ROCD Relationship OCD; Symptoms, self-help and treatment

Imagine an uninvited guest constantly whispering doubts and criticisms into your ear about your relationship. This is the reality for those living with Relationship Obsessive-Compulsive Disorder (ROCD). A mental health condition characterized by intrusive thoughts and compulsive behaviours, ROCD can erode self-esteem,make you doubt yourself and your relationship and strain even the strongest partnerships.

Relationships are the cornerstone of our lives, with romantic relationships offering love, support and hopefully a life-long partner. They are purported to provide better health and act as a buffer from stress and depression.

However, for some, intense doubts can overshadow and destroy your future with your partner. This is more than the ups and downs of relationships; these worries are intense, distressing and relentless.

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What is ROCD?

Relationship Obsessive-Compulsive Disorder (ROCD) is a subtype of Obsessive-Compulsive Disorder (OCD) that focuses on intimate relationships. Individuals with ROCD experience intrusive thoughts, persistent doubts, and compulsive behaviours related to their romantic partners and the relationship itself. Despite not being an official diagnosis in the DSM-5-TR, the term “ROCD” is used to describe these relationship-centred obsessive-compulsive symptoms.

Types of ROCD

Relationship Focused1, and
Partner Focused.

Relationship-focused ROCD.

This type involves obsessive doubts and anxieties about the relationship’s quality, suitability, and overall “rightness.” For instance, someone might continually worry if they are truly in love or if their relationship is destined to fail.

ROCD or wrong relationship.

• Is it good enough?
• Is it the right one?
• What if I miss out on a better relationship by staying in this one?
• Other couples go out more, have more holidays, are more in love, are happier, and have more sex.

These obsessions can lead to many doubts about your relationship, even though your relationship may be excellent.

Partner focused.

This type centres on intrusive thoughts and doubts about a partner’s characteristics, appearance, or behaviours. An individual might fixate on perceived flaws in their partner, such as physical appearance or personality traits, questioning whether these are deal-breakers.

You might find that you obsess about your partner’s appearance, intelligence, or what they are like with other people.

Finding flaws in their appearance.

How they dress; too shabby, not trendy enough, not the correct labels.

• Hair colour, too long, too short, not enough of it
• Too fat, thin, not strong enough, not curvy enough
• You can zone in on specific physical features, their nose, feet, hands, and how they walk.

Finding flaws in how intelligent they are

• Did they go to university? It might be an obsession you have, and if they did, did they go high enough? No Masters? No PhD?
• Poor grammar, using the wrong words, not talking in a way that you like
• Reading the wrong newspaper, not reading books,
• Having friends, you disagree with

Finding flaws in how they interact with other people

• How they speak to others
• Maybe you think they are too loud, too quiet, bad at socialising, and say the wrong things.
• Their mannerisms
• They drink too much or the wrong drink; they hold the glass wrong.

How do I know if I have ROCD?

Meeting with a mental health professional for assessment will let you know if you have OCD. In the interim, ROCD, like all forms of OCD, has specific signs and symptoms which should help you recognise this condition. I shall give some examples below.

Symptoms of ROCD.

ROCD is characterized by both obsessions and compulsions:

Obsessions:

• Persistent, unwanted, intrusive thoughts, images, or urges related to the relationship or partner.
• Common themes include doubts about love, fears of making the wrong decision, and fixations on perceived flaws.
• These obsessions are often ego-dystonic, meaning they conflict with the individual’s values and cause significant distress.

Examples of ROCD obsessions

• Is he the one?
• Would I be better off with someone else?
• Would I be happier with someone else?
• Does he love me?

Compulsions:

• Repetitive behaviours or mental acts are performed to alleviate the anxiety caused by obsessions.
• Common compulsions include seeking reassurance, comparing the relationship or partner to others, mentally analyzing the relationship, and excessive checking behaviours.

For example, a person with ROCD might repeatedly ask their friends if they think their partner is attractive or constantly compare their relationship to others they see on social media.

These are things you do to help you make sense of the thought and include seeking reassurance

• checking or finding out if they love you or if you love them
• comparing your partner to other people
• comparing your relationship to other relationships
• Looking for flaws in your relationship
• Analysing your relationship inside your head

What causes ROCD?

Recent research(2) suggests that for people with OCD,’ the brain responds too much to errors’. Applying this finding to people with ROCD might explain why you spend so much time focusing on the flaws in your relationship.

