Emma Kazarian, AMFT, APCC, of the OCD Center of Los Angeles discusses the benefit of seeking OCD-informed couples therapy when OCD impacts the relationship dynamic between partners. In part one, Emma discusses the ways in which the partner with OCD can know what to look out for in assessing the need for couples therapy, and how to support their partner through psychoeducation, communication and disclosure.
If you have Obsessive-Compulsive Disorder (OCD), you know firsthand how OCD has a nasty habit of attacking the people and things you love most. You know how time-consuming, demoralizing, and all-encompassing an obsessive spiral can be. You also likely know how common it is for your OCD symptoms to bleed into your most prized relationships.
As a therapist with the OCD Center of Los Angeles, I’ve noticed that couples therapy is a sorely under-utilized tool for managing OCD and its impact on our lives. People with OCD often feel shame about their disorder and try to shield their loved ones from the horror of their thoughts. While I completely understand the impulse to conceal the disorder from loved ones (and have lived experience to back this up), OCD actually thrives in disconnection, isolation and shame.
You may be scared to think about talking to your partner about your OCD, but couples therapy provides a dedicated space to do just that. In working with an OCD-informed couples therapist, partners learn about OCD together, develop a common language in understanding the inner workings of the disorder and process difficult emotions that arise in the midst of the obsessive-compulsive cycle.
What is OCD-informed couples therapy and how can it help?
At its core, couples therapy provides a structured, contained space to practice honest and vulnerable communication with your partner. Couples therapists bear witness to the stories told by each partner and to the relational dynamics at play, offering feedback that ideally allows everyone to hear and understand each other.
Unlike in individual therapy, the relationship is the client in couples therapy. This means that while one partner’s OCD may be the original issue bringing the couple in, the framing of a session looks quite different from individual therapy. Instead of focusing solely on your OCD and its impact on you individually, OCD-informed couples therapy shifts the focus to how OCD impacts the relationship, what maladaptive patterns are being played out that contribute to communication breakdowns and conflict and how to practice tools as a couple to work towards your relationship goals. Additionally, OCD is only one piece of the complexity of your relationship, and focus may shift to addressing relational concerns such as attachment trauma, life changes, differing values, and planning for the future
Although it’s not necessary to seek couples therapy from an OCD-informed therapist, generalized couples therapy may miss the mark in identifying the ways OCD affects the relational dynamic or, at worst, may perpetuate harmful misunderstanding between you, your partner and the therapist. For example, if you share that you are having recurrent intrusive doubts about the longevity of the relationship (and this is due to Relationship OCD), a generalized couples therapist may take the statement at face value and treat the doubts as valid concerns to “figure out”, prompting a session of reassurance-seeking and distress. However, an OCD-informed couples therapist will understand the difference between obsessions and real relationship concerns and steer you and your partner away from accidentally engaging in compulsive confession, rumination and reassurance-seeking. That being said, if OCD-informed couples therapy is not accessible for you for any reason, you can ask your individual OCD therapist to consult with your generalized couples therapist to provide guidance and psychoeducation on the basics of OCD.
How can OCD affect your relationships?
At this point you may be asking, “how do I even know if OCD is affecting my relationship?” Great question! Here are some common ways I see OCD impact daily life between partners:
- Repeatedly asking your partner for reassurance that you’re okay/safe, or if your intrusive thought is “valid”
- Mentally checking out during an important conversation due to rumination and mental compulsions, leading to a lack of presence and connection
- Tracking and/or controlling what your partner does at home out of fear of them accidentally contaminating your space
- Asking your partner to help you do a compulsion like checking locks or hiding knives, or showering after traveling
- Avoiding intimacy with your partner because you’re not sure if you’re 100% “into them” and it would be lying to act like you were without certainty
It’s not uncommon for our partners to become our emotional support humans during our struggles with OCD. Obsessive doubt is distressing, and our partners are easy targets for reassurance because they (hopefully) care about our well-being and don’t want us to be upset. However, there are a few issues here:
- Every time you engage in a compulsion (i.e. reassurance-seeking), you reinforce the obsessive-compulsive cycle
- Using someone like a reassurance Pez dispenser will likely put a strain on the relationship!
