Relationship OCD (ROCD) Explained: Causes, Treatment & More

If you are in a relationship, married, or just dating, you have probably questioned if your romantic partner or spouse is your “true love,” if your relationship is “solid,” and/or if there is someone better out there for you. You may have even wondered if you are really emotionally, physically, mentally, or sexually attracted to your partner. If so, you are not alone.

Doubts, fears, worries, concerns, questions, and attraction is likely to fluctuate during your relationship – and this is common and normal. You would not be human if you did not question your partner or relationship from time to time, especially if you have issues in the past.

However, if all you can think about is if you are happy with your partner and/or relationship – and if these unsettling thoughts are causing excessive stress and anxiety, you may be suffering from some form of ROCD. If you have ROCD, your doubts, fears, and worries go far beyond occasional bouts of insecurity. More specifically, people with ROCD tend to view “typical relationship doubts” as a signal that something is wrong with their partners and/or relationships. The good news is several OCD treatments can help you manage your ROCD symptoms.

So, yes, ROCD treatments can help you have a normal and healthy romantic relationship!

What is ROCD?

Relationship OCD (ROCD) is a subtype of obsessive-compulsive disorder (OCD) that involves intrusive or upsetting thoughts about your partner and/or relationship (obsessions), which can cause stress and anxiety, and compel you to behave in a certain way or perform certain actions (compulsions) to ease your distress. ROCD is a fairly common form of OCD. ROCD often presents in early adulthood, however, it can also arise during your teenage years or later in life.

ROCD symptoms tend to follow you in all of your romantic relationships, starting from the first time you are confronted with commitment-focused romantic questions or decisions (i.e., whether or not to take your relationship to the next level or get married, if you should have kids with your current partner, or if your partner is committed to you or is the “right” person for you).

ROCD can also involve obsessing over past relationships and/or relationships that are yet to develop (future romantic relationships). Still, most people with ROCD tend to experience the most distress as a result of their current partners and/or romantic relationships. And, for some people, the end of a romantic relationship is the catalyst for ROCD symptoms. These individuals may not only become obsessed with thoughts of their previous partners being the “right” people for them but also lament the “presumed” loss of love and happiness.

In this case, ROCD is linked to an extreme fear that you will never find someone like your ex, and regret that you will end up alone because you did not fight hard enough for your relationship. Fear and regret are often associated with self-reassuring behaviors, such as bashing your ex and/or remembering all of the reasons your relationship failed (relationship conflicts, betrayal, etc.)

Other people with ROCD may deliberately avoid romantic relationships for fear of hurting or betraying their partners, or experiencing a ROCD relapse. For example, a woman with ROCD may avoid entering into a committed relationship for fear of becoming “fixated” on her partner’s “flaws,” inconsistencies, beliefs, values, morals, and/or opinions, or becoming too attached to or obsessed with them.

Are There Different “Types” of ROCD?

Yes, there are three “types” of ROCD.

The three “types” of ROCD are: (1) relationship-centered ROCD, (2) partner-focused ROCD, and (3) a combination of relationship-centered ROCD and partner-focused ROCD.

• Relationship-centered ROCD involves fears and doubts about your relationship. For instance, people with this “type” of ROCD may incessantly worry that they are not experiencing “true love” with their romantic partners. They may also doubt that their romantic partners are truly in love with them, or fear that they are not in the “right” relationship.
• Person-centered ROCD, on the other hand, is narrower in focus. People, who struggle with this “type” of ROCD, typically focus solely on their partner’s attributes. For instance, these individuals may question their partner’s intelligence, manners, intentions, loyalty, attractiveness, morals, values, ethics, etc.
• It is also possible to have relationship-centered ROCD and person-centered ROCD at the same time. This is considered a hybrid “type” of ROCD. People with this “type” of ROCD tend to worry about their relationships and their partner’s traits simultaneously.

What Causes ROCD?

Truth be told, researchers are not quite sure what exactly causes ROCD. However, it appears to be linked to chemical processes in the brain and the way the brain uses hormones and neurotransmitters to communicate with cells in the body. Some experts believe that ROCD is genetic, for instance, if a parent has ROCD, you may develop it as well.

