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Key points
- Doubts, questions, and uncertainty commonly take place in romantic relationships.
- For people with relationship obsessive-compulsive disorder, relational doubts are accompanied by strong feelings of distress and urgency.
- Paradoxically, attempts at reducing relationship-related distress leave people repeatedly struggling with their unwanted thoughts and feelings.
- Cognitive-behavioral therapy can help clients discern ROCD from natural relationship-related doubts and promote effective coping.
“Is he truly the one for me?”
“How come I don’t feel any butterflies around her anymore?”
“How would I know if this is the right relationship for me?”
“If I leave this relationship, could I end up regretting it?”
“How come I feel bored when I’m with my partner? Is this the way true love should feel?”
“By staying with him, might I be missing out on a better relationship that’s waiting for me out there?”
If you’ve ever been in a romantic relationship, you may have found yourself contemplating such questions or similar ones. Occasionally, you may have chosen to take the time to think these through, consider your feelings towards your partner, wonder how compatible you are, or ask yourself whether you’re in a relationship that’s right for you. You may have even consulted a good friend, a close family member, the internet, or a therapist to try and answer these questions.
For some people, the manifestation of such questions is accompanied by intense feelings of distress and by a strong sense of urgency to resolve their doubts and uncertainties regarding their relationship. At times, people feel compelled to spend long hours struggling to resolve such questions, reduce the distress that comes along with them, and regain their sense of certainty in their relationship. For people coping with Relationship Obsessive-Compulsive Disorder (ROCD), such struggles may occur frequently, resulting in prolonged personal and relational distress, which can impact their ability to focus on their everyday lives.
What is ROCD?
ROCD is a type of Obsessive-Compulsive Disorder (OCD). It is not listed in the DSM-5 as a distinct diagnosis; rather, it describes a particular way that a diagnosis of OCD can manifest.
People with OCD repeatedly experience intrusive thoughts, images, or impulses (obsessions), to which they feel compelled to respond with a variety of behaviors (compulsions) with the intention of eliminating the intrusive thoughts and diminishing the distressing feelings that often accompany them. Obsessive concerns may revolve around a wide variety of themes, including contamination, fear of harming oneself and others, symmetry, sex, morality, and religion.
People with ROCD experience repetitive, obsessive doubts and preoccupations focusing on their romantic relationships. ROCD symptoms involve two main manifestations which often co-exist.
Relationship-centered ROCD symptoms include doubts about the ‘rightness’ of one’s relationship (e.g., “I repeatedly check whether my relationship feels ‘right’”), one’s love for their partner (e.g., “I feel that I must constantly remind myself why I love my partner”), and the partner’s feelings towards oneself (e.g., “I constantly look for evidence that my partner really loves me”; Doron et al., 2012a). Partner-focused ROCD symptoms involve a preoccupation with perceived flaws of one’s partner in a variety of domains such as appearance, intelligence, morality, sociability, and trustworthiness (e.g., “I constantly question whether my partner is intelligent enough” or “I find it hard to ignore my partner’s physical flaws”; Doron et al., 2012b).
People with ROCD often react to these repetitive doubts with a variety of compulsive reactions aimed at mitigating the obsession-related distress, resolving their relationship-related doubts, and achieving a sense of certainty. Such compulsions may include overt, external behaviors (e.g., repeatedly consulting others regarding the rightness of one’s relationship, searching the web for ways to know if one is in the right relationship), or covert, internal behaviors (e.g., continuously monitoring one’s feelings toward their partner, comparing their partner’s characteristics to others). Unfortunately, the use of such compulsions typically results in prolonged distress, often leading individuals further away from the desired resolution, and deeper into their circulating thoughts (Doron et al., 2014).
Discerning ROCD From Natural Relationship-Related Doubts
Experiencing doubts, questions, and uncertainty in romantic relationships is only natural. Even when experiencing meaningful, beneficial relationships, people may find themselves contemplating questions similar to the ones mentioned above.
Such questions may become more prominent at the beginning of a relationship or in the context of significant transition phases such as marriage, moving in together, having children, or other transitions that signify relational commitment. Hence, as the content of relationship-related doubts is often similar across individuals with and without ROCD, diagnosis of ROCD may be challenging to clients and therapists alike.
The key element for discerning ROCD from natural relationship-related doubts is to assess how people relate to their relational doubts and questions, rather than focusing on what the content of their thoughts is. For the most part, ROCD is not characterized by distorted thought content, but by a malfunctioning, ineffective thinking process.
Several mental processes and thinking patterns, such as extreme beliefs about the way relationships should be, placing importance on having control over one’s thoughts, fear of anticipated relational regret, and intolerance of uncertainty, lead individuals coping with ROCD to constantly react to the intrusive thoughts popping in their minds.
Paradoxically, the more one reacts to intrusive thoughts, the more meaningful those thoughts become, thus calling for further engagement the next time they arise. In that way, compulsive reactions to intrusive relationship-related doubts and questions may leave people trapped in a vicious circle of struggling with their unwanted thoughts and feelings, fruitlessly attempting to push them away and regain a sense of certainty, just to have these thoughts and feelings return even stronger.
How ROCD is Treated
Cognitive-behavioral therapy (CBT) is the gold standard treatment for OCD and ROCD. CBT supports clients in breaking the obsessive-compulsive cycle by strengthening their ability to tolerate the uncomfortable emotions that accompany their intrusive thoughts.
CBT teaches clients that they are not compelled to respond to their intrusions and reinforces the capability to refrain from compulsively reacting to intrusive thoughts. By doing so, CBT aids clients in developing additional, alternative thinking processes to utilize when facing relational questions, doubts, and distress. Once the obsessive-compulsive cycle has weakened, clients can go back to contemplating relationship-related questions which are important to them, and consider them in a flexible, constructive manner.
Working with an OCD specialist can help clients discern ROCD from natural relationship-related doubts and provide them with effective tools for coping with relationship-related obsessions and compulsions. Although challenging at times, CBT interventions are aimed at supporting the ability to engage in full, meaningful relationships, despite dealing with ROCD.
To know more about Relationship OCD, click here.
References
Doron, G., Derby, D. S., Szepsenwol, O., & Talmor, D. (2012a). Tainted love: Exploring relationship-centered obsessive compulsive symptoms in two non-clinical cohorts. Journal of Obsessive-Compulsive and Related Disorders, 1(1), 16–24.
Doron, G., Derby, D. S., Szepsenwol, O., & Talmor, D. (2012b). Flaws and all: Exploring partner-focused obsessive-compulsive symptoms. Journal of Obsessive-Compulsive and Related Disorders, 1(4), 234–243.
Doron, G., Derby, D. S., & Szepsenwol, O. (2014). Relationship obsessive compulsive disorder (ROCD): A conceptual framework. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 169–180.