Attending couples therapy allows you to protect your relationship from the damage OCD tries to inflict by letting your partner in on how OCD works more broadly and how it shows up for you personally. By discussing your OCD with your partner, they can learn how to best support you and gain understanding and empathy for your experience. A knowledgeable and supportive partner can be the best ally in the fight against your OCD.
Values-Based Relationship Concerns vs. ROCD
Couples therapy is appropriate for any subtype of OCD because any OCD subtype can and likely will impact the way you are able to engage with your partner. However, couples therapy can be particularly impactful if Relationship OCD (ROCD) is at play. ROCD is a subtype of OCD that leads to obsessive doubt about the rightness of your relationship or choice of partner. The obsessive doubts will lead you to minimize the things that are going well and fixate on the things that feel distressing, which in turn lead to compulsions to gain certainty about the viability of the relationship. ROCD thrives in isolation and disconnection between partners, so couples therapy is a perfect place to challenge avoidance compulsions, bolster emotional and physical intimacy and face your fears about your relationship head on.
Individual clients with ROCD will often ask me, “what if my concern about my partner isn’t OCD? What if this concern is something I owe to my partner to bring up, or something that, if addressed, could help our relationship get better?” I explain to them that valid concerns exist in every relationship, because no relationship is perfect and wholly satisfying at all times (even if OCD screams at you that perfection is achievable, like mine does). I also explain that because OCD is “the doubting disorder,” it’s going to try everything it can to get you caught up in the uncertainty of “valid vs OCD.”
A good way to tell if the concern is valid is to ask yourself, is this something my partner can do something about? For example, if the concern is “I feel dismissed when we have an argument,” that is something your partner may be able to work on if you let them know. On the other hand, if the concern is, “I don’t get turned on by your smell,” your partner can’t change that and may actually be hurt by the admission if you told them.
Another way to think about this is to ask yourself, “are my concerns egosyntonic or egodystonic?” Egosyntonic concerns relate to your values and are in line with your concept of self. In the example above, feeling heard when communicating with your partner may align with your values of respect and mutual understanding. Conversely, egodystonic concerns are based in fear and do not align with your values or how you see yourself. You may realize your physiological response to your partner’s smell is not actually that important in the grander scheme of the relationship, and does not negate all of the things you do find attractive about your partner, but should it?? What would your best friend say if they found out? Is the relationship doomed to failure due to a random mismatch in physiological compatibility?
When ROCD plagues you with a possibly hurtful, fear-based concern, individual therapy is a great place to verbalize your fear and challenge its meaning. But some concerns you have about your relationship may be values-based and those are crucial to express to your partner, which a couples therapist can help facilitate.
Case Study: Ruby and Jake
Ruby (she/her) and Jake (he/him) have been together for five years. They have been living together for the past three years and have many things in common, like a love of movies, board games, travel and dad jokes. Before moving in together, Ruby and Jake would prioritize quality time together with frequent date nights, parties and weekend getaways. Since moving in together, Ruby has found it harder to ignore her obsessive doubts about the relationship, especially as things get more serious and they begin to talk about the future. Jake knows Ruby has OCD, but Ruby has concealed the nature of her doubts to Jake in order to spare his feelings.
One of Ruby’s most distressing triggers is physical intimacy, specifically sex. Any time Jake indicates his desire for sex, Ruby’s stress response activates and she freezes up, leading her to come up with any excuse to avoid it. When she does muster up the courage to face her fears and agree to have sex, she’s so in her head she can barely enjoy herself. Ruby’s OCD tells her that the way he kisses her is “too sloppy,” the way he rubs her back is “too needy,” and “what does it mean about their compatibility that she dreads having sex?” Because Ruby’s OCD is scanning for threat, nothing Jake does to please Ruby is “right” and sex leaves Ruby feeling more awful and disconnected. The more Ruby dreads the OCD thoughts that plague her during sex, the more she avoids sex entirely, perpetuating the cycle. Jake picks up on Ruby’s dread and avoidance, noting that it’s been weeks since they’ve had sex, and even longer since Ruby initiated. Jake notices that Ruby seems to be avoiding cuddling or kissing altogether (in Ruby’s mind, these acts of intimacy may lead to Jake asking for sex, so best to avoid them). Jake is someone who needs physical intimacy to feel emotionally connected and satisfied in his relationship, and Ruby’s sex avoidance leads Jake to feeling disconnected, resentful and doubtful about himself and Ruby as a couple. Ruby feels Jake pull away, which only confirms her ROCD’s bias that he’s not the right one for her.
