By Guy Doron, PhD, and Danny Derby, PhD
This article was initially published in the Fall 2014 edition of the OCD Newsletter.
Case Example #1: At the age of 30, after many dating experiences, Evelyn found someone that she thought was great. He was smart, good-looking, had a good job, and they felt great together. After a year of dating, he started pressing her to commit. Since then, she can’t stop thinking, “Is he the Right One? Do I love him enough? Is he the love of my life or am I making the biggest mistake of my life?” She checks whether she thinks about him enough at work, whether she feels relaxed when she is with him, and whether she has critical thoughts about him. When she is unhappy or tense, she always thinks, “Maybe it is because I am not happy with him? Maybe he is not the ONE.” Evelyn is highly distressed and her obsessions impair her ability to work and function in social situations.
Case Example #2: Jeffery, a 35-year-old man, has been married for five years. He loves his wife dearly and he believes she is great for him and an excellent mother. He also thinks his wife, an IT consultant, is very intelligent. Every day, however, he feels distressed and angry. He can’t stop thinking that he could have found a better partner. Although he claims that he is sure his wife is intelligent and interesting, the thought that she is actually neither of those things pops up again and again. Every time he reads what other women write on Facebook or Twitter, the thought “My wife could not have written so interestingly” keeps coming up. Jeffery looks at other women, listens to them, and compares them to his wife. He realizes the problem is his, but still does not manage to get rid of these thoughts. These thoughts, he claims, consume most of his day. They make him irritated, and he finds that he does not enjoy spending time with his wife and kids.
Case Example #3: Norman is a 35-year-old educator; he is married to Linda, a 30-year-old social worker. Norman loves Linda; however, he is continuously preoccupied with her past relationships, particularly her past sexual experiences. Norman can’t stop thinking thoughts such as “Maybe they were better than me,” “Did she enjoy sex better with them?” and “Maybe she still loves him.” Norman spends hours thinking about Linda’s past. He repeatedly initiates conversation about her previous partners, interrogating her about feelings and sexual interactions. Norman is jealous of these men, although he knows it is senseless. He wants to stop his interrogations, but feels that he can’t. Norman and Linda suffer severe relationship distress.
Overview of Relationship OCD (ROCD)
Evelyn, Jeffery, and Norman present with what is commonly referred to as relationship obsessive-compulsive disorder (ROCD) — obsessive-compulsive symptoms that focus on intimate relationships. In the last decade, ROCD has been frequently mentioned and discussed in OCD forums and self-help discussion groups, as well as in the media. It is only recently, however, that ROCD has begun to draw more research attention. As can be seen in the above examples, this form of OCD often leads to severe personal and relationship distress, and often impairs functioning in other areas of life, such as work, study, or family functioning.
It is very common for people to have some doubts about the suitability of their partner (their qualities or attributes) or the relationship itself at some point during the course of a romantic relationship. In fact, experiencing opposing feelings and changes in emotions (strength or consistency) towards a romantic partner is considered a natural part of a developing intimate relationship. Similarly, we all pay more attention to our partner’s real or imagined flaws as intimate relationships progress. However, for some, these common relationship doubts and concerns (as in the case of Evelyn) or worries about the partner’s perceived flaws or flawed qualities (as in the case of Jeffery and Norman) become increasingly impairing, time-consuming, and distressing.
People presenting with ROCD often describe noticing their symptoms in early adulthood. In such cases, ROCD symptoms seem to have an effect on most of their later romantic relationships. Other people may trace their ROCD symptoms back to the first time they faced important romantic decisions (e.g., getting married, having children).
ROCD symptoms can occur outside of an ongoing romantic relationship. In such cases, they may obsess about one or more of their ex-partners. ROCD symptoms may also focus on the partners’ previous relationships (e.g., Norman’s case example). For some, the distress caused by ROCD is so severe that they avoid relationships altogether, while others may try numerous relationships but fail to maintain one past the few dates “barrier.” Interestingly, research has found that ROCD symptoms aren’t related to relationship length or sex. Both men and women suffer from ROCD.
ROCD symptoms are also not limited to romantic relationships. They can be present in various other types, including parent-child relationships (e.g., preoccupations with the perceived flaws of one's child) or an individual’s relationship with God (e.g., preoccupation with one’s love for God). ROCD symptoms have been linked with significant personal difficulties (e.g., mood, anxiety, other OCD symptoms) in all these relationship contexts.
