Relationship OCD Is a Real Diagnosis. Here's What to Do If You Have It

Doubt and anxiety can become intrusive—and eat away at your relationship. But there is help for it.

Ever gazed over at your significant other and thought, "What if you're not the one?"

You probably have. Fleeting moments of doubt about your relationship or wavering levels of attraction to your partner are very ordinary experiences.

But if you feel subsumed by relationship-focused uncertainty and anxiety—and these feelings are frequent and pervasive—you may have relationship obsessive-compulsive disorder or ROCD.

And 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," Misti Nicholson, PsyD, director and clinical psychologist at Austin Anxiety & OCD Specialists, told Health.

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 Bianchi, have unwanted, intrusive, and upsetting doubts about their romantic partners.

There are two common types of ROCD. "Some people experience relationship-centered symptoms, others experience partner-focused symptoms, and many experience both types," said 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, said Nicholson. And 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 Bianchi. But for people with ROCD, these doubts go far beyond a typical uncertainty, Bianchi added.

According to Bianchi, here's the difference: People who have ROCD interpret those ordinary doubts to mean that something's seriously wrong with the relationship.

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 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 Nicholson. Sometimes this takes the form of seeking reassurance from a partner about their love, added Bianchi.
  • Scanning for evidence: Like emotional detectives, people with ROCD seek evidence—for a partner being a good match, for attraction levels, to quantify a partner's love—to affirm the relationship, said 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 Bianchi.
  • Mental rituals: People with ROCD can spend hours monitoring their thoughts and feelings around the relationship, said Nicholson.

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

Treatments for Relationship OCD

As you may imagine, the symptoms and compulsions that accompany ROCD do not lead to healthy relationships, said Bianchi. But 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,'" said Bianchi.

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

Time is one factor, said 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, added Nicholson.

But the good news, said Nicholson, is "OCD is very treatable." 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. "Simultaneously, we have them engage in gradual exposure to their feared intrusive thoughts," said Bianchi.

Doing this, explained Bianchi, 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 control trial with college students showed that an app may be helpful in ROCD treatment. Published in 2020 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 used "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 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 treatment for major depression, then 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 to your healthcare provider about it. They can refer you to the appropriate specialists. With treatment, you'll not only be helping yourself but your relationships too.

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