With the help of OCD-informed couples therapy, Ruby feels supported to disclose to Jake the fact that she’s struggling with Relationship OCD. Jake learns that Ruby’s doubts are based in fear, and not an indication of what she values most about their relationship. Ruby practices keeping the more hurtful thoughts to herself, discerning what Jake ought to know more broadly, so he understands the way OCD impacts her, while shielding him from the specific ways OCD tries to convince her she’s not attracted to him. The couple discuss the pattern of sex avoidance and clarify their emotional and physical needs. Jake informs Ruby how sex isn’t just for a physical release, but something he needs to feel connected to her. Jake expresses that he feels like Ruby views sex as a chore, which makes him feel rejected. The couples therapist clarifies that Ruby does have to push through a significant burst of anticipatory anxiety to engage in sex, which may be being read as disinterest or even disgust by Jake, but that the pushing through is worth it to Ruby because sexual intimacy and connection with Jake are very important to her. Jake expresses sadness that Ruby has to go through this at all, and shares that her willingness to combat her OCD for the health and wellbeing of their relationship means a lot to him.
Ruby discovers that as she practices engaging in sex while resisting mental compulsions, she feels proud of herself for living in accordance with her values of connection and sexual intimacy and ends up feeling sexually satisfied and more in sync with Jake.
How to support your partner if you have OCD:
Here are some practical tips for how to show up for yourself and your partner when managing OCD:
Take ownership of your individual OCD work
It is not your partner’s job to soothe your OCD-related anxiety, even if both of you are willing to try! Making your mental health someone else’s problem only disempowers you and creates a power imbalance that negatively impacts the relationship. The only way to change your OCD experience and regain your autonomy is to challenge the thoughts, tolerate discomfort, and face your fears through exposures. Protect the relationship by seeking help from a mental health professional, practicing tools to regulate and ground yourself in moments of high stress and reflecting on the ways you want to show up in your relationship.
Invite your partner into your experience
Practice discerning what is helpful for your partner to know and what is not. It can be difficult to know when to shield your partner and when to allow them to see you at your most vulnerable, especially since there may be a narrative present that you should be able to handle this alone. But you’re not alone and allowing your partner to know you’re struggling, and how OCD is impacting you can be a powerful way to connect and grow. Invite your partner to an educational session with your therapist or teach your partner a grounding exercise you can do together when you’re needing more support.
Respect their boundaries
OCD can feel all-consuming when you’re in the thick of a compulsive spiral. It’s natural to want to turn to your loved one for relief, but your partner is human and may not have the mental or emotional capacity to help you every time. Remember that if your partner sets a boundary, or asks for a moment to tend to themselves, that does not mean you’re wrong, bad or too much. Challenge negative self-beliefs that OCD keeps you stuck in and resist making meaning when your partner prioritizes their needs. After all, it’s not about you! Instead, celebrate your partner for knowing when they need a break and how to prioritize self-care.
Reconnect with your values (as a couple)
When OCD is getting you down and bleeding into your relationship, remember what you love about your partner and your relationship and try to reconnect with those things. Do you have a shared interest or hobby? What do you like doing together when OCD isn’t trying to mess with your life? By engaging with values-based activities despite anxiety, you teach yourself that you do not have to wait for OCD to disappear for you to enjoy your life and find meaning in your relationship.
Conclusion
OCD will try every trick in its book to keep you trapped in the obsessive-compulsive cycle, and your relationship may end up in its crosshairs. My hope in writing this article is to arm you with knowledge about what patterns to look out for and how to seek help, and to provide hope that your relationships are not doomed to suffer just because you have OCD. In part two of this series, I’ll focus on the partners of people with OCD and how you can best support your loved one as they manage their mental health.
•Emma Kazarian, AMFT, APCC, is a psychotherapist 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 nine weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.