The exact causes of ROCD are not fully understood, but research suggests several contributing factors:

• Genetics and Brain Chemistry: Genetic predispositions and neurochemical imbalances can play a role in the development of ROCD.
• Life Events: Stressful or traumatic experiences, particularly those involving relationships, can trigger ROCD symptoms.
• Personal Values: Individuals who place a high value on romantic relationships may be more susceptible to ROCD.
• Early Childhood Experiences and Attachment Styles: Dysfunctional cognitive biases and self-perceptions stemming from childhood experiences and attachment issues can make individuals vulnerable to ROCD.

The ROCD Cycle

ROCD often follows a cyclical pattern:

1. Obsession: An intrusive thought or doubt arises, triggering anxiety and distress.
2. Anxiety: The individual experiences intense anxiety and discomfort due to the obsession.
3. Compulsion: The individual engages in compulsive behaviours to alleviate anxiety.
4. Temporary Relief: The compulsion provides temporary relief from anxiety.
5. Obsession Returns: The intrusive thought or doubt eventually returns, and the cycle repeats.

For instance, someone might obsess over whether their partner truly loves them, leading to anxiety. To cope, they might repeatedly seek reassurance, which offers temporary relief until the doubt resurfaces.

ROCD vs. Relationship Anxiety

While occasional doubts and insecurities are normal in relationships, ROCD is distinguished by the intensity, frequency, and duration of the obsessions and compulsions. ROCD significantly impacts daily functioning, relationships, work, and overall well-being, far beyond typical relationship anxieties.

Difference between normal worries and ROCD

Almost everyone worries about their relationship or questions it’s suitably at some point, and you might be confused concerning everyday worries and the worries that occur with ROCD.

Misunderstandings Surrounding ROCD

ROCD is often misunderstood and misdiagnosed, leading to ineffective treatment and increased distress. Common misunderstandings include:

• Attributing symptoms to personal insecurities or relationship issues rather than OCD.
• Believing that OCD only manifests as obsessive cleaning or handwashing.

The shame and stigma associated with ROCD can also prevent individuals from seeking professional help, exacerbating the condition.

Treatment for ROCD

Effective treatment options for ROCD include:

Cognitive Behavioral Therapy (CBT):

• Exposure and Response Prevention (ERP): ERP involves gradually exposing individuals to their feared thoughts and situations while resisting the urge to engage in compulsions. Through ERP, individuals learn that their anxiety will naturally decrease over time without the need for compulsions, and they develop healthier coping mechanisms.

Medication:

• Selective serotonin reuptake inhibitors (SSRIs) can help manage anxiety and obsessive thoughts, especially when combined with therapy. The choice of medication should be made in consultation with a healthcare professional.

Mindfulness and Relaxation Techniques:

• Practicing mindfulness and relaxation techniques, such as meditation, deep breathing, and progressive muscle relaxation, can help manage anxiety and reduce the intensity of obsessive thoughts.

Self-Help Strategies:

• Self-help strategies, such as journaling, challenging irrational thoughts, and focusing on positive aspects of the relationship, can be helpful. However, self-help should not replace professional treatment.

You can read more on treatment options here.

Get professional help

Seeking professional help is a crucial step in managing Relationship Obsessive-Compulsive Disorder (ROCD). Professional therapy can provide the structured support and evidence-based treatments necessary to break the cycle of obsessive doubts and compulsive behaviors. Here is a comprehensive guide on how to find and choose the right therapist for ROCD:

Why Professional Help is Important

1. Specialized Expertise: Professionals trained in OCD and ROCD can offer specialized knowledge and treatment techniques that are not commonly available through general therapy or self-help.
2. Evidence-Based Treatments: Therapists can provide access to evidence-based treatments like Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP), which are proven to be effective in treating OCD and its subtypes.
3. Personalized Treatment Plans: A professional can tailor treatment plans to the specific needs and circumstances of the individual, ensuring a more effective and sustainable recovery process.
4. Support and Accountability: Regular sessions with a therapist offer continuous support and hold individuals accountable to their treatment plans, which can be critical for long-term success.