ROCD symptoms may occur independently of other forms of OCD or alongside them. Findings from our lab comparing people with ROCD, people with other forms of OCD, and people with no known OCD diagnosis showed similar levels of interference in functioning and distress, similar levels of resistance to compulsions, and similar degrees of perceived control over symptoms in both the ROCD and OCD groups. These findings suggest ROCD symptoms may be as disabling as other forms of OCD (Doron et al., 2016).
ROCD Symptom Presentations
ROCD includes two main presentations: relationship-centered and partner-focused obsessive-compulsive symptoms. In the case examples above of ROCD within the romantic context, Evelyn (Case Example #1) has relationship-centered obsessions, while Jeffery and Norman (Case Examples #2-3) have partner-focused obsessions. People like Evelyn with relationship-centered obsessions often feel overwhelmed by doubts and worries focused on their feelings towards their partner, their partner’s feelings towards them, and the “rightness” of the relationship experience. They may repeatedly find themselves thinking, “Is this the right relationship for me?”, “This is not real love!”, “Do I feel ‘right’?”, and “Does my partner really love me?”
People like Jeffery who present with partner-focused obsessions may focus on their partner’s physical features (e.g., “Her nose is too big”), social qualities (e.g., “He is not social enough,” “She does not have what it takes to succeed in life”), or personality attributes, such as morality, intelligence, emotional stability, or trustworthiness (e.g., “She is not intelligent enough,” “He is not emotionally stable”, “They are not reliable/competent enough”).
People like Norman obsess about their partner’s past relationships. They are preoccupied with the quality of their partner’s previous relationships (e.g., “Was sex better in my partner’s previous relationship?”, “Was their previous partner more successful/smart/funny/good looking than me?”). They fear their partner’s previous relationships may indicate some flaw of their partner’s personality/character (e.g., ”My partner may not know how to love, may be frivolous, may tend to compare, may have standards that are too high or low.”). In order to reduce their distress, individuals with such retroactive jealousy may interrogate their partner regarding their previous emotional and physical relationships, search their social media accounts for prior or ongoing correspondence with previous partners, and confront their partner regarding their previous emotions or behaviors. Such fears often co-occur with obsessive distrust (i.e., perceiving the partner as untrustworthy), increasing fears of infidelity. In our example, Norman perceived his obsessions as senseless, but continued to struggle with them, and began to fear that his obsessions might be due to some flaw in Linda’s personality. He feared that she might be too “weak,” “unreliable,” or “easy-going” — and therefore, that she might be unfaithful to him in the future.
Relationship-centered and partner-focused symptoms can often happen at the same time, and sometimes can even reinforce one another. Many people describe being preoccupied with a perceived flaw of their partner (e.g., body proportion) at first, and then being plagued by thoughts about the rightness of the relationship. Although less common, some people start with doubts regarding the relationship and only later become preoccupied with a flaw of the partner.
What Does ROCD Look Like?
In addition to obsessive preoccupation and doubts, both presentations of ROCD are associated with a variety of compulsive behaviors aimed to reduce their feelings of uncertainty, anxiety, and distress, or to reduce the frequency of such thoughts. Common compulsions include, but are not limited to:
- Monitoring and checking their own feelings (“Do I feel love?”), behaviors (“Am I looking at others?”), and thoughts (“Do I have critical thoughts about her?”, “Do I have doubts?”).
- Comparing their relationships with other people’s relationships, such as friends, colleagues, or even characters in romantic films or TV sitcoms.
- Trying to recall “good” experiences with their partner of times when they felt sure about them.
- Seeking reassurance and consulting friends, family, therapists, or even fortune-tellers and psychics about the relationship.
- Testing their partners to see whether they are “intelligent enough.”
- Attempting to correct the partner to fit the obsessional need (“Just righting”).
People with ROCD often try to avoid situations that trigger their unwanted thoughts and doubts. For instance, they may avoid specific social situations, such as time with friends who they consider to have a “perfect” relationship or to be very much in love with their partners. Similarly, they may also avoid particular leisure activities, such as seeing romantic movies for fear of not feeling as “strong” or “passionate” love as the characters in the movies.
