Constantly grappling with doubt and uncertainty about your relationship, and seeking definitive answers to these questions, may actually be symptoms of obsessive-compulsive disorder (OCD), specifically relationship obsessive-compulsive disorder (ROCD), rather than an indication that something is fundamentally wrong with your relationship. As a doctor of psychology, I can often recognize the signs of OCD more quickly than someone caught in the grips of ROCD, where the focus is solely on obsessive doubts about the relationship. I’m here to provide some clarity on what’s happening, and if you’re open to it, to suggest that this may be a mental health issue rather than a relationship problem.
What is Relationship OCD (ROCD)?
Relationship Obsessive-Compulsive Disorder (ROCD) is a specific subtype of Obsessive-Compulsive Disorder (OCD) that fixates on romantic relationships. While OCD generally involves intrusive thoughts and compulsive behaviours, ROCD is characterized by persistent doubts and fears regarding the authenticity or quality of one’s romantic relationship. In this guide, we’ll delve into the symptoms, causes, impact, and treatment options for ROCD, providing insights grounded in the latest psychological research and therapeutic practices.
ROCD manifests as obsessive thoughts and compulsions focused on the status of one’s romantic relationship. Unlike normal relationship anxieties, individuals with ROCD are overwhelmed by chronic doubt and often engage in repetitive behaviours seeking reassurance. These compulsions can intensify anxiety, creating a vicious cycle that strains or even jeopardizes relationships.
Common Symptoms of ROCD
ROCD symptoms can be debilitating, affecting both the individual and the relationship. Key symptoms include:
- Constant Doubt: Persistent questioning of whether you truly love your partner, if they are the “right” one, or if the relationship is meant to last.
- Compulsive Reassurance Seeking: Repeatedly asking your partner or loved ones for reassurance about the relationship, which temporarily eases anxiety but reinforces the compulsive behaviour.
- Comparisons: Frequently comparing your relationship to others, looking for validation of your feelings or the relationship’s status.
- Obsessive Checking: Mentally reviewing your partner’s behaviour, analyzing past conversations, or continuously checking how you feel about your partner.
- Avoidance: Avoiding situations that trigger relationship anxieties, such as romantic conversations or intimate moments.
- Obsessional Jealousy: Unfounded fears of infidelity or betrayal, leading to constant monitoring of your partner’s actions.
- Fear of Infidelity: Persistent, intrusive thoughts that your partner may cheat on you, even in the absence of evidence.
Understanding the Causes of ROCD
ROCD is caused by habitual thoughts about your relationship, that create anxiety, and is maintained by the compulsions that you carry out to reduce your anxiety.
I shall explain what I mean by taking you through an example and I shall also explain what I meant above, when I mentioned;
- habitual thoughts
- that create anxiety
- and maintained by compulsions
Habitual thoughts
If you get a thought, for example, “what if I am in the wrong relationship?” The first time this happens, it is just a thought, in that no habit has been formed in your brain. However, if you analyse the thought repeatedly and keep returning to it, you are likely to develop a ‘habit.’ Your brain learns from past experience, if you keep repeating the thought (or have similar thoughts), your brain learns, and you develop a habit (so to speak.)
Thoughts create anxiety about your relationship
These thoughts, understandably make you feel anxious about your relationship. You may even feel it in your body; nervous, feeling or edge.
Maintained by compulsions
When you have these thoughts about your relationship and are feeling anxious, you more than likely ‘do‘ things to help you ‘check out‘ that you are meant to be in the relationship. The things that you do, also help to temporarily reduce the anxiety that you are experiencing.
Like all forms of OCD, ROCD is thought to result from a combination of genetic, biological, and environmental factors. It shares commonalities with other forms of OCD, particularly in how the brain processes fear and anxiety. Key contributing factors include:
- Biological Factors: Abnormalities in brain areas involved in fear and threat processing are linked to OCD and ROCD.
- Genetic Predisposition: A family history of OCD or anxiety disorders increases the likelihood of developing ROCD.
- Cognitive Distortions: Irrational thinking patterns, such as catastrophic or all-or-nothing thinking, often contribute to the onset and maintenance of ROCD.
- Perfectionism: Individuals with perfectionistic tendencies or those who have experienced traumatic relationships may be more prone to ROCD.
Recent studies have highlighted the role of serotonin dysfunction in OCD, suggesting that abnormalities in serotonin levels may contribute to the intrusive thoughts and compulsions characteristic of ROCD .
Impact of ROCD on Romantic Relationships
An important point to note with ROCD, is that it is usually not your relationship that is the problem. The reason you are concerned about your relationship is due to the meaning you give to the thoughts in your head, and what you do to help you cope with the thoughts. I shall explain to you what I mean by this.
If you have ROCD, you will be placing too much emphasis on your thought processes (your obsessions). It is very important that I call them obsessions as I want to help you to see them for what they are; they part of OCD, as opposed to being ‘the truth.’ When you start to identify the worries you have about your relationship as obsessions, you can start to distance yourself from them and get down to working with getting over your obsessions.
You suffer, not because of a problem in your relationship, but rather, you suffer because of obsessions and compulsions. This in itself, if you think about it can start to bring some relief if you are able to see your difficulty in terms of OCD, as opposed to having a bad relationship.
If you see your thoughts (obsessions) as being ‘the truth’, of course you will want to investigate this further and get some reassurance or answers to questions you have about your relationship, and this is where your compulsions can start.
