Relationship OCD, or R-OCD, is a subtype of obsessive-compulsive disorder where people experience intrusive thoughts and compulsive behaviors related to worries, fears, and doubts in their relationships. While R-OCD can apply to any kind of relationship, we’re going to focus on romantic ones. Today I’ll be teaching you what exactly Relationship OCD is, why you might have it, and the top evidence-based ways to make lasting change.
What is Relationship OCD?
To understand R-OCD, we first need to get clear on regular old obsessive-compulsive disorder (OCD). OCD is a mental illness that involves repeated and unwanted thoughts or obsessions, coupled with repeated behaviors or compulsions related to those thoughts. Something that might come to mind is a person whose OCD centers on an obsession with safety. They might be fixated on locking doors, so they will check the doors of their home multiple times per day and might even leave work because they fear they left doors open at home despite knowing they didn’t.
A person with Relationship OCD will have repetitive fearful thoughts about their relationship. They constantly doubt all their decisions in regard to their relationship. For example, if they doubt if this is “the one” for them but stay with the person, they’re full of dread that they should leave. If they leave the relationship, they’ll be obsessed with thinking they made the wrong decision and want to get back together with that person. If they do get back together, they’ll doubt that decision as well and stay stuck in this cycle of breaking up and getting back together.
They’ll doubt if their partner really loves them or if they really love their partner. They’ll ask themselves grand questions like, “What is love anyway?” They question their compatibility with their partner, their attraction to their partner, and even their partner’s love for them. They then look to their partner to help them feel reassured, which creates tension and conflict since no amount of reassurance is ever enough.
What’s an Intrusive Thought?
You might be thinking right now, “That’s me! I worry about my partner leaving me. I’m anxious about whether my partner really loves me!” But we all go through moments of doubt in our relationships. What signifies R-OCD are intrusive thoughts which you might not be having. Intrusive thoughts are a very particular type of thought. They’re disturbing or alarming thoughts that enter your consciousness often without any warning or external prompting.
For example, let’s say you’re a heterosexual woman walking down the street and see your partner walking out of a restaurant with another woman. They’re laughing and seem very close. You might get a thought that he’s cheating, even if you’ve never worried about that before. You might even think about it all day until you’re able to discuss what you saw with him after work. These thoughts might come at you all day, but it’s because something reasonable prompted those thoughts; they weren’t out of nowhere, and it’s not a strange “jump” to think your partner is cheating.
However, if you and your partner are doing well overall but you keep perseverating on whether to get married, that could be R-OCD. All day, practically every day, you think about whether you really love your partner and if you should make the next step. Your thinking is circular, and you never get to any conclusions or “right answers.” Or, if you do decide to marry your partner, you’re happy for a day and then suddenly get swarmed with doubts and fears about whether this is the right decision. There’s no prompting or external cue. These thoughts are pervasive and never really stop. Intrusive thoughts are thoughts all of us might have at some point, but these thoughts I’m discussing here get stuck and create a huge amount of anxiety and distress.
Symptoms of R-OCD
There are two main ways R-OCD presents itself. One is relationship-centered, and the other is partner-focused. You might have one or both.
In these cases, you might feel overwhelmed by your worries or doubts surrounding your feelings towards your partner, their feelings towards you, and whether this is the “right” one for you. You think thoughts like:
- Is this the right relationship for me?
- Do they really love me?
- Do I really love them?
- What is love?
- Are they “the one,” or am I making the biggest mistake of my life?
- Are we even compatible?
In general, you’ll need constant reassurance from your partner (although it’s never enough), and you’ll have a hard time focusing at work or on other tasks because you’re spinning on one or more of the above questions. You also might constantly compare your partner to other potential partners even though you intellectually and objectively know that your partner has many great qualities you want.
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In these cases, your worries about your partner’s characteristics, such as their physical features, social attributes, flaws, or personality, become increasingly impairing, time-consuming, and upsetting to you. You think thoughts like:
- I hate x about my partner (focusing on what you don’t like or a particular flaw)
- Is she pretty enough?
- Is he too heavy?
