The Comprehensive Guide To Relationship Obsessive-Compulsive Disorder (ROCD)

Relationship obsessive-compulsive disorder (ROCD) is marked by obsessions and doubts over your relationship. Among other things, you may wonder if you (or your partner) made the right decision when you committed to each other or spend excessive time worrying without basis that your relationship will end suddenly and painfully.

Having intermittent concerns and relationship doubts from time to time is expected-- but doubts and worries that adversely affect your relationship or make you want to avoid relationships typically aren’t. In this article, we discuss Relationship Obsessive-Compulsive Disorder (ROCD), provide strategies for dealing with this potentially debilitating and life-altering relationship disorder, and offer resources for getting therapy online.

Relationship obsessive compulsive disorder - the basics

According to the latest DSM 5 diagnosis, there is a subset of obsessive-compulsive disorder (OCD), where symptoms manifest as maladaptive beliefs about relationship patterns. 

Referred to as relationship obsessive-compulsive disorder (ROCD), this type of OCD is a commonly misunderstood mental health disorder in which people experience obsessions and compulsions in tandem. Obsessions are often cyclical, anxiety-inducing patterns of thought surrounding specific topics -- more than a preoccupation, obsessions can be very difficult to dispel. 

They can grow to give people an inflated or distorted sense of how dire or unpleasant the object of their obsession is. Compulsions are repetitive and difficult-to-control impulses toward specific actions or rituals which, to the person, might relieve some of the stress or anxiety of their obsessive thoughts. For instance, if a person is particularly worried about the possibility of leaving the stove on, they might ritualistically check all the knobs on it every few hours, even if it hasn’t been used.

Relationship obsessive-compulsive disorder (ROCD) is not one of these disorders -- it is simply OCD with a relationship-centered focus, where people experience relationship-centered obsessions and compulsions. However, relationship OCD may be comorbid with some of these, which can sometimes be diagnostically confusing and mentally exhausting for the person when they’re presenting with ROCD.

It’s not uncommon for symptoms of OCD to have a ‘theme’ in how they manifest for different individuals --

In this case, people with ROCD have issues continuously and obsessively doubting their partner, themselves, and their relationships. They struggle with feelings of worth and the idea that the relationship should (or could) abruptly end for reasons outside their control. This undue focus on intimate relationships can be quite anxiety-inducing.

The secondary component of this two-faceted relationship disorder is that although someone living with relationship OCD may fear the outcome of staying in a relationship where they may deem themselves unworthy, they fear the thought of being alone even more. People with ROCD often report having concurring and conflicting beliefs about relationships and develop an obsession as a result.

While others without ROCD might experience relationship thoughts as fleeting concerns throughout the day, people with ROCD are consumed by them. Identifying the symptoms and patterns accompanying ROCD can help let qualified mental health providers know they are experiencing the stress and worry of this relationship-based form of obsessive-compulsive disorder. With ROCD, relationship-centered symptoms take center stage, and they focus symptoms on the relationship, while other areas of life may be functional.

Living with relationship obsessive-compulsive disorder

Ruminations on images, thoughts, and urges that all center on the relationship are the primary symptom of ROCD. These repetitive thoughts and actions surrounding the relationship can become debilitating to the person experiencing ROCD, as thoughts of the relationship can consume their lives.

The  relationship catastrophizing scale (RECATS) is a self-administered, three-part scale that involves the following three key components and can give ROCD a conceptual framework:

1. Overestimation of the consequences of being alone.
2. Overestimation of the consequences of separation.
3. Overestimation of the consequences of being in the wrong relationship.

They further subdivide these three categories into scenarios in the form of questions commonly applied in cases where one partner is experiencing ROCD.

RECATS Scenario examples from the NCBI

• Being without a partner would cause me and everyone around me great pain.
• The thought of going through life without a partner scares me to death.
• I believe there is nothing more important than romantic relationships.

If you find that you're constantly obsessing over your romantic relationships to the point where it is affecting your life, or you see reflections of your own life in the examples above, it's time to seek help from a licensed mental health professional.

Having heart-to-heart conversations with close friends and family may give people experiencing ROCD some emotional support. However, discussions with a friend or family are unlikely to determine what's causing obsessive behavior and related symptoms. Today's licensed professional counselors and therapists are licensed, accredited, and board-certified mental health professionals educated on using evidence-based therapy to mitigate the negative symptoms of mental illness and mental health-related disorders.

ROCD symptoms

Relationship-centered symptoms are the hallmark of ROCD. When clients find themselves consistently occupied with the state of their relationships, ROCD symptoms can become debilitating. This is especially true if they leave the disorder untreated as the person experiencing the symptoms spirals into an increasingly obsessive state of mind.

Relationship concerns can become relationship obsessions, inflated, and disproportionately distressing for the person. What might be considered a minor hitch can transform into obsessive thoughts and compulsive behaviors about the issue. Additionally, people experiencing ROCD might believe unrealistic things about what the “ideal” relationship looks like, that ongoing romantic relationships shouldn’t change over time, or that ongoing romantic relationships should always be worry-free and completely passionate.

