How OCD affects relationships: overcoming challenges

Relationships are complex, period. Throw obsessive-compulsive disorder (OCD) into the mix, and you’ve got even more to navigate. As one NOCD community member put it, “A romantic relationship is such a beautiful thing, and it’s the one thing you wish OCD wouldn’t touch.” That’s true, but Stacy Quick, LPC, a clinician at NOCD (and OCD sufferer herself) offers this important reminder: “Plenty of people with OCD are in happy, successful relationships. Having the condition doesn’t mean your relationship is doomed.” 

Here’s a look at the many ways OCD can impact your relationship, and expert advice on what you can do about it.

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5 ways OCD can affect relationships 

• Isolation. If you find yourself withdrawing from your partner at times—or even avoiding relationships altogether—you’re not alone. Research shows that many people with OCD experience embarrassment surrounding their intrusive thoughts and compulsive behaviors. As a result, they may create some distance between themselves and loved ones, because they don’t want to risk shame or questions like, “Why do you feel the need to repeat that behavior?” This tendency to hold back can have an isolating effect on both people in a relationship. “Lack of communication can lead to distance and feelings of separateness rather than connection,” says Patrick McGrath, PhD, NOCD’s Chief Clinical Officer.
• Lack of spontaneity and adventure. OCD tries to make its sufferers’ worlds very small. There may be activities that are important to you or your partner, that might be off the table amid an OCD flare-up. Crowded music festivals, for example, aren’t exactly an inviting prospect for some people with Contamination OCD. These limits on what you can and cannot do may lead to a partner feeling like they are missing out. “If they don’t fully understand OCD, they might feel confused, and say things like, ‘Why can’t you just move past this?’ or ‘Can’t you just not think about the germs?’ which can then lead you to feel misunderstood,” notes Dr. McGrath.
• Challenges with intimacy. Intrusive thoughts can and do show up unannounced, often at the most inconvenient time. The moment that you decide to have sex is not off limits—and this can clearly stand in the way of enjoying intimacy. For some people, decreased libido is a result of increased anxiety and distress due to OCD, or even a side-effect of certain medications that may be included in your treatment plan. Partners may interpret this as a lack of interest, which can cause a riff in the relationship. 
• Excessive doubt. Seeking reassurance—especially from the people closest to you—is a highly common compulsion given how much doubt is experienced by people with OCD. “Someone with OCD may be able to recognize when feelings and thoughts are illogical, but the intensity of the doubt can override that knowledge,” says Quick. Repeatedly asking your partner for reassurance can be draining for them—even when the thing you doubt is unrelated to your relationship. For instance, you might constantly be asking, “Am I a bad person if I have disturbing thoughts?” And if you’re dealing with relationship OCD (ROCD)—which often centers on doubts within the relationship (i.e. “Are you sure you still love me?”, there can be an added strain. 
• Misplaced emotional accountability. “Driven by concern and a deep need to help their loved one be OK, partners of people with OCD take on a lot of emotional responsibility,” says Dr. McGrath. “They feel like they have to protect their partner from any unnecessary upset.” The problem is that this is a futile goal—no one can fix their loved ones’ feelings, especially when those feelings are linked to a chronic condition like OCD. Not only that, but your partner can end up feeling exhausted by the mental effort required to tend to your emotional needs.

What types of OCD can affect your relationships?

Living with OCD means living with repetitive and unwanted intrusive thoughts—obsessions—that cause significant distress. But the content of obsessions—and resulting compulsions—varies widely from person to person. As for which OCD subtypes and can affect your relationship, the answer is: all of them. Here are some examples:

Contamination OCD

Contamination OCD is a subtype of OCD characterized by an obsessive fear of becoming contaminated or contaminating others. It might lead you to compulsively create rules for your partner to make sure you aren’t exposed to perceived dirt or germs. “You might tell them they have to wash their hands three times before they touch you, shower before they get in bed, or wipe down surfaces multiple times a day,” says Dr. McGrath. “You might even avoid sexual activities for fear of genital infections.” 

Harm OCD (HOCD)

This OCD theme makes you obsess over the possibility of hurting someone, either by accident or on purpose. You might withdraw from your partner out of fear you’ll accidentally hurt them, ask for constant reassurance that you haven’t harmed anyone, avoid situations that trigger your fears, including everyday habits like driving or using a knife to prepare a meal may be troublesome. In an effort to keep yourself feeling safe and steer clear of your triggers, your world as a couple can feel contracted. 