- Are they successful/ambitious enough for me?
- I need someone my friends like.
- What did my friend think of that joke my partner told?
- What do my parents think about my partner?
- She’s not intelligent/funny enough.
- Are they trustworthy?
- Was their previous partner better in bed than me?
- Do they still love their ex?
- I could find someone who’s a better match for me.
- There’s no one I’ll ever find as good as this person.
- Do they wish they were with someone more successful than me?
- Am I attracted to them?
- I’ve thought about/been attracted to other people; does that mean I don’t love them?
- You might be obsessed with your partner’s past relationships. “Did he love her more than me? Was he better in bed than I am? Does he still carry a torch for her?”
When these thoughts (obsessions) or any actions (compulsions) you take related to those intrusive, obsessive thoughts interfere with your normal activities or your ability to function fully in your life, you might have R-OCD.
R-OCD in Action
Regardless of which type of R-OCD you might have, there are a variety of compulsive ways you behave in your efforts to reduce your feelings of anxiety, upset, uncertainty, doubt, and fear.
These might include:
- Constantly thinking about what you’re thinking or feeling about your partner or the relationship.
- Looking for reassurance about the relationship from friends, counselors, and other important people in your life. You might even be on social media DM’ing therapists asking for advice.
- Comparing your relationship to others.
- Comparing your partner to your own past partner or comparing yourself to their past partner (this can result in jealous interrogations).
- Trying to catch your partner not being smart, fun, or ambitious. You set them up and test them to make sure they’re what you think.
- Avoiding watching romantic movies because you’re not as “in love” as they are on film.
- Not hanging out with certain friends because they seem to have a more perfect relationship than you do.
- Not going to the office holiday party because you’re embarrassed by your partner in some way or fear they won’t measure up (i.e., you’re a lawyer, and they’re a park ranger, and you’re afraid of what people will think. Or maybe your partner is a little overweight, so you don’t invite them out when your college friends are in town).
Why Do People Have R-OCD?
The reasons for R-OCD aren’t entirely clear and are likely multi-faceted. These overlapping reasons might include:
- History of trauma, abuse, or bullying
- Attachment style
- Biology: Genetic and hereditary factors which create chemical, structural and functional abnormalities in the brain, such as changes in serotonin levels or changes in activity in certain areas of the brain
- Life changes such as a death, moving, divorce, having a baby/getting pregnant, being fired/hired at a new job, a car accident, or getting married
- Low self-esteem
- Other mental health issues, such as anxiety
Treatment for R-OCD
Treatment for R-OCD is similar to other cognitive-behavioral treatments for OCD. There are a few that have great evidence-based research to back them up, but I’m only going to go a little deeper with one of them.
I. Exposure and Response Prevention (ERP)
Exposure and response prevention therapy (ERP) can be an effective type of relationship OCD treatment. This type of therapy involves slowly exposing yourself to triggers such as an unflattering photo of your partner. Over time, research has shown that ERP can reduce the power of those triggers.
II. Imagery Rescripting
Imagery Rescripting is a technique that challenges dysfunctional and maladaptive self-perceptions and beliefs by looking at memories, and the mental pictures we create from those memories, in another way. Research has shown it to be effective with OCD and Relationship OCD.
III. Cognitive Reconstruction
Cognitive restructuring is a technique that helps people change the way they think. Since we feel the way we think, it can then help people feel differently about things that worry or frustrate them (like all these thoughts about your partner or relationship). When you feel differently about an event or person, you’re able to change your actions, reactions, and behavior. Cognitive restructuring shouldn’t be confused with cognitive behavioral therapy (CBT), which I’ve talked about many times before on the podcast, which is a specific type of cognitive restructuring. Cognitive restructuring involves slowly replacing a maladaptive belief (in this case, about your relationship) with one that’s more accurate and helpful. Instead of predicting that your relationship is doomed because you don’t feel in love every day, you might instead start believing that everyone has ups and downs in a relationship, so it’s totally normal and OK.
