ROCD (Relationship OCD)

ROCD (Relationship OCD) is often misunderstood by
mental health professionals and the public.

Relationship OCD (ROCD) is a form of Obsessive Compulsive Disorder (OCD) in which the sufferer experiences intrusive, unwanted and distressing thoughts about the strength, quality, and “true nature” of their love for their partner. Obsessions in ROCD include a preoccupation with a partner’s appropriateness as a mate, overall level of attractiveness, sexual desirability, or long-term compatibility, and often arise in otherwise entirely healthy relationships.

When most lay people think of OCD, they envision hours of hand washing or compulsive lock checking. However, there are numerous equally exhausting sub-types of OCD in which the compulsive symptoms are less overt, and which together are colloquially described as Pure Obsessional OCD, or “Pure O”. But this term is a misnomer, as people suffering with Pure O exhibit numerous, albeit less obvious, compulsions. And while these compulsions are less noticeable by others, they still take a huge toll on sufferers. ROCD is one such sub-type.

As with all forms of OCD, the compulsions done in ROCD are done in an effort to reduce the individual’s anxiety related to their unwanted obsessional thoughts. For those suffering with ROCD (and other Pure O variants such as HOCD, Harm OCD, and Scrupulosity), compulsions are often performed mentally, and can be fairly imperceptible to others.

Unfortunately, the lack of knowledge about the less visible symptoms of ROCD often leads to misdiagnosis. Well-intentioned family members, friends, and therapists often suggest that “maybe you’re just not that into him”. We are all conditioned by the media to focus on the honeymoon stage of a relationship – the fireworks and drug-like hunger described in love songs, romance novels, and Hollywood happy endings. When faced with a real person, full of flaws and humanity, it can be difficult to let go of the dream of true and perfect love long enough to see the good thing standing right in front of us.

Millions of dollars are made off misconceptions about love every day. Through movies, songs and advertisements, we are fed a dream of love meant to save us from the mundane. We are whisked off on a white horse to a dream world free of pain, suffering, anxiety, and as it turns out…reality. When we are so regularly fed a diet of fantasy, it is no wonder that our anxiety surrounding relationships, commitment, and marriage can skyrocket.

Common Obsessions in ROCD

Obsessions in OCD are defined as repetitive thoughts, ideas, mental images, or impulses that an individual experiences as intrusive, unwanted, and/or inappropriate. As with other forms of OCD, the obsessions in ROCD focus on issues of doubt and an intense discomfort with uncertainty. At it’s most basic, ROCD is focused on one simple obsession: “What if I don’t really love my partner”. The individual with ROCD is beset by doubts about whether their partner is “the one”, or if they are truly in love with their partner. These obsessions frequently lead the sufferer to unrealistically demand absolute, 100% certainty in their mind about their feelings for their partner. Common obsessions in ROCD include thoughts such as:

  • “What if I don’t really love my partner?”
  • “What if he/she is not ‘the one’?”
  • “What if I’m not really attracted to him/her?”
  • “If I don’t think about my partner all day long, do I really love him/her?”
  • “If I didn’t “completely” enjoy that one kiss, does that mean I’m not really attracted to my partner?”
  • “I noticed another attractive guy/girl…that must mean I’m in the wrong relationship!”
  • “I enjoyed having alone time today while my partner was visiting their relatives. This must mean I’m not truly in love with my partner.”
  • “There are times when I feel turned off by the thought of intimacy or sex with my partner. This must be proof that I’m not sexually attracted to them and therefore in the wrong relationship.”
  • “I can imagine cheating on my partner, therefore I must secretly want to be with someone else.”
  • Fixation on flaws or negative aspects of a partner’s appearance or character.
  • Fixation on compatibility and/or long-term viability of the relationship.
  • Obsessive concern about harming one’s partner emotionally by staying in a relationship if you may not truly love them.

As with all obsessions, these thoughts are intrusive and highly distressing. And in the case of ROCD, these obsessions can, and often do, lead to the loss of an otherwise great relationship with a loving partner. Obsessions can be especially intense when the OCD sufferer is in close proximity to their partner, and/or if issues of long-term commitment arise, such as relationship exclusivity, meeting the family, living together, or possible marriage.

Our clients frequently ask what the difference is between an OCD thought and a genuinely incompatible relationship. They wonder: ”How do I know this is really ROCD, and not just the real truth about what I feel?” This is a difficult question, because compatibility is an entirely personal concept as well as a total toss-up. Everyone has a friend or relative in a relationship that looked perfect only to see a break-up occur just months later. Likewise, we all know people who seem completely wrong for each other at first glance, but somehow end up happily married for decades.

