thoughts (e.g. intrusive doubts mean the relationship is doomed)
Intolerance of uncertainty
In therapy you will learn how such thoughts influence how you feel and your engagement with your relationship and use real-life behavioral experiments, to distance yourself and respond differently to such thoughts.
Medications like SSRIs can also be beneficial, especially alongside therapy. Mindfulness techniques help manage anxiety. Support groups validate and diminish the isolation.
There is Light Ahead
ROCD is a challenging condition. The road may be long and arduous. However, countless individuals with ROCD do achieve happiness, fulfilling relationships and a vastly improved quality of life. They reach a point where they can say “these are just thoughts” and continue on with their day.
While ROCD may always be lurking in the background for some, the volume can be turned down substantially. Remission is possible. I encourage anyone struggling with ROCD to start with getting an accurate diagnosis and then begin evidence-based treatment. Be compassionate with yourself. There are brighter days ahead.