Relationship OCD (ROCD) Is a Real Diagnosis—Here's What to Do If You Have It

Have you ever gazed at your significant other and thought, "What if you're not the one?" You probably have because fleeting moments of doubt about your relationship or wavering levels of attraction to your partner are ordinary experiences. But, if you feel consumed by relationship-focused uncertainty and anxiety—and these feelings are frequent and pervasive—you may have relationship obsessive-compulsive disorder (ROCD).

Yes, that's a real diagnosis.

"Most people experience occasional doubt about relationships, but for people experiencing relationship OCD, anxiety, and doubt hijack their relationships," said Misti Nicholson, PsyD, director and clinical psychologist at Austin Anxiety and OCD Specialists.

What Is Relationship OCD?

Relationship OCD is a common type of OCD, said Kristin Bianchi, PhD, a licensed clinical psychologist who specializes in treating anxiety disorders and OCD. People with this disorder, said Dr. Bianchi, have unwanted, intrusive, and upsetting doubts about their romantic partners.

Just as the causes of general OCD are not completely certain—though it's thought that genetics, brain abnormalities, and a person's environment might be partly responsible, per Johns Hopkins Medicine—so is the case for the causes of ROCD.

There are two common types of ROCD. "Some people experience relationship-centered symptoms, others experience partner-focused symptoms, and many will experience both types," said Dr. Nicholson.

Doubts focused around the relationship—worrying if you're truly in love, if your partner is in love, and if this is the "right" relationship—point to relationship-centered symptoms, she said. Partner-focused ROCD manifests in doubts about your partner's characteristics. Despite feelings of love, said Nicholson, people with ROCD may question a partner's attractiveness, intelligence, and other qualities.

If you've dated or been in a serious relationship, these symptoms likely have a familiar ring. "Doubts and fluctuations in phenomena like attraction and loving feelings are inevitable in all relationships," said Dr. Bianchi, who added that for people with ROCD, these doubts go far beyond typical uncertainty.

Here's the difference: People who have ROCD interpret those ordinary doubts to mean that something's seriously wrong with the relationship, she said.

Signs of Relationship OCD

Another difference: People with ROCD respond to doubts with compulsive behavior. "In an attempt to feel relief from the anxiety associated with these intrusive thoughts, people with ROCD often engage in rituals or repetitive behaviors known as compulsions," explained Dr. Nicholson.

Here are some common compulsions in relationship OCD:

• Seeking reassurance: Compulsively consulting with others about your relationship is a common indicator of ROCD, said Dr. Nicholson. Sometimes this takes the form of seeking reassurance from a partner, added Dr. Bianchi.
• Scanning for evidence: Like emotional detectives, people with ROCD seek evidence—for a partner's being a good match, for attraction levels, to quantify a partner's love—to affirm the relationship, said Dr. Bianchi.
• Making comparisons: Another indicator of ROCD is compulsively comparing your relationship with other people's relationships—from friends and families to fictional characters on TV, said Nicholson. The comparisons can also be between your current and previous relationships, added Dr. Bianchi.
• Mental rituals: People with ROCD can spend hours monitoring their thoughts and feelings around the relationship, said Dr. Nicholson.

These behaviors aren't productive, and they won't ease relationship doubts over the long term. "The problem with compulsions is that they provide only temporary relief and ultimately reinforce the anxiety, making it worse over time," said Dr. Nicholson.

Additionally, the symptoms of ROCD have been associated with different types of distress, according to an April 2016 Frontiers in Psychiatry article. The personal and relationship distresses have included:

• General OCD symptoms
• Negative affect
• Low self-esteem or relationship satisfaction
• A lack of security regarding attachment
• Sexual functioning issues

Treatments for Relationship OCD

As you may imagine, the symptoms and compulsions that accompany ROCD do not lead to healthy relationships, said Dr. Bianchi. And often, people fail to realize there's a disorder involved. "People will dismiss their symptoms and label themselves as 'too picky' or a 'worrywart,' or 'bad at relationships.'"

So how can you tell if you're "bad at relationships"—or if you may have ROCD?

Time is one factor, said Dr. Nicholson—track if obsessive thoughts or compulsions eat up more than an hour a day. To be diagnosed with relationship OCD, the thoughts and compulsions also have to cause you significant distress or impair your relationships, your work, or other areas of your life, she added.

But the good news, Dr. Nicholson said, is "OCD is very treatable." Johns Hopkins Medicine says that treatment will vary based on the following factors for an individual:

• Their age
• Their health and medical history
• How sick they are
• How well specific medicines, procedures, or therapies are tolerated
• How prolonged the condition might be
• The individual's opinion or preference

Therapists typically turn to two tactics: cognitive behavioral therapy (CBT) and exposure and ritual prevention (Ex/RP). With these treatments, therapists have patients forgo engaging in compulsive behaviors. Dr. Bianchi added, "Simultaneously, we have them engage in gradual exposure to their feared intrusive thoughts."

Doing this, she explained, reduces the compulsive response to thoughts and helps people see that having doubts in a relationship or seesawing levels of attraction is common—and not a signal the relationship is failing.

One small randomized controlled trial with college students showed that an app may be helpful in ROCD treatment. In a 2020 study published in the Journal of Affective Disorders, researchers had students with subclinical ROCD (they had the obsessions and/or compulsions of ROCD without functional impairment) use an app that featured "short, game-like, daily cognitive interventions."

The results showed improvement in ROCD symptoms and even an increase in self-esteem after 15 days of using the app (due to the small sample size of just 50, researchers said more research needs to be done with larger clinical populations).

With severe symptoms, said Dr. Nicholson, the most helpful treatment is typically a combination of medication and therapy. According to the National Institute of Mental Health (NIMH), serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are commonly used medications to treat OCD.

The NIMH states that another possible adjunct treatment, approved by the Food and Drug Administration (FDA) in 2018 as a treatment for OCD, is transcranial magnetic stimulation (TMS). Originally approved for the treatment of major depression and later for certain types of migraine pain, TMS uses magnetic fields to stimulate nerve cells in the brain.

If you feel like you have any of the symptoms of ROCD, talk with a healthcare provider, who can refer you to the appropriate specialists.

A Quick Review

Relationship OCD, or ROCD, is the experience of having relationship-related uncertainty and anxiety. Signs that someone has ROCD can include seeking reassurance that the relationship or partner is right for them or making comparisons between their relationship and that of others. The symptoms also may be partner-focused, relationship-focused, or both.

However, treatments for OCD (e.g., cognitive-behavioral therapy or medications) can be used for those with ROCD. Engaging in treatment may be helpful for improving how individuals with ROCD feel about their relationships.