Ultimately, there is no way to know with 100% certainty whether a relationship is “right” or “wrong”, just as we cannot guarantee (however morbidly) that we will even wake up tomorrow morning, or that our children will be safe even when we are not there to supervise them. Life is full of risks, and the decision to be in a committed partnership carries with it the possibility of both success and failure. In ROCD, the problem lies not in the partner, but rather in the need to know, with 100% certainty, that one’s partner is “the one”.

Common Compulsions in ROCD

Compulsions in OCD are defined as repetitive behaviors that an individual feels compelled to perform in an effort to avoid or decrease anxiety related to obsessions. Compulsions in OCD generally fall into one of four categories:

  • Overt compulsions
  • Avoidant compulsions
  • Reassurance seeking compulsions
  • Mental compulsions

As noted above, compulsions in ROCD and other Pure O variants of OCD often occur entirely in the mind of the sufferer, and are usually less overt than hand washing or door checking. That said, there are often some outwardly apparent compulsions that involve checking, as well as countless avoidant, reassurance-seeking and mental compulsions. Some common compulsions seen in ROCD include:

Overt Compulsions

  • Having sex with your partner in order to check for arousal and/or feelings of emotional connection.
  • Repeatedly confessing to your partner that you are experiencing doubts about your feelings or about the viability of the relationship.
  • Repeatedly confessing to your partner that you are attracted to other people.
  • Frequently breaking up with your partner.
  • “Testing” your feelings by spending time with / flirting with others, or searching dating sites to see if you are attracted to others.
  • Compulsive online researching about love or relationship issues.

Avoidant Compulsions

  • Avoiding being around attractive or triggering people such as ex-lovers or people you could possibly see as attractive.
  • Avoiding being intimate with your partner (verbally, physically or both).
  • Avoiding saying “I love you” or praising/complimenting your partner.
  • Avoiding loving gestures for fear these will further entangle you.

Reassurance Seeking Compulsions

  • Asking family members and friends to rate the compatibility of your relationship.
  • Asking family members and friends to confirm your partner’s attractiveness or sexual desirability.
  • Asking family members or friends if they think your relationship will last or if you are meant for marriage.
  • Compulsively asking others about their relationships and comparing feedback.

Mental Compulsions

  • Mentally comparing your significant other to attractive or desirable people.
  • Mentally checking your arousal or attraction during sex or other intimate moments, such as kissing, when saying, “I love you”, or holding hands.
  • Mentally comparing your relationship to those of friends and family to see if your relationship sizes up – is it “better than” or “worse than”.
  • Mentally comparing your relationship to thoughts and feelings expressed in love songs, romantic novels, or movies.
  • Mentally reviewing past relationships and comparing them with your current one.

As with all forms of OCD, compulsions in ROCD are done in an attempt to obtain momentary respite from the nagging obsessional thoughts. And often they do provide comfort…temporarily. In the long run however, compulsions only fuel the Obsessive Compulsive Cycle, making sufferers believe that if they just search long enough, and just keep trying hard enough, they’ll find “the one”.

Impact on Relationships

Needless to say, the obsessions and compulsions experienced by those with ROCD can take a devastating toll on both the sufferer and their partner. Relationships in which one partner has ROCD are often chaotic, and unstable due to seemingly endless misunderstandings, conflict, and break-ups. Even the most compassionate and understanding partner may struggle with repeatedly hearing all the ways that the person they love doubts their feelings for them. One of the cruel and ironic twists of ROCD is that the fear of hurting one’s partner often results in the sufferer doing just that – by repeatedly expressing their doubts about their partner and the relationship, those with ROCD often cause significant emotional suffering for the very person they most love.

ROCD and Other Variants of OCD

It is also worth noting that ROCD often occurs simultaneously with other variants of OCD. As noted above, the individual with ROCD is often extremely distressed about the harm they are causing their partner, often to the point of believing that they are ruining their partner’s life by staying involved with them despite their doubts. This fear of causing emotional harm to one’s partner is quite similar to the harming obsessions commonly seen in Harm OCD.

Likewise, these concerns of causing harm often lead the sufferer to experience obsessions quite similar to those experienced by those suffering with Moral Scrupulosity. For example, the individual with ROCD may obsess about being a morally bad person for staying with a partner when they are experiencing doubts.

ROCD is also frequently related to obsessive doubts about sexual orientation seen in HOCD. The individual with HOCD often has thoughts such as “if I have these doubts about my orientation, I must be in the wrong relationship”.

This overlap between various subtypes of OCD, especially variants that are sometimes described as Pure Obsessional OCD, or “Pure O”, demonstrates how the line between various subtypes of OCD is somewhat arbitrary, and can be quite grey at times. All of these variants of OCD revolve around a common discomfort with the uncertainty that is inherent in the human experience.

