When we hear the words “Obsessive Compulsive Disorder,” many of us have a very particular (stereotypical) image that comes to mind: someone that can’t stop washing their hands, checking that the door is locked, or straightening items on their desk. While these can be manifestations of OCD, they are by no means exhaustive or representative of the many, many ways that OCD can show up in our lives (and our relationships!).

Relationship Obsessive Compulsive Disorder (ROCD), a specific subtype of OCD that involves unwanted, intrusive thoughts and behaviors specifically about relationships. It is relatively new and a growing area of study, but for many people with the disorder, receiving a diagnosis can feel like a weight has been lifted off their shoulders. They may have been beating themselves up for their irrational jealousy, for their constant unreasonable doubt and hypersensitivity to their partner’s flaws, or the nagging thought that “maybe ‘the one’ is still out there,” even when in an objectively fulfilling and happy relationship. Knowing that these thoughts are just, well, thoughts–and nothing more– can be a game changer. Better yet, ROCD (just like OCD) is very treatable!

OCD Basics

To understand ROCD, it is helpful to have a basic knowledge of OCD in general. OCD (including ROCD) consists of two main components: obsessions, which are recurrent and intrusive thoughts or mental images; and compulsions, which are repetitive behaviors that accompany obsessions and have been developed to provide relief from the unwanted thought. The compulsions may seem to an outsider to be totally irrational or unrelated to the obsessions, but to the person experiencing OCD, the behaviors have become a lifeline and the only thing providing relief from their paralyzing fear or distress.

Here’s an example scenario to help you better understand what OCD might look like in this context:

Thalia has unwanted, random, and intrusive thoughts and mental images about harming her young daughter with a knife. She experiences a lot of shame about this, and thinks that she must be a terrible, disturbed person to have these thoughts; every day, she worries herself sick for her daughter’s safety. Thalia loves her daughter more than anything in the world and doesn’t understand how she could want to harm her, but figures that she must secretly want to since she spends so much time thinking about it. Thalia has found that the only thing that helps with these thoughts is hiding all of the sharp objects in her house in her upstairs closet. Every time she thinks about hurting her daughter, she goes upstairs to make sure that the knives are still in the closet and not somewhere else where she might stumble upon them and lose control. She also has withdrawn from her daughter, spending as little time with her as possible in order to keep her safe. If she doesn’t see her daughter, she can’t hurt her. This has caused a great deal of hurt and strife in the family. Fortunately, Thalia’s counselor helped her realize that instead of being a danger to her daughter, Thalia is experiencing OCD, and that Thalia actually has no urge or desire to harm her daughter and is not at risk of doing so. Thalia and her therapist work together on something called ERP (Exposure and Response Prevention, explained more below), which helps Thalia unravel the associations between her unwanted thoughts and the corresponding behaviors. After lots of hard work in therapy, Thalia is able to show up for her daughter and live her life without constant fear and doubt!

OCD or Intrusive Thoughts?

We all have many, many thoughts, every single day of our lives. In fact, everyone experiences intrusive thoughts, not just people with OCD! Think about it: have you ever been driving across a bridge, and had the sudden thought— What if I just jerked the wheel, and drove right off? Most of us without OCD would then just think, “Huh, what a weird thought,” and keep driving, thoughts immediately wandering off to something more mundane, like what you’re going to eat for lunch. OCD is a problem of the filter between your thoughts and beliefs, between the things that pop into your mind, and what you do with them. A person with OCD takes an ordinary run-of-the-mill intrusive thought and attaches unwarranted significance to it, believing that it must be true or that it must say something about who they are as a person.

ROCD

OCD can be about many different things: harm, contamination/cleanliness, spiritual damnation, etc. ROCD is a particular subtype of OCD that shows up specifically in relationships. Of all the subtypes, it can be particularly difficult to notice because it often mirrors behaviors that show up in unhealthy relationships (not as a result of OCD). For instance, someone might truly be very jealous and controlling by nature, or as a result of trauma, or any number or other causes– or, someone with ROCD might have unwanted obsessions about being cheated on, that they know are irrational and would like to control, and turn to compulsions to gain relief. It’s important to note that ROCD behaviors can still be harmful to a partner, if they result in unhealthy or damaging patterns and it’s also important to know where they are coming from so that they can be treated effectively.

Common obsessions with ROCD involve cheating/infidelity (as described above), hyper-fixation on a partner’s flaws, fears about breaking up or heartbreak, constant thoughts that maybe there’s a better fit for you out there somewhere, worries that you cannot match up to partner’s previous partners, thoughts that your partner doesn’t truly love you or is just pretending to care, or any number of other intrusive negative thoughts about relationships. We all have thoughts like this from time to time when we’re feeling insecure, but if these thoughts are constant, distressing, all-consuming, and don’t actually correlate to any real warning signs in the relationship, it might be ROCD. Some ROCD compulsions might be reassurance-seeking (constantly asking if your partner is mad/hates you/cheating on you, etc.), avoiding your partner, frequently breaking things off prematurely, cycling through partners since nobody is “quite right,” mentally reviewing every single interaction you’ve had with your partner that day, etc.

ROCD Treatment

ROCD is often treated similarly to OCD! The first step in getting better is simply knowing that what you are experiencing is OCD and learning more about what that means. Your brain may learn this fact fairly easily, but your body will take more effort. Even once you’ve gotten the ROCD label, and can say to yourself “this is an obsession that I am having that is irrational- my partner is not cheating on me,” your body will still kick into gear and you will have an urge to do your compulsion. These behaviors become ingrained and are hard to break.

Exposure and Response Prevention (ERP), involves training your brain and body to unravel the connections between obsession and compulsion by learning to tolerate the distress that the obsession brings. This is often done through baby steps; getting used to progressively more distressing things related to the core fear that underlies the obsession. Someone with ROCD causing them to think about their partner cheating would work with their therapist to create a hierarchy of things that cause them distress– unsharing locations with their partner on Find My Friends, sitting at home while their partner is hanging out with an attractive coworker, picturing their partner kissing someone else, etc. When they complete those feared tasks–while avoiding the compulsion AND practicing self-soothing techniques, like deep breathing– they will slowly get used to the idea that they don’t need to do the compulsions to keep that dreaded thing from happening. Over time, it will get easier and easier, and even the obsessions themselves will dwindle.

ERP is extremely effective– but also extremely difficult and can very much go awry if done improperly (it’s intentionally causing distress!)– so don’t do it yourself. Reach out to a professional. Particularly with ROCD, couples counseling can be extremely helpful because often the ROCD obsessions revolve around someone’s partner. The partner might even be unwittingly reinforcing the cycle by accommodating the compulsions. In couples counseling for ROCD, you and your partner can work as a team to unravel the OCD and reconnect as your authentic, trusting selves.