Other researchers believe ROCD is triggered by a traumatic experience, for instance, if you experienced domestic violence, unhealthy romantic relationships, or a dysfunctional home life as a child or adolescent, you may be at risk of experiencing ROCD.

Understand that a key component in ROCD is a relentless need to feel like your partner and/or romantic relationship is “perfect” or “right,” because that is the only way to avoid or stop the intrusive thoughts (i.e., worrying that something is wrong with your partner and/or relationship) and/or compulsive behaviors (i.e., spying on or judging your partner, finding things wrong with the relationship, etc.).

What Are Some Examples of ROCD Obsessions and Compulsions?

ROCD Obsessions

Listed before are common questions that someone with ROCD may ask themselves and become “fixated” on:

• Is this “true love?”
• Is my partner the “One?”
• Am I being “fake” for staying in the relationship even though I am unsure about it?
• I need to decide between staying or breaking up with my partner, but what if I make a mistake?
• What if there is someone better for me out there?
• What if this relationship does not last forever – then what?
• What if my partner and I are not evenly matched?
• Why am I still attracted to other people – is that a sign that I should not be with my partner?
• What if I do not find my partner attractive – what should I do?
• How can I tell if I am truly in love with my partner?
• What if I am actually homosexual and just pretending to be heterosexual?
• Or, what if I am actually heterosexual and pretending to be homosexual?
• Why do I keep focusing on my partner’s appearance?
• Why do I keep obsessing over my partner’s “flaws?”
• Will I ever stop being bothered by how unattractive my partner is?
• What if I am “settling” for second best?
• What if my partner is not intelligent enough for my liking?
• What if my partner is a terrible person?
• What if I am just in denial about my doomed relationship?
• What if I am making a horrible mistake by being with my partner?
• What if I am never able to completely trust my partner because of previous relationships or a past betrayal?
• What if I am just leading my partner on?
• What if I regret my choice to be in a relationship in the future?
• What if other people can see that my partner is not good enough for me, and are judging me or pitying me because of it?
• What if my partner embarrasses me?
• What if I am not good enough for my partner?
• What if I am in the wrong relationship?

ROCD Compulsions

Listed before are behaviors that someone with ROCD may exhibit to reduce or eliminate their worrisome thoughts:

• Continuously reviewing in your mind all of the good and bad times you have had with your partner
• Trying to determine for sure if you and your partner are truly “soulmates”
• Asking friends and family what they think about your partner, and then comparing what they said to how you feel about him or her
• Tactfully (or not so tactfully if desperate), guiding conversations with friends and family towards listening to and interjecting their beliefs and opinions on your relationship, so you are reassured that you are making the “right” decision
• Searching the internet for love stories, and then comparing your romantic relationship to other people’s romantic relationships
• Comparing your previous relationships to your current one to determine if you are in a “good” or “bad” relationship
• Comparing your partner’s appearance and/or emotional, social, or intellectual attributes or achievements to other people’s traits in those areas
• Comparing your romantic relationship to the romantic relationships that you see on social media sites (i.e., the couples look happier and more committed than you and your partner, and/or the couples appear to be having more fun than you and your partner)
• Constantly obsessing over your partner’s “flaws” (i.e., face, hair, physique, and/or other physical characteristics)
• Continually concentrating on your partner’s “bad habits”
• Watching how others react to your partner, and then trying to determine if they are judging him or her
• Confessing to your partner that you may not be in love with him or her, and/or that you found a random person attractive, or that nothing your partner does sexually arouses you (i.e., kissing, cuddling, foreplay, etc.).
• Checking your genital area or groin (groinal response) to see if you are sexually aroused by your partner
• Deliberately initiating sex with your partner to reassure yourself that you are still sexually attracted to him or her
• Subjecting yourself and/or your partner to various tests to become certain about your relationship
• Taking online relationship tests and quizzes, such as “Am I Really in Love with My Partner?” or “Is My Partner the “One” for me?” to determine if you should stay with him or her
• Writing down all of the “pros” and “cons” of staying in the relationship
• Constantly ruminating about (thinking about) anything relationship-based
• Incessantly monitoring or checking how you feel about your partner
• Relying on therapy to tell you if you are truly in love with your partner
• Breaking up with (or divorcing) your partner because of your insecurities
• Watching romantic movies and comparing your relationship to the ones in the movies
• Avoiding committing to relationships or making long-term plans with a partner out of fear that it will not last and you will end up alone
• Avoiding being intimate with your partner for fear of not being able to sexually satisfy him or her
• Avoiding watching romantic movies altogether
• Avoiding hanging out with your single friends out of fear that it will cause you to want to be single again