What ROCD is Not

Misunderstandings about ROCD abound, and it is important to clarify the difference between this condition and normal relationship doubts. For the individual with ROCD, doubts about their relationship are ego-dystonic, which simply means that their doubts are inconsistent with their true feelings. They experience their doubts as being in direct contradiction of how they truly feel about their partner, and are extremely distressed that they are experiencing these unwanted and inexplicable thoughts. On the other hand, those with ego-syntonic doubts about their relationship experience their thoughts as a normal and genuine expression of their feelings (or lack thereof). While they may be sad about their relationship doubts, they are not tortured by them.

ROCD is often misdiagnosed by mental health treatment providers who simply don’t have a solid grasp of the complexities of OCD and all of its variations. As a result, many therapists frequently mis-read the symptoms of ROCD as a sign of “relationship issues”, rather than as evidence of ROCD. This problem is perhaps complicated by shortcomings in the Diagnostic and Statistical Manual (DSM-5) in which the criteria for a diagnosis of OCD does not include a description of ROCD. Furthermore, the vague nomenclature attached to various subtypes of OCD may be a factor – it is not difficult to see that a term like “Relationship OCD” could easily be misunderstood.

Unfortunately, the issue of misdiagnosis has been further exacerbated by recent media coverage of ROCD that has misconstrued the very nature of the condition. It is important to note that obsessions in ROCD focus entirely on doubts one has about their own feelings for their partner, and not on insecurities about whether their partner loves them in return. Insecurity is not ROCD.

Likewise, being jealous of your partner’s friendships, sneaking through their mobile phone records, or reading their private emails is not ROCD. And calling your ex-boyfriend 47 times a day, or surreptitiously following a woman you find attractive is not ROCD. In other words, stalking is not ROCD.

Finally, it is important to note that a fear of intimacy is not ROCD. When one fears intimacy, they are afraid of being emotionally vulnerable with their partner, and all the risks involved in being intimate. With ROCD, the sufferer is not afraid of intimacy, but rather is specifically afraid of being in the wrong relationship. The core issue with ROCD is not intimacy, but discomfort with uncertainty. Being afraid to commit to another person is not the same as ROCD.

Treatment for ROCD

Thankfully, ROCD is a highly treatable condition with an optimistic prognosis. Treatment with a psychotherapist who specializes in Cognitive Behavioral Therapy (CBT) is the first step to escaping the cycle of obsessions and compulsions that characterize ROCD. CBT for ROCD includes a combination of psycho-education, Cognitive Restructuring, Exposure and Response Prevention (ERP) and mindfulness skills training.

The first step in treating ROCD is to educate the client about the disorder, turning on a light in an otherwise dark room, and illuminating the various ways in which their obsessions and compulsions combine in a seemingly endless cycle of doubt. The psycho-education process helps the client to understand how ROCD works, and how the condition profoundly affects their daily life and their ability to be in a healthy, meaningful, committed relationship.

The next step is Cognitive Restructuring, which is the “C” part of CBT. In Cognitive Restructuring, the client learns to identify the various ways in which their thoughts about relationships are distorted, and to challenge those thoughts with more accurate and realistic thoughts.

Next, mindfulness training is used to help the client develop more awareness and acceptance of the obsessive thoughts and feelings they experience related to ROCD, rather than resisting them and thus perpetuating the cycle.

Finally, Exposure and Response Prevention (ERP) is introduced to gently and gradually expose a client to situations that engender relationship anxiety, whether it be saying “I love you” without checking for truth, or eliminating reassurance seeking from conversations with family and friends, or challenging any other compulsive behavior done in an effort to reduce discomfort. Additionally, a variant of ERP called imaginal exposure involves writing and reading stories based on the client’s actual ROCD obsessions.  Ultimately, the goal of ERP is to help the client learn that their fears, while real, are not realistic, and not nearly as threatening as they think. Future installments of this series will focus on these treatment modalities for ROCD.

Beyond ROCD

A certain amount of anxiety and uncertainty is quite natural, and anyone considering “forever” would be well-advised to accept the possibility that their relationship may not endure. However, those with ROCD are missing out on the best parts of their relationship with their partner precisely because of their dysfunctional relationship with their anxiety.

If you are struggling with ROCD, your obsessions and compulsions are keeping you from being fully present in a committed relationship with your partner. Only after divorcing your ROCD will you be able to clearly see the person in front of you. By pulling the plug on this most toxic of relationships, and accepting uncertainty as a normative experience, you can then begin a deeper commitment to intimacy with the person you love.

•Sheva Rajaee, MMFT, and Tom Corboy, MFT, are psychotherapists at the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related anxiety based conditions.  In addition to individual therapy, the center offers five weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.