Let’s Talk About Maladaptive Beliefs for a Moment
Before I say more about cognitive restructuring, we’ve got to talk about maladaptive beliefs. The research shows that in OCD-related disorders, maladaptive beliefs related to not being able to tolerate any uncertainty, giving way too much importance to your thoughts (believing they’re facts), and a sense of inflated responsibility all increase the likelihood that, when you get an intrusive thought, you’ll start to catastrophize.
For example, you might have a normal relationship doubt. But because you give it so much power (thoughts are facts), you then catastrophize and decide that having a doubt means you should get out of the relationship, or it’s doomed to failure. If you have difficulty tolerating uncertainty, you’ll have a lot of difficulty with concepts like passion or love because they’re fuzzy to begin with! This means you’ll become more distressed and upset (“What is love anyway?” “How do I know if they’re the right one?”) and then react in dysfunctional ways. Your beliefs about the potential negative consequences of your relationship and unrealistic expectations about how you should think and feel about your partner or the relationship can create a negative spiral with R-OCD.
If you start thinking about how bad it’ll be to stay in the relationship or you have fear about ending the relationship, you’ll start to create what’s called “catastrophic scripts.” Scripts can be things like being afraid you’ll end up trapped in an unsatisfying or bad relationship for the rest of your life. Or you might have a script about somehow missing out on your soul mate, “the one,” and then regretting forever. You might have a script related to unrealistic expectations about what love should look like or some fairytale romance.
- “If I don’t think about them all the time, then they’re not “the one.”
- If I think about my ex sometimes, it means I’m not in love with my current partner.
- If I find other people attractive, it means I’m not in love.
- I can’t be in love because my heart doesn’t beat more quickly when I think of them.
Actionable Tip for Cognitive Restructuring
Get a pack of index cards. On one side of each card, write down a belief you have about your partner or relationship. Then, on the other side of that card, you’ll write down a dispute or challenge to that particular belief.
- For instance, on one side, you might write, “If we don’t get along all the time, it means it’s not true love.” Then on the other side, you’d write down your dispute, such as, “Is there a relationship that exists where the partners get along 100% of the time?” or “Is it possible to have the same feelings about anything or any one person 100% of the time?”
- Or you might write on one side of a card, “If I have doubts or fears about my relationship, it means they’re not the one.” On the other side, you might write, “My mishandling of my intrusive thoughts is the real issue. That’s why my doubts are increasing or feeling so strong.”
As a last note, medications can also be very helpful (especially SSRIs) in easing the anxiety, intrusive thoughts, and depression related to R-OCD. Psychotropic medications are always best coupled with therapy such as those listed above.
Resources for Relationship OCD
Research for Relationship OCD
Doron, Guy & Derby, Danny & Szepsenwol, Ohad & Nahaloni, Elad & Moulding, Richard. (2016). Relationship Obsessive–Compulsive Disorder: Interference, Symptoms, and Maladaptive Beliefs. Frontiers in Psychiatry. 7. 10.3389/fpsyt.2016.00058.
Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian J Psychiatry. 2019 Jan;61(Suppl 1):S85-S92. doi: 10.4103/psychiatry.IndianJPsychiatry_516_18. PMID: 30745681; PMCID: PMC6343408.
Veale, David & Page, Nicholas & Woodward, Elizabeth & Salkovskis, Paul. (2015). Imagery Rescripting for Obsessive Compulsive Disorder: A single case experimental design in 12 cases. Journal of Behavior Therapy and Experimental Psychiatry. 49. 10.1016/j.jb
Ciharova, M., Furukawa, T. A., Efthimiou, O., Karyotaki, E., Miguel, C., Noma, H., Cipriani, A., Riper, H., & Cuijpers, P. (2021). Cognitive restructuring, behavioral activation and cognitive-behavioral therapy in the treatment of adult depression: A netw
Dominic Julien, Kieron P. O’Connor, Frederick Aardema, Christo Todorov, The specificity of belief domains in obsessive–compulsive symptom subtypes, Personality and Individual Differences, Volume 41, Issue 7, 2006, Pages 1205-1216, ISSN 0191-8869, https://doi.org/10.1016/j.paid.2006.04.019.