Relationship OCD (ROCD)
What is Relationship OCD?
Obsessive-compulsive disorder (OCD) is a mental health diagnosis that affects between 1-2% of the population. It is characterized by recurrent intrusive thoughts known as obsessions and repetitive, ritualistic behavior called compulsions. There are numerous types of OCD, with different obsessions and compulsive behavior associated with each of them. One common subtype of OCD is Relationship Obsessive-compulsive Disorder (ROCD). ROCD involves obsessions and compulsions having to do with doubting one's relationship. Relationship OCD can be a debilitating disorder, affecting not only important relationships, but also job performance, daily functioning, and quality of life in general.
Symptoms of Relationship OCD
Obsessions
Relationship OCD symptoms include the presence of obsessions, compulsions, or, more commonly, both obsessions and compulsions. Obsessions are persistent intrusive thoughts or urges that trigger significant anxiety. People with obsessive thoughts frequently try to suppress them or neutralize them with some thought or action. Here are some common relationship concerns seen in ROCD:
Doubts about compatibility: These insecurities center on whether your partner is "the one" or the "perfect" match. People with these worries often focus on relatively insignificant differences or minor flaws perceived in their partner.
Fear of not loving your partner: This kind of preoccupation is a persistent worry that you don't love your partner, or that your love isn't strong enough. People with this worry often scrutinize their feelings and fixate on any evidence that their feelings of love aren't genuine.
Focus on partner's attributes: Constant comparisons of the partner to others involving physical appearance, personality, or status are common in this obsessive pattern.
Obsessing about not being in the right relationship: This is a persistent fear that you're in the wrong relationship despite significant evidence to the contrary. The "rightness" obsession manifests as an unshakable conviction that staying in the relationship is a mistake.
Paranoia about fidelity: A common obsessive thought, this often results in invasive behaviors including checking your partner's phone, social media, etc.
Compulsions
Compulsions are rituals of other behaviors whose function is to neutralize anxiety and worries caused by obsessions. Because compulsive behavior tends to provide immediate comfort, they are naturally reinforcing, meaning their ability to decrease anxiety can cause them to increase in severity over time. Here are some examples of compulsions that tend to develop in relationship OCD:
Reassurance seeking: Common in most forms of OCD, asking for reassurance about your obsession can provide short-term comfort, but can also increase OCD symptoms over time. Asking your partner or other people for reassurance about your relationship doubts is a very frequent impulse seen in ROCD, and paradoxically, can be destructive to the relationship over time.
Checking behaviors: Checking behaviors are common in OCD, and refer to repeatedly checking things related to your obsessive thoughts. In ROCD, a common checking behavior is checking your partner's phone, email, etc., searching for signs of threats to the relationship, such as infidelity.
Mental reviewing: Mental reviewing occurs in OCD often when people fear there may be some evidence of their concern, so people scrutinize their memory, looking for signs of compatibility, true love, fidelity, etc.
Making comparisons: In ROCD, mental comparisons refer to comparing your own relationship to other people's relationships or, in some cases, comparing your partner to other people, looking for indications of the strength or fit of the relationship.
Overt avoidance: Because obsessions trigger anxiety, one common compulsive behavior people with ROCD engage in is avoiding situations that may trigger relationship anxieties. This can mean avoiding situations, conversations, people, or even thoughts you find troubling.
Living With Relationship OCD
If you are or you're with someone you know who is suffering from relationship OCD, it's important that you consider seeking professional help. There are evidence-based treatment options for OCD that can result in reduced symptoms and complete symptom remission. If your romantic partner may have ROCD, here are some things you can do to support their recovery:
Get educated: Learning about ROCD may help you develop empathy for your partner's emotional pain and teach you what signs to look out for and what to do when they arise.
Communicate: Be open and honest with your partner about symptoms and relationship issues rather than trying to avoid topics you think they may be too sensitive to handle. Be sensitive, but don't walk on eggshells.
Encourage them to get help: ROCD is highly treatable, and Cognitive-behavioral treatment for OCD, in particular, can be highly effective, but only if you seek it out. If you think your loved one may have OCD, have an honest discussion with them, and sensitively encourage them to seek help.
Support them in treatment: Evidence-based OCD treatment can benefit significantly when a loved one is involved. It's common for partners to occasionally attend therapy sessions to learn how to best support their loved ones. It can also be helpful to involve partners in therapy homework involving the romantic relationship.
Set boundaries: reasonable, mutually-agreed upon limits are important in any healthy relationship, and they're all the more important with relationship OCD. Boundaries can help you prevent enabling OCD behaviors while also helping to make your relationship rewarding for you.
CBT Treatment for Relationship OCD
Cognitive-Behavioral Therapy for Relationship OCD
Cognitive behavioral therapy is the treatment of choice for obsessive-compulsive disorder, including relationship OCD. Numerous research articles have been published, finding CBT to be the gold standard treatment for most psychiatric disorders, including OCD.
CBT for OCD uses a mix of methods based on science to help people change their behaviors and thoughts. The behavioral components of CBT for OCD focus on reducing rituals. This is done by helping people learn to tolerate stress and anxiety without reverting to rituals, and through practicing new, healthier ways to respond to distress. The cognitive components of CBT aim to help people learn more adaptive patterns of thinking. What distinguishes CBT from other treatments is that it targets specific problems, using techniques from research in cognitive science and learning.
Exposure with Response Prevention (ERP)
Exposure with response prevention (ERP) is a CBT technique that significant scientific research has found to be the most effective treatment for every kind of OCD, ROCD included. Although ERP should be practiced with a therapist trained in CBT for OCD, after several exposures, people are taught how to engage in the intervention on their own, reducing the need for regular therapy. Exposure with response prevention involves several steps:
Creating an exposure hierarchy: An exposure hierarchy is a list of anxiety-inducing thoughts and/or situations ordered from least to most anxiety-provoking. This is a list you create collaboratively with your therapist.
Engaging in graded exposure: Once you have your exposure therapy hierarchy, you start with the easier items, confronting them using tools your therapist teaches you, such as mindfulness or cognitive reappraisal. The more you confront your fears, the less triggering they become, reducing your obsessions' power over you. Once you've mastered the easier ones, you move up your hierarchy, confronting the next set of feared situations until they no longer trigger anxiety.
Inhibiting compulsions: While you are doing exposure therapy, it's important to inhibit engaging in rituals such as checking or seeking reassurance. This way, you learn experientially how to face difficult situations confidently without unhelpful rituals.
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