Unravelling the Conceptual Framework of Relationship OCD

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For this post, I had the privilege to interview Guy Doron and Danny Derby, pioneers in defining and studying Relationship OCD. ROCD is a specific type of obsessive-compulsive disorder (OCD) in which individuals struggle with persistent and distressing doubts regarding the suitability of their romantic relationship or partner.

Doron and Derby have published numerous papers on ROCD and developed a tailored treatment protocol, striving to make knowledge and support accessible to those struggling with this condition^1-7. This first of a three-post series based on my interview with the researchers.

Q. What led you to recognize clients who presented with relationship-related problems as struggling with a form of OCD?

Derby: Initially, we didn’t view these clients as having OCD; we saw them as individuals grappling with relationship dilemmas. In an effort to help, we employed standard cognitive-behavioral therapy tools like making lists of pros and cons or challenging the rationality of their questions and beliefs regarding the rightness of the partner or relationship. However, during a session, I suddenly realized the client and I were caught in an obsessive cycle and that my approach wasn’t effective. That’s when I decided to treat it as OCD and introduced compulsion reduction techniques. Surprisingly, for the first time in a long while, positive therapeutic changes began to emerge.

Doron: Around the same time, I was working with a client who became fixated on her husband’s sense of humor during her pregnancy. This presentation was entirely new to me, and like Danny, I attempted to address it as a relationship problem. Eventually, I realized she was stuck in an endless cycle of obsession.

I then tried using specific OCD interventions, which were somewhat helpful, but they didn’t fully address the unique challenges she and other individuals with ROCD faced. This made me realize that specific interventions tailored to the issues of those struggling with ROCD were necessary. Shortly after, Danny and I met at a conference in 2007 and discovered that we were both working with clients struggling with similar issues. We decided to expand our understanding of the phenomenon.

We began searching for clinical and scientific literature about similar cases but found virtually nothing. Then we went into online forums for people struggling with OCD and discovered that people were sharing their experiences of obsessing over their relationships and named it “Relationship OCD."

At that point, we started reaching out to people who seemed to struggle with similar issues and invited them to open clinical interviews to begin to study the phenomenon. We wanted to understand how ROCD develops, what core beliefs people with ROCD hold, and how they cope with relationship-related doubts.

Derby: We were surprised to discover the amount of people who were willing to come and talk to us about their severe relationship-related doubts. It was overwhelming to see how burning and relevant their relationship-related doubts were, and how much support they needed. As we collected more data on ROCD and realized the lack of existing clinical and scientific literature, we understood that we had to develop a tailored treatment for ROCD ourselves. This treatment builds upon existing OCD interventions but addresses the unique struggles faced by individuals with ROCD.

Q. What are the main questions and themes that preoccupy people with ROCD?

Doron: Our clinical interviews revealed two primary manifestations of ROCD. The first is “relationship-centered symptoms,” which involve doubts regarding the suitability of the relationship. This includes constant monitoring of whether the relationship “feels right," concerns about the strength and consistency of one’s feelings of love for their partner, and seeking evidence of their partner’s love.

The second is “partner-focused symptoms,” which involve an ongoing preoccupation with perceived flaws in the partner. These often involve deliberations regarding whether the partner is intelligent, social, funny, trustworthy, or moral enough, or obsessions regarding the partner’s appearance or physical features. Many individuals with ROCD experience both relationship-centered and partner-focused symptoms.

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Q. How do people with ROCD typically deal with relationship-related doubts and questions?

Derby: Individuals with ROCD actively use doubt as a coping mechanism. Doubt is not just an automatic reaction, but an ongoing process that makes people feel like they are “dealing with the problem” by constantly deliberating. In therapy, we aim to help clients recognize that this continuous doubt is not a solution, but rather part of the problem. We then teach them how to reduce their engagement in this deliberation process.

Doron: In response to their relationship-related worries, individuals with ROCD engage in various compulsions to resolve questions like “Am I in the right relationship?” or “Is my partner suitable for me?” These compulsions typically include monitoring their feelings or sexual arousal towards their partner, comparing their partner to others, repeatedly consulting friends and family regarding their relationship, and, of course, engaging in ongoing doubts and deliberations. [For more examples, click here.]

The first step in therapy is to help clients understand that the primary problem lies not in the relationship itself but rather in their attempts to resolve their doubts through compulsions, deliberations, and ongoing questioning. Only after addressing the obsessive elements can we go back and explore the relationship-related questions and challenges. It is almost impossible to consider these questions while still obsessing. Before making informed relationship decisions, it’s crucial to stop the obsessive cycling and truly experience the relationship.

This post is part I of a three-part interview with Prof. Guy Doron and Dr. Danny Derby. Part II explores the facets of diagnosing ROCD, its emergence, and its impact on people’s lives and their romantic partners. Part III discusses the core features of the treatment of ROCD.

To learn more about Relationship OCD, click here.