What Is Relationship OCD?

Obsessive-compulsive disorder (OCD) is a mental health disorder characterized by intrusive and distressing thoughts, impulses (obsessions), and repetitive behaviors (compulsions).

Although not currently an official diagnosis in the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), relationship OCD (ROCD) is a form of OCD that involves obsessions, preoccupations, doubts, and compulsive behaviors related to a relationship with another person.

These types of relationship symptoms have been frequently discussed in OCD forums for several years. However, only recently have these symptoms begun to receive more formal research attention.

Though ROCD can occur in different types of relationships, this article focuses on ROCD in romantic relationships.

What Is Relationship OCD?

Having some degree of worry or doubt in a relationship is typical, but for people with relationship OCD, these preoccupations significantly disrupt the relationship and the person's ability to function as an individual. They are constantly analyzing themselves, their partner, or their relationship, obsessing over even minor perceived flaws.

ROCD can manifest in two ways: as relationship-centered or partner-focused ROCD.

Relationship-Centered ROCD

• Symptoms focus on doubts and preoccupations about how the person feels toward their partner, how they think their partner feels toward them, and the "rightness" of their relationship.
• Obsessions can manifest in ways such as images, thoughts, and urges.
• Symptom triggers might include experiencing negative feelings (including boredom or distress) in the presence of their partner or seeing "happy couples."
• It involves repeatedly questioning the quality, suitability, and validity of their relationship.

Partner-Focused ROCD

• It involves an intense preoccupation with flaws they perceive in their partner across a variety of areas, such as intelligence, sociability, morality, and appearance.
• Symptoms can be triggered by noticing the perceived flaw or encounters with other potential partners.
• The person frequently analyzes their partner's strengths and weaknesses, often comparing their partner's attributes and characteristics against those of other potential partners.

Both presentations of ROCD often cause extreme and debilitating distress for the individual and their relationship. It can also affect psychological well-being.

Their obsessions may conflict with their personal values. For example, morally and objectively, they may believe that people should not be judged by their looks, but their OCD obsessions compel them to scrutinize and find fault with their partner's appearance. This disconnect can cause feelings of shame or guilt.

ROCD obsessions and compulsions can take up a lot of time and energy, interfering with functioning in other areas of life.

Signs and Symptoms of ROCD

As with other forms of OCD, ROCD involves obsessive thoughts and compulsive behaviors.

Obsessive Thoughts

Obsessive symptoms in ROCD can include:

• Extreme fear of making the wrong relationship-related decision (alternating between anxiety over the thought of leaving the relationship, and anxiety over being "trapped" in the wrong relationship)
• Overwhelming doubts and fears relating to how they feel toward their partner, how they believe their partner feels about them, and whether or not the relationship is "right"
• Hyper-focusing on perceived flaws they see in their partner
• Fear that they aren't "good enough" for their partner
• Constantly questioning whether they really love/are attracted to their partner
• Constantly questioning if their partner is right for them or really "the one"
• Worrying about the potential to hurt their partner by staying in the relationship even if they don't really love their partner

People with ROCD may perceive innocuous thoughts and behaviors as "signs" that they don't really love their partner or that their relationship isn't viable. These can include:

• Not thinking about their partner all day long
• Not completely enjoying a kiss or act of intimacy
• Noticing that another person is attractive
• Enjoying having time to themselves on occasion
• Not always being in the mood for sexual intimacy
• Having the ability to imagine cheating on their partner (interpreted as secretly wanting to do so for real)

Compulsive Behaviors

People with ROCD engage in compulsive behaviors in an attempt to relieve the anxiety caused by their obsessions.

