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 work and ability to function in social situations.
Case Example #2: Jeffery, a 35-year-old man, has been married for 5 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 that 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 woman, 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 he does not enjoy his time with his wife and kids.
Overview of Relationship OCD (ROCD)
Evelyn and Jeffery present with what is commonly referred to as Relationship Obsessive Compulsive Disorder (ROCD) — obsessive compulsive symptoms that focus on intimate relationships. In the last several years, ROCD has been frequently mentioned and discussed in OCD forums/help groups, as well as 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 common for people to have some doubts about the suitability of their partner or the relationship at some point during their romantic connection. In fact, experiencing changeable or opposing feelings 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 (as in the case of Jeffery) become increasingly impairing, time-consuming, and distressing.
People presenting with ROCD often report 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 also occur outside of an ongoing romantic relationship (e.g., obsessing about the past) and may cause people to avoid entering relationships altogether. Interestingly, ROCD symptoms were not found to relate to relationship length or gender.
ROCD symptoms have been linked with significant personal difficulties (e.g., mood, anxiety, other OCD symptoms) and couple difficulties (e.g., relationship and sexual dissatisfaction). ROCD symptoms may occur independently of other forms of OCD, or along with them. Recent 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, distress, resistance attempts, and degree of perceived control due to symptoms in both the ROCD and OCD groups. These findings suggest ROCD symptoms may be as disabling as other forms of OCD.
Types of ROCD
ROCD includes two common presentations: relationship-centered and partner-focused obsessive compulsive symptoms. In the case examples above, Evelyn (Case Example #1) has relationship-centered obsessions, while Jeffrey (Case Example #2) has 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, or emotional stability (e.g., “She is not intelligent enough”, “He is not emotionally stable”).
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 only:
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 peoples’ 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.
Consulting friends, family, therapists, or even fortune-tellers and psychics about the relationship.
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 friends they consider to be very much in love or having a ‘perfect’ relationship. 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, therefore, cause them significant distress and make them doubt their own worth. 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, therefore, may cause intense distress and trigger preoccupation.
People with ROCD may have a variety of extreme beliefs about relationships that may make them more responsive and emotionally reactive to relationship concerns and doubts. These 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 relationships (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, s/he is 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, therefore, 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, and mapping of the client’s symptoms. The therapist and client must also reach an understanding of what beliefs and views of self and others may be affected by the individual’s ROCD symptoms. A variety of CBT [e.g., 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.
Individuals suffering with OCD typically find great relief in reading or hearing about someone going through what they are experiencing. And 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 and presentation of ROCD, and investigate ways of improving treatments aimed at helping these individuals live better and more productive lives.
Doron, G., Derby, D., & Szepsenwol. O. (2014). Relationship obsessive-compulsive disorder (ROCD): A conceptual framework. Journal of Obsessive-Compulsive and Related Disorders, 3, 169-180.
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, Interdisciplinary Center (IDC) Herzliya, Israel (http://rocd.net). They have recently published a summary of findings from their lab’s research on Relationship OCD in the Journal of Obsessive Compulsive and Related Disorders. The following article presents some of those findings.