People with ROCD may give great importance to romantic relationships. Negative events relating to their relationships may cause them significant distress and make them doubt their own worth as a result. People with partner-focused obsessions may be particularly sensitive to the way their partner compares with others and the way their partner is looked upon by the rest of the world. Situations where their partner is viewed unfavorably or when encountering potential alternative partners may lead to intense distress and trigger preoccupation.
People with ROCD may have a variety of extreme beliefs about relationships that may make them more sensitive to relationship concerns and doubts, and these doubts and concerns may have a greater emotional effect on them than they would for the average person. Extreme beliefs can include beliefs about the terrible consequences of being in the “wrong” relationships (e.g., “A romantic relationship that doesn’t always feel right is probably a destructive relationship”), about leaving an existing relationship (e.g., “I think breaking up with a partner is one of the worst things that can happen to anyone”), or about being without a partner (e.g., “The thought of going through life without a partner scares me to death”).
Extreme beliefs about love may also make people with ROCD more vulnerable to negative relationship thoughts or emotions. Examples of such beliefs about love may include: “If the relationship is not completely perfect, it is unlikely to be ‘true love,’” “If you doubt your love for your partner, it is likely it is not the ‘right’ relationship,” and “If you don’t think about your partner all the time, they are probably not THE ONE.” Similar to other forms of OCD, beliefs about the importance of thoughts (e.g., “If I think about it, it must mean something”), difficulty with uncertainty, and an inflated sense of responsibility (e.g., failing to prevent disaster is as bad as causing it) may also increase sensitivity to ROCD.
Treatment Options for ROCD
Treatment of ROCD is similar to other cognitive-behavioral treatments of OCD. Before treatment can begin, however, it is important for those with ROCD to recognize that the ROCD symptoms are getting in the way of their ability to fully experience their relationships. Significant symptom reduction through treatment would then allow them to reach a decision about their relationship based on their experience of it, rather than based on ROCD-related fears.
Therapy includes assessment and information gathering, as well as mapping of the client’s symptoms. The therapist and client must also reach an understanding of what beliefs and views of the self and others may be affected by the individual’s ROCD symptoms. A variety of cognitive-behavioral therapy approaches such as cognitive restructuring, exposure and response prevention (ERP) and experiential techniques (e.g., imagination-based exposures) are then used to explore and challenge these beliefs and views and reduce compulsive behaviors. Finally, treatment gains are reviewed, effective strategies are summarized, and relapse prevention plans are made for possible setbacks down the road.
Recently, we’ve developed a mobile health platform (GGtude.com) targeting unhealthy beliefs associated with symptoms of ROCD and related disorders. Several randomized controlled trials have shown that using the Relationship OCD module of ‘GG OCD Anxiety and Depression’ is associated with reduction in ROCD symptoms and cognition (Editor’s note: IOCDF partner One Mind PsyberGuide offers a review of GG OCD — click here to read it).
Individuals suffering with OCD typically find great relief in reading or hearing about someone going through what they are experiencing. It is our hope that this research will help raise awareness and understanding about this type of OCD. As with other forms of OCD, ROCD is treatable with the right approach. The goal of our research is to continue to clarify the nature of ROCD and the unique symptoms that people with ROCD experience, and to investigate ways of improving treatments aimed at helping these individuals live better lives and maintain strong and secure relationships.
Doron, G., Derby, D., Szepsenwol, O., Nahaloni, E., & Moulding, R. (2016). Relationship obsessive-compulsive disorder: Interference, symptoms, and maladaptive beliefs. Frontiers in Psychiatry, 7(58). doi:10.3389/fpsyt.2016.00058
Doron, G., & Derby, D. (2017). Assessment and treatment of relationship-related OCD symptoms (ROCD): A modular approach. In J. S. Abramowitz, D. McKay, & E. A. Storch (Eds.), The Wiley handbook of obsessive-compulsive disorder across the lifespan. Hoboken, NJ: Wiley.
Guy Doron, PhD, and Danny Derby, PhD, are Clinical Psychologists and Co-Directors of the Relationship Obsessive Compulsive Research Unit at the School of Psychology, Reichman University (IDC) Herzliya, Israel (http://rocd.net). Recently published findings from their lab’s research on Relationship OCD can be found on https://rocd.net/papers/. Finding regarding their GGtude mobile platform can be found on https://ggtude.com/the-science-behind-ggtude/.