Compulsive behaviors common in ROCD include:

• Monitoring/checking their own feelings
• Comparing, such as comparing their partner's attributes to other potential partners, or comparing their relationship to the relationships of those around them, past relationships, relationships on TV, etc.
• Neutralizing, such as picturing themselves and their partner happy together or trying to recall good experiences with their partner
• Reassurance-seeking about their partner or relationship by consulting with friends, family, therapists, or even psychics
• Avoiding potential triggers, such as friends they consider to have a perfect relationship or romantic movies
• Obsessive questioning and preoccupation with small details
• Researching, such as constantly reading articles that outline what a successful relationship should be like
• Passion-seeking, such as becoming upset if sexual intimacy with their partner is not satisfying
• Testing, such as initiating sex with their partner to confirm arousal/feelings of connection, or spending time/flirting with other people to test if they are attracted to others
• Being constantly on a quest for "perfect" love
• Creating rules for their partner and questioning the relationship if their partner does not uphold them
• Repeated confessions, such as frequently telling their partner they are having doubts or that they find other people attractive

Compulsive behaviors may provide temporary relief from obsessive thoughts, but the obsessions always return.

Causes or Triggers of ROCD

The age of onset of ROCD is not known, but clinical evidence has shown symptoms often begin to present in early adulthood or when a person is first faced with commitment-related romantic decisions.

ROCD symptoms often persist from one relationship to another and can occur when a person is not actively in a relationship (such as having obsessions about past or future relationships).

Certain beliefs and thought processes common to other forms of OCD may be linked to ROCD as well, such as:

• Tendency to overestimate threats
• Perfectionist tendencies
• Intolerance for uncertainty
• Cultural or religious beliefs
• Attachment anxiety
• Relationship-dependent self-worth
• Extreme beliefs about love and relationships
• Inflated sense of responsibility

ROCD symptoms do not seem to be significantly related to relationship length or gender.

Treatment for ROCD

ROCD is typically treated with therapy, but medication may be used in some cases.

Therapy

While involving a person's partner in the therapeutic process can be beneficial, the goal of therapy for ROCD is not to "save" the relationship, but rather to address the ROCD symptoms.

Treatment for ROCD can still benefit the relationship (even if the relationship ends), because the person can make decisions based on their real experiences instead of those distorted by ROCD-influenced thinking.

Relationship OCD is typically treated with cognitive behavioral therapy (CBT). CBT involves learning to recognize problematic thinking and behaviors, then, over time, replacing them with healthier, more productive ones.

Exposure response prevention therapy (ERP) is a type of CBT commonly used to treat OCD, including ROCD. ERP involves repeated, gradually intense exposure to the source of fear (such as obsessive thoughts), while resisting the urge to perform compensatory or neutralizing behaviors (compulsions). With repeated exposure to the trigger, the brain learns to recognize it as irrational, often reducing the obsessions and, in turn, lessening the urge to engage in compulsions.

Medication

Medication is not a first-line treatment for OCD, but selective serotonin reuptake inhibitors (SSRIs) may be used alongside therapy to help manage symptoms. Dosages of SSRIs tend to be higher when used to treat OCD than in other conditions, such as depression.

SSRIs that may be used to treat OCD include:

• Prozac (fluoxetine)
• Paxil (paroxetine)
• Zoloft (sertraline)
• Lexapro (escitalopram)
  

Summary

ROCD is a form of obsessive-compulsive disorder in which a person experiences obsessions and compulsions related to their relationships. It can involve symptoms such as constantly questioning if they really want to be with their partner, being hyper-focused on perceived flaws they see in their partner, and seeking reassurance or proof that their relationship is "right." ROCD can cause distress to the individual experiencing it and strain their relationship.

ROCD is typically treated with therapy, particularly CBT or ERP, but medication may be prescribed if necessary to help with symptom relief.

A Word From Verywell 

It's normal to have some doubts in a relationship, even ones that are healthy. But if those doubts are extreme, obsessive, and disruptive to your functioning, there may be more to them than relationship dissatisfaction. If you find yourself engaging in obsessive and compulsive behavior related to your relationship that is causing you distress, speak to a healthcare provider or mental health professional about exploring the possibility of an ROCD diagnosis and treatment plan.