How is ROCD Treated?

Like OCD, in general, ROCD, a subtype of OCD, is addressed using a multi-treatment approach involving exposure and response prevention (ERP) therapy, cognitive-behavioral therapy (CBT), and acceptance and commitment therapy (ACT), along with lifestyle changes, and self-help tools.

Although OCD is always fueled by compulsions, these compulsions are not always triggered by obsessions. In other words, the more ritualistic you become, the more rigid and repetitive your obsessions become. However, once your compulsions are properly addressed, you can start the healing process and win the war against your ROCD symptoms. But, first, you must acknowledge how ROCD has pulled you into an endless cycle of stress, anxiety, obsessions, and/or compulsions (temporary relief).

ROCD can make you feel like you are “caught up in a web” that you cannot escape from. It is the uncertainty, along with your insecurities, that causes you to feel “stuck” in an OCD cycle. And, even if you receive some relief through reassurance or avoidance, it is only temporary.

In other words, the thoughts and urges (i.e., “What if my partner is not right for me?) to perform specific actions or engage in certain actions (i.e., spying, doubting, or judging your partner) keep returning over and over again. The good news is you do not have to stay in a looping ROCD sequence. There are OCD treatments available that can help you get a handle on your symptoms, so you can live – without doubt, worry, or fear.

Listed below are common ROCD treatments:

ERP Therapy for ROCD

Exposure-response prevention (ERP) therapy encourages you to deliberately “expose” yourself to your OCD triggers so that you become desensitized to them. The belief is that if you place yourself in challenging or uncomfortable situations, your intrusive thoughts (obsessions) and ritualistic behaviors will lose their power over you. ERP therapy “rewires” your brain so that your worrisome thoughts (obsessions) are fleeting. Thus, there is no need to perform rituals or routines (compulsions) to quell your angst. This “exposure” varies depending on your specific ROCD symptoms – i.e., the root cause of it, symptoms, fears and doubts, goals, obsessions, and/or compulsions.

CBT for ROCD

Cognitive-behavioral therapy (CBT) is extremely beneficial for ROCD. Like ERP therapy, CBT addresses your obsessions and compulsions. The “cognitive” part of CBT teaches you how to become more aware of your thought processes – so you can change them. And, the “behavioral” part of CBT helps you address your reassurance-seeking and avoidance behaviors (compulsions that are commonly linked to people with ROCD).

One thing people with ROCD fail to understand is that their relationships are not the real problem. No, it is how you think about or interpret your partner’s characteristics or lack thereof, your insecurities, the uncertainty, and/or the relationship that is causing all of the strife. It is also how you react to your doubt, worries, and fears that can make having ROCD feel like emotional hell.

A constant need for reassurance or validation also plays an important role in the development and continuation of this “type” of OCD. CBT can help you stop placing weight on your intrusive ROCD thoughts (obsessions), so you can quit engaging in compulsive behaviors (i.e., seeking reassurance that your partner and/or relationship is good, healthy, and/or true).

More specifically, CBT teaches you how to alter your thought processes, so they are more realistic and “balanced.” In other words, it teaches you how to ignore your OCD thoughts because they are faulty and inaccurate, so you are not compelled to engage in rituals or routines. So, ultimately CBT “dares” you to question your ROCD-driven thoughts and behaviors.

