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What is OCDOCD SubtypesYour Complete Guide to Relationship OCD (ROCD)

Your Complete Guide to Relationship OCD (ROCD)

8 min read
Nicholas Farrell, Ph.D

By Nicholas Farrell, Ph.D

Apr 17, 2021

Relationship OCD Symptoms

Relationship obsessive-compulsive disorder (R-OCD) is an OCD subtype that is characterized by ongoing intrusive thoughts and compulsive behavior around uncertainty of a relationship. People with R-OCD experience frequent doubting thoughts about one or more relationships (e.g., “Am I truly in love with my partner?”) in spite of little evidence supporting the need for these doubts. The doubting thoughts are often viewed as an indication that the relationship may be ingenuine or “flawed” in some way, which fuels anxiety about the relationship and drives sufferers to engage in various compulsions aimed at gaining certainty about their relationship status (e.g., asking for continual reassurance from a friend). 

Most people with R-OCD find their doubting thoughts feel impossible to let go of. They might worry they are stuck in the wrong relationship. They might find themselves questioning everything about their relationship, their partner, or about themselves. The unrelenting obsessions and compulsions they engage in can often take over or sabotage the relationship.

R-OCD can be incredibly time consuming, drain someone of energy and incapacitate them from being able to feel connected to others. People worry that these thoughts will go on and on, for hours or days and won’t leave until the person has found reassurance either internally or externally to dismiss these concerns. 

R-OCD Obsessions: Some Examples of R-OCD Thoughts

Is my partner good enough for me? 

Am I good enough for my partner? 

Am I in love with my partner?

Are we a happy couple? Are other people happier than we are? Is this relationship working?

Is it okay that I found someone else attractive? Does it mean that this relationship isn’t meant to be?

What if I’m with the wrong partner? 

Is my partner too tall for me? Too short? Do they have the right eye color?

What if I made the wrong choice and I’m stuck with this person forever?

Is it okay that we have different political opinions? Do other couples differ in political opinions? Does this mean we aren’t compatible? 

Just as in all types of OCD, obsessive thoughts are followed by compulsive actions meant to neutralize the anxiety evoked by the obsessions. Here are examples of what this could look like for R-OCD

R-OCD Compulsions: Some Examples

Reassurance seeking: people with R-OCD might call a friend to ask whether they think their relationship is working. This could be done directly, by asking “do you think my relationship is working?”, or perhaps more subtly. You might ask someone: “how did you know you met the right person?” Rather than asking out of pure curiosity, this question is an attempt to quell anxiety about whether you are with the right person. Someone with ROCD might also seek reassurance from their partner that they are in love with them or haven’t been unfaithful. Again, it could be direct, or more subtle. They might ask their partner about previous relationships, how they felt in them, and why they ended, in order to try and answer the question: is my partner in love with me?

Mental tracking/Mental review: A common R-OCD compulsion is making lists in your head that try to prove or disprove your doubts. So if the obsessive thought is that maybe you aren’t meant to be together, to calm yourself down, you’ll come up with a list of reasons you are. You might mentally go through everything you’ve done together and list out why this person is a good fit. Or you might scan your brain for evidence that they are the wrong person, tracing back everything you’ve done together, and everything you don’t like about them, and why they aren’t the one. Another way to think about mental tracking is as a form of self-reassurance, in which a person tries to gather as much evidence as possible to assure themselves of some conclusion (e.g., “My spouse must love me. She’s been with me for 5 years, has never talked about wanting a divorce, and always says ‘I love you’ before she leaves for work.”)

Social comparisons/Checking: This could look like spending hours on social media, examining other people’s relationships, and asking yourself questions like, are they happier than I am? It could also look like spending time thinking about your friends’ relationships and comparing them with yours. For example, if your obsessive thought is: should we be married by now? You might think about every married couple you know, and do a deep dive investigation on your social media to try to figure out how long it took each couple you know to get married in an attempt to answer whether your relationship is normal. 

Some of these symptoms might seem pretty common. Almost everyone compares themselves to others on social media and at times wants to know what their friends think. While relationship doubts are normal at one point or another, one criteria to diagnose R-OCD is whether someone spends at least one hour per day on these obsessions and compulsions. Another important factor is that the obsessions and compulsions are carried from one relationship to the next, independent of how well the relationship is going. 