Scrupulosity OCD

Scrupulosity OCD is a subtype of OCD featuring obsessive fears about one’s religious or moral values and actions. You might second guess everything you do, worried that you’re not a good person or aren’t doing the “right” thing. You might question your partner’s morals, too, worried over what it could mean about you if you weren’t with a good person. This could lead your partner to feel like they’re constantly under a microscope, or being judged. 

Sexual Orientation OCD (SO-OCD)

People with SO-OCD often worry that they’ll never get to the bottom of their true sexuality. As a result, you may find yourself constantly questioning your attraction to your partner. You might feel worried about hurting them in the event that you discover you’ve been in denial about your sexuality. You might withdraw from your partner, and be less interested in intimacy, worried that getting too close will trigger your intrusive thoughts.

Relationship OCD (ROCD)

In the case of ROCD, intrusive thoughts specifically center around a romantic partner or relationship. They often make you question if your relationship is right for you or if you’ve found “the one.” They can sound like, What if I’m actually not attracted to them? What if they’re lying when they say they love me? What if I break up with them, and it blows up our lives? Dr. McGrath says, “Your partner has to live with that daily questioning of the relationship. Maybe they have to watch you ‘check out’ strangers to ‘test’ your attraction, take ‘am I in love?’ quizzes online, or express doubt verbally to friends. Over time, this can wear down your partner’s confidence in the relationship, and in themselves.”

What to do if OCD is affecting your relationship 

First of all, don’t get too down on yourself. “If you and your partner are frustrated about how OCD is affecting your relationship, that’s a reflection of the condition, and not you as a person,” Dr. McGrath says.

But the most important thing to do is make sure you’re getting the right kind of treatment for OCD. Exposure and Response Prevention (ERP) therapy is the gold-standard treatment for all forms of OCD, and it can lessen the impact OCD is having in all areas of your life—including your relationship. This specialized treatment is unlike traditional talk therapy or general cognitive behavioral therapy (CBT). And without practicing ERP specifically, it’s very likely that your OCD will get worse, not better.

ERP works by gradually exposing you to your triggers, and teaching you response prevention strategies to cope with your distress—things that don’t involve compulsions. Once you find a therapist who specializes in ERP, you’ll work together on exposures.

Exposures are different for everyone. “If you have relationship OCD, for example, maybe I’ll have you write out a script of your worst case scenario, like ‘If we break up, then both of our lives will be ruined,’ and read it back to yourself,” says Dr. McGrath. “If you have contamination OCD, I might show you a photo of a dirty public restroom.” By learning ways to sit with the discomfort without responding with compulsions, over time you become desensitized to the things that used to trigger you. 

Advice for partners: How to cope if the person you love has OCD

Sometimes people wonder whether OCD treatment should be a joint affair for couples.  Not exactly—ERP is nothing like couples’ counseling, for instance—but “if OCD is interfering in someone’s relationship, a therapist might encourage them to bring their partner in for a session or two to gain a better understanding of OCD symptoms, and how they can best be supportive,” Dr. McGrath says. “This might involve teaching your partner how to respond to reassurance-seeking requests.” 

Here are some additional tips to help partners cope:

• Find a support group. 

The IOCDF hosts a comprehensive list of online support groups, including ones for loved ones of OCD, such as the Mental Illness Caregiver Support Group, the GSO OCD Family Member Support Group, and the OCD Support Group for Families and Loved Ones. “A support group can provide a safe place to share your feelings with people who’ve been through similar experiences, and gain hope from hearing how others have overcome challenges in their relationships,” says Quick.

• Recognize progress—no matter how small.

People with OCD often feel that others don’t understand how big of a feat it is to resist a compulsion—even if it’s a “small” improvement like washing their hands 5 times in an hour instead of 10. Acknowledging their progress can be a huge motivator. 

• Take care of yourself. 

Regardless of the amount of love that exists in a relationship, it’s okay to feel exhausted and need to tend to yourself first at times. This can look like ensuring you have time for your hobbies and doing things you enjoy, or even seeking out your own individual therapy with a talk therapist to get support. 

• Remember that people do recover from OCD 

It can be hard to feel hopeful at times, but it’s essential to remind yourself—and the person you love—that people do emerge from OCD with their symptoms under control and their relationships intact and thriving. Our therapists at NOCD see it every day when people access the right treatment. In the hopeful words of a NOCD community member, “You can have a happy relationship in spite of OCD.”