Romantic relationships are an important part of life for most of us. But due to their significance and the amount of effort we put into looking for and maintaining healthy relationships, they can also be a source of worry and anxiety. A certain amount of distress can be perfectly normal, but when anxiety about a romantic relationship takes over, a person may develop a mental health condition known as relationship obsessive-compulsive disorder (ROCD). Understanding the causes and symptoms of ROCD can be a helpful first step toward seeking treatment options.

‍Relationship OCD: At a glance ‍

‍ROCD is a type of obsessive compulsive disorder that centers on obsessive thoughts about a romantic partner, and compulsions that are used to cope with these disturbing thoughts. Here are some common causes, symptoms, and treatments of relationship OCD.

‍Causes 

• Biological factors
• Catastrophic beliefs
• Environment

Symptoms

• Intrusive thoughts 
• Neutralizing behaviors, like seeking reassurance
• Anxiety
• Sexual problems

Treatments 

• Individual therapy
• Couples therapy
• Medication

‍Types of relationship OCD ‍

There are typically two types of ROCD: relationship-focused ROCD and partner-focused ROCD. A person usually experiences one of these two types of ROCD. 

‍Relationship-focused: People with this kind of ROCD obsess over whether they are in the right relationship with the right person. They may be plagued by doubts and worries that their partner doesn't love them enough, or that they don’t love their partner enough. They may constantly question whether the relationship is a good fit or whether it will last. There is a tendency to blow little differences out of proportion. For instance, if you have ROCD, you might think to yourself, “We don’t like the same movies, so we can’t be right for each other.” Such thoughts may become so overpowering, you cannot move on from them. 

‍Partner-focused: In this variation, the person with ROCD may become obsessed with the idea that their partner doesn’t measure up in some way (e.g., isn’t smart enough, pretty enough, doesn’t have the right level of education, etc). They obsessively pick their partner apart and dwell on insignificant flaws such as a facial line, the way they laugh, or an overbite, even if they don’t dislike these features. It doesn’t matter how much they love their partner, they can’t stop thinking about what’s “wrong” with them or comparing them to others. 

‍3 relationship OCD causes‍

The causes of ROCD are oftentimes the same as the causes of OCD, as ROCD is a type of obsessive compulsive disorder. Here are three common factors that may cause some people to experience OCD, which may also manifest as relationship OCD.

1. Biological factors. ‍

ROCD is a subtype of OCD, and there are well-known biological factors behind the development of OCD. For instance, it is more common among those who are closely related genetically (e.g., first-degree relatives). Brain abnormalities have also been implicated in the development of OCD, though the research there is still underway.

2. Catastrophic beliefs.

‍People with ROCD are often perfectionists who blow relationship threats out of proportion. They can have little tolerance for anything about their relationship that doesn’t meet their expectations. Due to their anxiety and their maladaptive belief systems, they may catastrophize the significance of their anxious thoughts and the consequences of their relationship choices. This can turn trivial partner differences and flaws into monumental problems. 

3. Environment.

‍OCD can be associated with a history of trauma, abuse, and an anxious attachment style. According to researchers Doron, Derby, and Szepsenwol the latter is especially important for ROCD. How secure we feel in our relationships may be based on how attached we were to our caregivers as a child. When people don’t feel safe (a common occurrence in the anxiously attached), they engage in “energetic, insistent attempts to obtain care, support, and love from attachment figures) as a means of regulating distress.” Doron, Derby and Szepsenwol believe that this exacerbates ROCD symptoms, especially if a person bases their self-worth on their partnerships. 

Growing up with intense parental discord can also be a vulnerability factor in ROCD. Individuals who grew up in homes where their parents were always fighting might be more likely to fear the consequences of making a poor choice regarding a life partner. 

‍4 ROCD symptoms‍

Here are four common symptoms of relationship OCD to look out for, though there are more not listed here. Understanding how your symptoms manifest can help you better seek treatments that work best for you. 

1. Intrusive Thoughts.

Sometimes the unwanted thoughts in R-OCD go in an illogical direction that the person intellectually knows isn’t grounded in reality. Romantic relationships are often not easy and it’s normal to have questions about whether a partner is right for you or whether they love you. The difference between these common worries and ROCD is that the intrusive thoughts of the clinical condition may feel uncontrollable, are associated with extreme fear about making a bad relationship choice, and cause great deal of anguish for the sufferer. Moreover, a person may know their thoughts aren’t true but can’t stop obsessing about them nonetheless. 