Relationship OCD ERP Therapy 

The best course of treatment for R-OCD, like all types of OCD, is Exposure and Response Prevention (ERP) therapy. ERP is considered the gold standard for OCD treatment and has been found 80% effective. The majority of patients experience results within 12 – 25 sessions. As part of ERP therapy, you’d be tracking your obsessions and compulsions, and making a list of how distressing each thought is. You’ll work with your therapist to slowly put yourself into situations that bring on your obsessions. This has to be carefully planned to ensure it’s effective, and so that you’re gradually building toward your goal rather than moving too quickly and getting completely overwhelmed.

While traditional talk therapy is effective for treating different issues, it can potentially be counterproductive for R-OCD. Here is a brief example. Say you are worried about whether you’re with the right person. In talk therapy, you might focus on how you are actually in a great relationship. The therapist might say something like, “I’ve known you for five years, and I think this is the happiest you’ve been with a person. You’ve talked a lot about how this person makes you happy. Is there something specific that’s bothering you about them now?” Although this comment may feel helpful for someone concerned about their relationship, for someone struggling with R-OCD, it may fulfill the compulsive need for reassurance.  

It might feel good in the short term to have your anxieties relieved, but in the long term, this isn’t doing anything to help R-OCD. ERP takes a targeted approach to address your obsessions and compulsions. An ERP-trained therapist will help by reviewing which thoughts or scenarios are causing you the most anxiety, and then work with you to come up with a specialized treatment plan to alleviate them through gradual, controlled exposure to them. In this case, rather than engaging in reassurance seeking, you might spend time with your therapist getting to the bottom of this stressful thought. What might happen if you actually are with the wrong person?

The idea behind ERP therapy is that exposure to these thoughts and the discomfort is the most effective way to treat OCD. When you continually submit to the urge to do the compulsions, it only strengthens your need to engage them. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety as you provide yourself with opportunities to change your learning and practice living with uncertainty.

Example of Relationship OCD Exposures 

Even though it is challenging, many people find ERP therapy very rewarding once they begin to experience results and their OCD symptoms are alleviated. Here are examples of potential exposures for R-OCD. Let’s say you’ve identified with your therapist that every time your partner makes a joke you don’t find funny, suddenly you’re questioning their sense of humor and whether you’re really meant to be together. In these moments of doubt, the only thing that helps is calling a friend for reassurance.
ERP therapy will help to identify this cycle so you know how to handle the situation when it comes up. So the next time your partner makes an unfunny joke and your obsessive doubts kick in, instead of reaching for the phone to call your friend, you’ll sit with the anxiety that comes from thinking you may be with the wrong partner. This may be overwhelming at first, so you’ll work with your therapist to come up with specific goals tailored to what makes sense for you. Maybe the first few times you’ll wait 10 minutes before calling your friend. The next time you’ll wait an hour, and then maybe an hour and a half, until eventually, you will get to a point where the anxiety subsides as you learn to tolerate uncertainty and  you no longer need to call them at all 

How to Get Help For ROCD

R-OCD can be difficult to diagnosisbecause many of the behaviors can sound like normal components of any relationship. However, a mental health professional who specializes in OCD will be able to make an accurate diagnosis. If you’re interested in learning about R-OCD and how it’s treated with ERP, you can schedule a free call with the NOCD clinical team to find out how this type of treatment can help you. All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is. NOCD offers live face-to-face video therapy sessions with OCD therapists, in addition to ongoing support on the NOCD telehealth app, so that you’re fully supported during the course of your treatment. You can also join our ROCD community and get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.

Learn More About Relationship OCD

If you’re interested in learning more about ROCD, here is some further reading:

Learn more about ERP
Nicholas Farrell, Ph.D

Nicholas R. Farrell, Ph.D. is a psychologist and the Regional Clinical Director at NOCD where he provides clinical leadership and direction for our teletherapy services. In this role, he works closely with our clinical leadership team to provide a high-quality training and developmental experience for all of our therapists with the aim of maximizing treatment effectiveness and improving our members’ experience. Dr. Farrell received his master's and doctoral degrees in Clinical Psychology from the University of Wyoming (Laramie, WY, USA). He served as a graduate research assistant in the Anxiety Disorders Research Laboratory at the University of Wyoming from 2010 to 2015 and completed his predoctoral internship training as a psychology resident at St. Joseph’s Healthcare Hamilton (Ontario, Canada).