How to Find a Professional Therapist for ROCD

1. Start with Primary Care: Consult your primary care physician or a general practitioner. They can provide referrals to mental health professionals who specialize in OCD and ROCD.
2. Search Online Directories:
   • Websites like the International OCD Foundation (IOCDF) and Psychology Today have directories of therapists who specialize in OCD.
   • The Anxiety and Depression Association of America (ADAA) also provides resources and listings for OCD specialists.
3. Check with Insurance Providers: Contact your health insurance provider for a list of covered mental health professionals who specialize in OCD and ROCD. This can help manage the cost of therapy.
4. Local Mental Health Clinics: Many communities have mental health clinics that offer specialized services for OCD. These clinics often have sliding scale fees based on income.
5. University Clinics: Universities with psychology programs often have clinics that offer therapy services at reduced rates. These are typically staffed by advanced graduate students under the supervision of licensed professionals.
6. Ask for Recommendations: Reach out to support groups, online forums, or friends and family who may have experience with OCD therapy. Personal recommendations can be invaluable.

What to Look for in a Therapist

1. Experience and Specialization: Ensure the therapist has experience and specialization in treating OCD and specifically ROCD. Ask about their training, certifications, and the types of treatments they use.
2. Use of Evidence-Based Treatments: Confirm that the therapist uses evidence-based treatments like CBT and ERP. These therapies are the gold standard for OCD treatment.
3. Comfort and Trust: The therapeutic relationship is crucial. Choose a therapist with whom you feel comfortable and who you can trust. The initial consultation can help gauge this.
4. Licensing and Accreditation: Verify that the therapist is licensed and accredited by relevant professional bodies. This ensures they meet professional standards and ethical guidelines.

Questions to Ask Potential Therapists

1. What is your experience with treating ROCD?
2. What therapeutic approaches do you use for ROCD?
3. Can you explain how CBT and ERP work in the treatment of ROCD?
4. How long do you typically work with clients on ROCD?
5. What is your policy on confidentiality?
6. How do you measure progress in therapy?

Coping with ROCD as a Partner

Supporting a partner with ROCD can be emotionally challenging. Partners can help by:

• Educating themselves about ROCD.
• Communicating openly and honestly.
• Setting healthy boundaries, especially regarding reassurance-seeking.
• Encouraging their partner to seek professional help and follow their treatment plan.
• Practicing self-care and seeking support for themselves.

Couples therapy can also be beneficial in addressing relationship dynamics and developing effective communication strategies.

Living with ROCD

ROCD is a chronic condition, but it is manageable with appropriate treatment and support. Recovery is a journey that requires patience, self-compassion, and ongoing effort. Individuals with ROCD can lead fulfilling lives and have healthy, loving relationships with the right tools and support.

By understanding ROCD and seeking appropriate treatment, those affected can break the cycle of obsessive doubts and compulsive behaviours, paving the way for healthier and more satisfying relationships.

References

Twohig, M. P., & Hayes, S. C. (2008). ACT verbatim for depression and anxiety: Annotated transcripts for learning acceptance and commitment therapy. New Harbinger Publications.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Abramowitz, J. S., McKay, D., & Storch, E. A. (Eds.). (2017). The Wiley Handbook of Obsessive Compulsive Disorders. John Wiley & Sons.

Doron, G., Derby, D. S., Szepsenwol, O., & Talmor, D. (2014). Tainted love: Exploring relationship-centered obsessive compulsive symptoms in two non-clinical cohorts. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 137-144.

Simpson, H. B., & Riddle, M. A. (2014). Obsessive-Compulsive Disorder: Developing Strategies to Improve Treatment. Oxford University Press.

1. Doron, G., Derby, D. S., & Szepsenwol, O. (2014). Relationship obsessive compulsive disorder (ROCD): A conceptual framework. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 169-180.DOI: doi.org/10.1016/j.jocrd.2013.12.005
2. Luke Norman, Stephan Taylor, Yanni Liu, Joaquim Radua, James Abelson, Mike Angstadt, Yann Chye, Stella de Wit, Joseph Himle, Chaim Huyser, Isik Karahanoglu, Tracy Luks, Dara Manoach, Carol Mathews, Katya Rubia, Chao Suo, Odile van den Heuvel, Murat Yücel, Kate Fitzgerald. S20. Error-Processing in OCD: A Meta-Analysis of fMRI Studies and Investigation of Changes Following CBT. Biological Psychiatry, 2018; 83 (9): S354 DOI: 10.1016/j.biopsych.2018.02.911