Relationship OCD (ROCD) is a form of obsessive-compulsive disorder that involves obsessions, preoccupations, doubts, and compulsive behaviors related to a relationship with another person.
ROCD is not currently an official diagnosis in the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, these types of relationship symptoms have been frequently discussed in OCD forums for several years. These symptoms have recently begun to receive more formal research attention.
This article focuses on ROCD in romantic relationships, exploring the risk factors, symptoms, and ways of managing ROCD.
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What Is Relationship OCD?
Obsessive-compulsive disorder (OCD) is a mental health disorder characterized by intrusive and distressing thoughts, impulses (obsessions), and repetitive behaviors (compulsions). ROCD is a form of OCD that is explicitly focused on relationships.
Having some degree of worry or doubt in a relationship is typical. Still, for people with relationship OCD, these preoccupations significantly disrupt the relationship and the person's ability to function as an individual. They constantly analyze themselves, their partner, or their relationship, obsessing over even minor perceived flaws.
While a lot of research focuses on ROCD in romantic relationships, it can occur in any relationship, including friendships, siblinghood, and parent-child relationships.
Types of Relationship OCD
ROCD can manifest in two ways: as relationship-centered or partner-focused ROCD. Both presentations of ROCD often cause extreme and debilitating distress for the individual and their relationship. It can also affect psychological well-being. ROCD obsessions and compulsions can take up a lot of time and energy, interfering with functioning in other areas of life.
Relationship-Centered ROCD
Features of relationship-centered ROCD are as follows.
- Symptoms focus on doubts and preoccupations about how the person feels toward their partner, how they think their partner feels toward them, and the "rightness" of their relationship.
- Obsessions can manifest in ways such as images, thoughts, and urges.
- Symptom triggers might include experiencing negative feelings (including boredom or distress) in the presence of their partner or seeing "happy couples."
- It involves repeatedly questioning the quality, suitability, and validity of their relationship.
Partner-Focused ROCD
In partner-focused ROCD, the person may experience the following.
- There is an intense preoccupation with flaws they perceive in their partner across various areas, such as intelligence, sociability, morality, and appearance.
- Symptoms can be triggered by noticing the perceived flaw or encounters with other potential partners.
- The person frequently analyzes their partner's strengths and weaknesses, often comparing their partner's attributes and characteristics against those of other potential partners.
Their obsessions may conflict with their values. For example, morally and objectively, they may believe that people should not be judged by their looks, but their OCD obsessions compel them to scrutinize and find fault with their partner's appearance. This disconnect can cause feelings of shame or guilt.
Is ROCD Always One Type or Another?
Both presentations of ROCD can occur together. Often, a person with ROCD begins with a preoccupation with a perceived flaw in their partner (partner-focused), which then leads to obsessive thoughts about the "rightness" of the relationship (relationship-centered).
Less commonly, doubts about the relationship can start first, followed by a preoccupation with a partner's perceived flaw(s).
Symptoms of Relationship OCD
As with other forms of OCD, ROCD involves obsessive thoughts and compulsive behaviors. It's important to distinguish between typical relationship worries and doubts and ones indicative of ROCD. Almost everyone experiences some of these thoughts at times, such as not always being in the mood for sexual intimacy or wondering if your relationship is right for you.
However, if these feelings or thoughts begin to interfere with your relationship or mental health, visiting a healthcare professional is a good idea.
Obsessive Thoughts
Obsessive symptoms in ROCD can include:
- Extreme fear of making the wrong relationship-related decision (alternating between anxiety over the thought of leaving the relationship and anxiety over being "trapped" in the wrong relationship)
- Overwhelming doubts and fears relating to how they feel toward their partner, how they believe their partner feels about them, and whether or not the relationship is "right"
- Hyper-focusing on perceived flaws they see in their partner
- Fear that they aren't "good enough" for their partner
- Constantly questioning whether they really love/are attracted to their partner
- Constantly questioning if their partner is right for them or really "the one"
- Worrying about the potential to hurt their partner by staying in the relationship even if they don't really love their partner
People with ROCD may perceive innocuous thoughts and behaviors as "signs" that they don't really love their partner or that their relationship isn't viable. These can include:
- Not thinking about their partner all day long
- Not completely enjoying a kiss or act of intimacy
- Noticing that another person is attractive
- Enjoying having time to themselves on occasion
- Not always being in the mood for sexual intimacy
- Having the ability to imagine cheating on their partner (interpreted as secretly wanting to do so for real)
Compulsive Behaviors
People with ROCD engage in compulsive behaviors in an attempt to relieve the anxiety caused by their obsessions.
Compulsive behaviors common in ROCD include:
- Monitoring/checking their feelings
- Comparing, such as comparing their partner's attributes to other potential partners or comparing their relationship to those around them, past relationships, relationships on TV, etc.