According to ROCD researchers, Guy Doron PhD and Danny Derby PhD, “Such intrusions are perceived as unacceptable and unwanted, and often bring about feelings of guilt and shame regarding their occurrence and/or content.” Common intrusive thoughts in ROCD may include: I’m not sure I really love my partner, what if I’m marrying the wrong person?, I don’t know if I’m attracted to my partner enough, I worry my partner’s not socially skilled enough and will embarrass me. ‍

2. Checking and seeking reassurance.

People who have ROCD try to neutralize the anxiety created by their intrusive thoughts by engaging in compulsive behaviors like obsessively checking on their feelings about their partner, trying to recall positive encounters they have had with them, and constantly seeking reassurance that they are loved or that all is well in the relationship. 

3. Anxiety.

A person with ROCD may experience anxiety and confusion that can take a major toll on their well-being and on their relationship. They may feel a great deal of distress, guilt, and shame over their uncontrollable obsessions and compulsions. This behavior can also irritate and alienate a partner who may mistake the constant questioning and need for reassurance as immature, intrusive, or needy. 

4. Sexual Problems.

‍Obsessive compulsive disorders (of any kind) are highly associated with anxiety, which can distract a person from being in the moment and in their body. People with OCD and anxiety may have issues with sexual desire, arousal, and their ability to perform. Individuals with ROCD may also have intrusive or obsessive thoughts making it difficult to be in the moment with their partner. For example, a person with ROCD may have obsessive thoughts that their partner’s bodily fluids are unhygienic. 

‍Relationship OCD Test‍

If you are wondering how to know if you have ROCD, it’s important to talk to a mental healthcare professional. They can help you determine if ROCD is a fitting diagnosis for you, and how to seek treatment. There are also some relationship OCD tests out there which may help you determine if the common symptoms of ROCD resonate with you. Some common questions in a relationship OCD test might include: I check and recheck whether my relationship feels right, and I often seek reassurance (from friends, family, etc.) about whether my partner is smart enough. ‍

Don’t rely on results from a relationship OCD test for a diagnosis, however. It’s always best to check in with a mental healthcare professional to determine if you’re experiencing ROCD, the severity of it, and treatment options. 

‍3 Relationship OCD treatments ‍

Finding the right treatment, or combination of treatments, for relationship OCD might require time, experimentation, and working with a mental health professional, or a couple’s counselor. Some effective approaches include: 

1. Individual therapy.

Cognitive behavioral therapy focuses on changing dysfunctional thought patterns and can be an effective treatment for ROCD, especially an approach called Exposure and Response Prevention (EX/RP). This treatment involved gradually exposing a person with ROCD to situations that trigger their OCD without allowing them to engage in their compulsions. Seeking a therapist who specializes in OCD and/or relationship OCD can help you work through the root of the issue, work on coping skills, and help you learn how to communicate needs, blockers, and limitations with a partner. 

2. Couples therapy.

‍While it’s important for a person with ROCD to seek individual therapy, seeing a couples therapy can also be beneficial. A couple’s therapist can help partners better communicate wants, needs, desires, and limitations, and can help a person with ROCD communicate about how their ROCD impacts them. A therapist may also help the partner of a person with ROCD better understand why and how ROCD is impacting the relationship, how they can be more supportive, how they can watch out for their own well-being, and set their own boundaries. The therapist can mediate and support communication and help partners work through ROCD, together. 

3. Medication.

‍SSRIs (selective reuptake inhibitors) like Prozac, Paxil, or Zoloft have been successful in the treatment of OCD. It’s important to check in with your healthcare professional to find a medication that's right for you. It should be pointed out that SSRIs often have sexual side effects. They can reduce desire and make arousal and orgasm difficult. 

How to talk to your partner about ROCD

It’s important to communicate with a partner about your ROCD because, chances are, it’s impacting them too. A good way to start may be to introduce them to some helpful resources explaining OCD and ROCD. If you feel comfortable, you might discuss how ROCD affects you personally and answer any questions they might have. You don’t have to go into detail about your intrusive thoughts, but if you do, emphasize the fact that you know they are frequently illogical, and you don’t really believe them. You can explain that there are things they can do to support a partner with OCD, but that it is not their job to cure you or be your therapist. As much as your partner may show up for you, it’s important to make sure they are showing up for themselves and that they are prioritizing their own well-being. 

‍The bottom line ‍

Understanding the causes, symptoms, and treatments of ROCD is a great first step toward healing. If you feel you have ROCD, consider seeking help from a mental healthcare professional, and working with your partner on how you can best support each other.