Mindfulness for ROCD

Mindfulness is often used to combat OCD symptoms. Mindfulness teaches you how to “let go” of the upsetting thoughts by improving your self-awareness. It also helps you stay in the present instead of comparing your partner and/or relationship to your past ones. Ultimately, mindfulness teaches you how to challenge your ROCD thoughts, so they no longer overpower your life.

Anxiety Management Tools

Researchers suggest that self-help tools, like anxiety management tools, not only help you control your anxiety but can also play an important role in ROCD recovery. And, although, learning how to channel your anxiety into something more productive (by changing how you “see” your partner and/or relationship), doing so can cause you to feel even more stressed. Still, anxiety management tools may be just what you need to finally get a grip on your symptoms.

Understand, however, that at the beginning of the ROCD recovery process, your partner/relationship compulsions (i.e., seeking reassurance, overanalyzing your partner and/or relationship, looking for something to be wrong, etc.) may be challenging to detect and acknowledge. This is normal. It is a process, after all. So, it is important to be patient with yourself and utilize all anxiety management tools at your disposal.

ACT for ROCD

Acceptance and commitment therapy (ACT) encourages people with ROCD to “accept” or “embrace” their thoughts, feelings, fears, and doubts, instead of allowing these emotions to “force” them into finding ways to “quiet” them. Researchers have found that combining ACT with ERP can be extremely beneficial in the treatment of OCD and ROCD.

ACT is designed to help you “expose” yourself to upsetting triggers, while simultaneously altering your thought process, so your fears, worries, concerns, and doubts no longer have a prominent place in your life. Thus, the ultimate goal of ACT and ERP therapy is not to avoid your intrusive thoughts or make yourself “feel better.” Rather, the aim is to change how you react to those thoughts, so they no longer take center stage in your mind.

Medications

Sometimes, ROCD is treated with medications like antidepressants (i.e., SSRIs or SNRIs). Researchers suggest that selective-serotonin reuptake inhibitors (SSRIs), especially when they are combined with CBT, ACT, and/or ERP therapy, can be extremely effective in the treatment of ROCD symptoms.

Studies also indicate that serotonin-norepinephrine reuptake inhibitors (SNRIs) may be beneficial when combined with SSRIs or when SSRIs are ineffective. “Off-label” tricyclic antidepressants and atypical antipsychotics are also sometimes used to treat OCD/ROCD symptoms, however, they may not be as effective as other anxiety medications.

FDA-approved SSRIs for OCD include:

• Zoloft (sertraline)
• Prozac (fluoxetine)
• Luvox (fluvoxamine)
• Paxil (paroxetine)

FDA-approved tricyclic antidepressants for OCD include:

• Anafranil (clomipramine)

“Off-label” SSRIs for OCD include:

• Celexa (citalopram)
• Lexapro (escitalopram)

“Off-label” SNRIs for OCD include:

• Effexor (venlafaxine)
• Cymbalta (duloxetine)

“Off-label” atypical antipsychotics include:

• Abilify (aripiprazole)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Zyprexa (olanzapine)
• Haldol (haloperidol)

Surgical Procedures

Brain surgeries, like gamma knife radiosurgery (ablative neurosurgery), and/or deep brain stimulation may be treatment options for people with severe ROCD, especially when conventional therapeutic interventions have been ineffective. Gamma knife radiosurgery is not FDA-approved for OCD; however, it can be utilized for OCD, “off-label,” when needed. Deep brain stimulation, on the other hand, received an FDA “Humanitarian Device Exemption” for the use of severe and stubborn OCD symptoms.

Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) (neuromodulation) for OCD symptoms is inconclusive. However, some studies have found that TMS may be effective for resistant OCD symptoms.

Online OCD Treatment Programs

Online OCD treatment programs, like Impulse Therapy, can help you better manage your ROCD symptoms and get on with your life. Impulse Therapy offers OCD assessments, expert guidance and content, and some much-needed support as you address your ROCD thoughts and behaviors. Another plus? With Impulse Therapy’s help, you can gain a new lease on life!