There are two types of ROCD -- relationship-centered and partner-focused ROCD. Relationship-centered obsessions are characterized by concerns about the quality of the relationship itself and the purity of the love either or both partners feel. In contrast, partner-focused obsessions are concerned with the quality of the non-ROCD partner’s attributes and characteristics.

Relationship obsessive-compulsive disorder might be present if one of the related persons is always second-guessing their love for their partner and constantly seeking affirmation and confirmation that that relationship should exist. People with ROCD rarely feel good enough for their partner and worry that their partner will leave them.

People with ROCD might feel undue worry about their partner’s compatibility with them, too, or worry persistently about the rightness of the relationship. Despite being together for a long time without any particular inciting incident, a person experiencing ROCD might fear their partner is not “the one” and cannot think about much else outside their romantic relationships.

People living with ROCD might also have compulsions that prompt them to do things like repeatedly and ritualistically checking if everything is all right with their partner. They may do mental “tests” measuring if they love their partner enough and/or if their partner is sufficiently attractive, intelligent, good-natured, or otherwise “good enough.”  These compulsive behaviors may not truly reflect people's feelings about their partners -- and the person might intellectually register that they really do find their partner to be “good enough” -- but they are patterns that are difficult to resist.

Repetitive thoughts and compulsive behaviors can lead to adverse circumstances in other areas of the person’s life that can make the condition feel even worse. Non-OCD partners in an ROCD relationship experience related symptoms themselves sometimes, too, as they might feel uncertain about their self-worth and value (both inside and outside the relationship).

The constant focus of one partner on the other can leave other critical areas of the couple's life beyond either partner or the relationship unattended when it comes to career, home, and family. Familial relationships and job performance can stall as the person experiencing ROCD has become consumed with thoughts regarding the relationship.

Relationship obsessive-compulsive disorder therapy types

Now that you know what ROCD symptoms look like, we'll move on to treating the symptoms and reducing the adverse effects on your life. Below are three therapy types that today's board-certified and licensed therapists use to treat this new DSM-5 diagnosis.

• Cognitive-behavioral therapy (CBT)

CBT is a form of behavior therapy that teaches clients to identify triggers of negative behavior and learn how to place new behaviors in their place. This brain-based therapy operates under the assumption that people behave negatively or positively in response to their perception of their environment. Therefore, according to the principles of cognitive-behavioral treatment, changing negative perceptions can also change (or eliminate) negative reactions to the environment.

• Exposure therapy with response prevention (ERP)

Exposure therapy is a graduated form that gradually introduces people with mental health challenges to the stimulus that triggers them. People who take part in exposure therapy are progressively exposed to the object or situation of their fear and coached through the process until the negative response to the situation is reduced or eliminated.

• Mindfulness-based cognitive therapy (MBCT)

MBCT is a form of therapy combining critical components of mindfulness-based therapy (MBT) and cognitive-behavioral therapy (CBT). The result is a therapy type that combines mindfulness with cognitive processes—in other words, being more aware of what you're thinking and purposefully changing your thoughts by choosing new behaviors or responses.

Online therapy for ROCD

People experiencing relationship OCD now have a wide variety of options to get therapy. ROCD clients can attend sessions with traditional in-office or online therapists to get advice, support, and resources for medication management. Whatever treatment avenue they choose, ROCD clients must comply with all the components of their treatment plan to successfully manage or combat the symptoms of ROCD.

Taking part in ROCD therapy online eliminates the need for lengthy or frustrating commutes and saves the couple's time and money, which is another stress relief for the relationship. Online treatment isn’t only convenient but is often more affordable than traditional therapy without insurance. A growing body of research indicates that online therapy is just as effective as conventional therapy for couples and individuals experiencing challenges like ROCD, anxiety, depression, and more.  

The Regain platform has licensed and board-certified therapists and counselors that specialize in managing the symptoms of ROCD. When you connect with a Regain therapist, you're matched with a therapist who is licensed to practice in your state of residence to assure an uninterrupted continuum of quality care in case you should need an offline referral for resources and services related to your condition. 

Getting started with online therapy is as easy as completing a simple email registration process and an online questionnaire to help your therapist assess your symptoms and determine your treatment plan. Your treatment plan will include your therapist's recommendations for the number of therapy sessions you're scheduled to attend online, medication management resources, and other related local resources and referrals.

If you're serious about managing your symptoms of ROCD, you suspect that you have ROCD, or you already have a ROCD diagnosis, reach out to one of the relationship specialists at Regain who can get you matched with the best therapist to help you cope with ROCD successfully.

Counselor reviews

Below are some reviews of Regain therapists by people with similar experiences: 

“Sessions with Natalie are very insightful and give practical advice on implementing new habits and changes. Be prepared to engage and be challenged to think in a different way. I know that my partner and I can already see improvements in our relationship and feel more positive about working through our issues together.”

“Austa has been wonderful thus far. She has helped my partner and I during an unimaginably difficult time... She has also guided us in communicating effectively and setting appropriate boundaries in our relationship. I was hesitant to pursue counseling at the beginning, but I truly believe that it is making a difference for our relationship. Austa is easy to talk to and she is a great listener. I would wholeheartedly recommend her as a counselor.”