Your obsessions will understandably make you worried about your relationship, might make you anxious and you deal with this by ‘checking out your relationship’, comparing it to other relationships, checking up on your partner, analysing over whether you really love them, or do they love you.
I want you start to see these things as ‘compulsions’ as it is the compulsions that keep your ROCD going. Let me explain.
If you have a good enough relationship and you start to obsess over it, you might start to change how you interact with your partner; you start to see them differently. If you are constantly asking them questions about your relationship, or become distant as you are analysing everything in your head, you are started to affect your good enough relationship.
The point I am trying to make is that if you have ROCD, if you start to see this in terms of obsessions and compulsions, rather than a problem with your relationship, then you get down to fixing the OCD, as opposed to fixing your relationship.
The effects of ROCD on relationships can be profound and far-reaching. The constant need for reassurance and persistent doubts can lead to significant strain on both partners, often resulting in:
- Increased Conflict: Frequent arguments may arise from constant doubts and reassurance-seeking behaviours.
- Emotional Distress: Both partners may experience heightened levels of stress, anxiety, and emotional exhaustion due to the repetitive nature of the compulsions and perceived lack of trust.
- Relationship Breakdown: In severe cases, the strain caused by ROCD can lead to a breakup or divorce.
Case Study: The Impact of ROCD
Consider the case of “Sarah,” a woman in her early 30s who has been in a relationship with her partner, “John,” for three years. Despite the apparent stability of the relationship, Sarah is consumed by thoughts that John might not be the “right” person for her. She constantly seeks reassurance, often asking John if he truly loves her and analyzing his responses for any signs of doubt. This behavior has led to frequent arguments and has caused significant emotional distress for both Sarah and John. With the help of therapy, including CBT and ERP, Sarah has begun to understand the irrationality of her fears and is working on reducing her compulsive behaviors.
Effective Treatment Options for ROCD
If you have taken the decision to get help with your ROCD, I recommend that you meet with a licensed mental health professional who can discuss treatment options with you, most likely CBT and ERP.
Treating ROCD typically involves a combination of Cognitive-Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and medication. The goal is to reduce obsessive thoughts and compulsive behaviours by challenging cognitive distortions and gradually exposing the individual to their fears without engaging in compulsions.
- Cognitive-Behavioural Therapy (CBT): The gold standard for treating OCD, CBT involves identifying and challenging the irrational beliefs that fuel ROCD.
- Exposure and Response Prevention (ERP): A specialized form of CBT, ERP exposes the individual to situations that trigger obsessive thoughts while preventing them from performing compulsive behaviours.
- Medication: Selective Serotonin Reuptake Inhibitors (SSRIs) are often prescribed to help reduce OCD symptoms, including those associated with ROCD. These medications work by increasing serotonin levels in the brain, which can help alleviate the intensity of obsessive thoughts and compulsive behaviours.
- Mindfulness-Based Cognitive Therapy (MBCT): This therapy combines traditional CBT with mindfulness strategies to help individuals become more aware of their thoughts and emotions without reacting to them.
- Acceptance and Commitment Therapy (ACT): ACT encourages individuals to accept their intrusive thoughts without judgment and commit to actions aligned with their values, despite the presence of these thoughts.
Coping Strategies for Individuals and Partners
In addition to professional treatment, there are practical strategies that individuals and their partners can use to manage ROCD:
- For Individuals with ROCD:
- Practice Mindfulness: Cultivate awareness of your thoughts without reacting to them, reducing the power of intrusive thoughts.
- Limit Reassurance-Seeking: Resist the urge to seek constant reassurance from your partner or loved ones, as this often reinforces anxiety.
- Engage in Self-Care: Prioritize self-compassion and engage in activities that reduce stress and promote well-being.
- Challenge Cognitive Distortions: Actively work on identifying and challenging irrational thoughts, such as black-and-white thinking or catastrophic thinking.
- For Partners:
- Set Boundaries: Support your partner while setting boundaries to avoid reinforcing compulsive behaviours.
- Encourage Professional Help: Advocate for therapy and be patient with the therapeutic process, offering consistent support.
- Communicate Openly: Foster open communication to address concerns and manage the impact of ROCD on the relationship.
- Educate Yourself: Understanding ROCD can help you empathize with your partner’s struggles and provide better support.
Stigma Reduction and Seeking Help
ROCD, like other forms of OCD, is often misunderstood, leading to stigma and reluctance to seek help. It’s important to recognize that ROCD is a legitimate mental health condition that requires professional intervention. Addressing the stigma surrounding OCD and ROCD can encourage more individuals to seek the help they need.
Resources for Further Information
If you or someone you know is struggling with ROCD, the following resources can provide additional support:
- International OCD Foundation (IOCDF): www.iocdf.org – Offers information on OCD, including ROCD, and lists of qualified therapists.
- National Institute of Mental Health (NIMH): www.nimh.nih.gov – Provides comprehensive information on OCD, treatment options, and ongoing research.
- Anxiety and Depression Association of America (ADAA): www.adaa.org – Offers resources for understanding and managing anxiety disorders, including OCD.
Conclusion
Relationship OCD (ROCD) is a challenging and often misunderstood condition that can significantly impact romantic relationships. However, with appropriate treatment and effective coping strategies, individuals with ROCD can manage their symptoms and maintain healthy, fulfilling relationships. If you or someone you know is struggling with ROCD, it’s crucial to seek help from a qualified mental health professional.
This comprehensive guide provides valuable insights and practical advice for both sufferers and their partners, based on the latest psychological research and treatment modalities. Remember, understanding and managing ROCD is possible with the right support and interventions.