- Neutralizing, such as picturing themselves and their partner happy together or trying to recall good experiences with their partner
- Reassurance-seeking about their partner or relationship by consulting with friends, family, therapists, or even psychics
- Avoiding potential triggers, such as friends, they consider to have a perfect relationship or romantic movies
- Obsessive questioning and preoccupation with small details
- Researching, such as constantly reading articles that outline what a successful relationship should be like
- Passion-seeking, such as becoming upset if sexual intimacy with their partner is not satisfying
- Testing, such as initiating sex with their partner to confirm arousal/feelings of connection or spending time/flirting with other people to test if they are attracted to others
- Being constantly on a quest for "perfect" love
- Creating rules for their partner and questioning the relationship if their partner does not uphold them
- Repeated confessions, such as frequently telling their partner they are having doubts or that they find other people attractive
Compulsive behaviors may provide temporary relief from obsessive thoughts, but the obsessions always return.
What's the Difference Between ROCD and Normal Doubts?
It is a normal human experience to have doubts about romantic relationships. If you are having unexpected or unwanted preoccupations with your relationship, such as intrusive thoughts that your partner has a particular flaw or urges to leave your partner for no known reason, speak to a mental health provider. They can help you determine if your feelings might be part of ROCD.
Risk Factors for ROCD
The exact causes of ROCD are not known. However, researchers have identified some risk factors:
- Biology: Studies have shown there may be physical brain differences in those with OCD, including ROCD. More research needs to be done to determine how differences in the frontal cortex may contribute to obsessive and compulsive thoughts and behaviors.
- Genetics: Those who have a family member with OCD are statistically more likely to experience it themselves.
- Co-morbid conditions: Those who experience depression and anxiety have a higher likelihood of developing OCD-like thoughts and behaviors.
- Childhood trauma: There are some theories that adverse childhood experiences, such as abuse and/or neglect, might be more likely to develop OCD, though more research needs to be done in this area.
Triggers of Relationship OCD
There are certain things that can trigger ROCD in those who have risk factors.
Age
The age of onset of ROCD is not known. Still, clinical evidence has shown symptoms often begin to present in early adulthood or when a person is first faced with commitment-related romantic decisions.
Previous ROCD symptoms
ROCD symptoms often persist from one relationship to another and can occur when a person is not actively in a relationship (such as having obsessions about past or future relationships).
Belief Systems
Certain beliefs and thought processes common to other forms of OCD may be linked to ROCD as well, such as:
- Tendency to overestimate threats
- Perfectionist tendencies
- Intolerance for uncertainty
- Cultural or religious beliefs
- Attachment anxiety
- Relationship-dependent self-worth
- Extreme beliefs about love and relationships
- Inflated sense of responsibility
ROCD symptoms do not seem to be significantly related to relationship length or gender.
Treatment
ROCD is typically treated with therapy, but medication may be used in some cases.
Therapy
While involving a person's partner in the therapeutic process can be beneficial, the goal of therapy for ROCD is not to "save" the relationship but rather to address the ROCD symptoms.
Treatment for ROCD can still benefit the relationship (even if the relationship ends) because the person can make decisions based on their actual experiences instead of those distorted by ROCD-influenced thinking.
Relationship OCD is typically treated with cognitive behavioral therapy (CBT). CBT involves learning to recognize problematic thinking and behaviors, then, over time, replacing them with healthier, more productive ones.
Exposure response prevention therapy (ERP) is a type of CBT commonly used to treat OCD, including ROCD. ERP involves repeated, gradually intense exposure to the source of fear (such as obsessive thoughts) while resisting the urge to perform compensatory or neutralizing behaviors (compulsions). With repeated exposure to the trigger, the brain learns to recognize it as irrational, often reducing the obsessions and, in turn, lessening the urge to engage in compulsions.
Medication
Medication is not a first-line treatment for OCD, but selective serotonin reuptake inhibitors (SSRIs) may be used alongside therapy to help manage symptoms. Dosages of SSRIs tend to be higher when used to treat OCD than in other conditions, such as depression.
SSRIs that may be used to treat OCD include:
- Prozac (fluoxetine)
- Paxil (paroxetine)
- Zoloft (sertraline)
- Lexapro (escitalopram)
Similarities and Differences Between Zoloft and Prozac
Coping
ROCD is not a fear of intimacy or commitment but rather a specific and intense fear of being in the wrong relationship.
ROCD can put strain on a relationship and both people in it. A relationship can survive ROCD, but ROCD symptoms should be addressed regardless of their effects on the relationship or its outcome. Treatment for ROCD can help a person see their relationship more clearly and make better decisions, including if they want to stay in it.
You can support your partner with ROCD by offering patience and transparency. If they are OK with it, it can be helpful for you to be involved in their treatment.
Summary
ROCD is a form of obsessive-compulsive disorder in which a person experiences obsessions and compulsions related to their relationships. It can involve symptoms such as constantly questioning if they really want to be with their partner, being hyper-focused on perceived flaws they see in their partner, and seeking reassurance or proof that their relationship is "right." ROCD can cause distress to the individual experiencing it and strain their relationship.
ROCD is typically treated with therapy, particularly CBT or ERP, but medication may be prescribed if necessary to help with symptom relief.
