Relational OCD

Today we’re going to be looking at relational obsessive-compulsive disorder — a condition that I was only made aware of in the last year first through a friend. Relational Obsessive Compulsive Disorder is a sub-type of OCD in which a person experiences “obsessive preoccupation, doubt and compulsive behaviors focused on one’s romantic partner[i]”. People with this condition report uncontrollable thoughts or obsessions about their relationship to their romantic partner and this can be very distressing and draining. What Is ROCD? ROCD or Relational Obsessive Compulsive Disorder is a condition where you have repeated uncontrollable thoughts or obsessions either about your relationship with your spouse (or fiancee or boy/girlfriend) or else you have those thoughts about the partner themselves. Because of these thoughts, there are also certain actions or compulsions that arise in order to try to satisfy or calm those obsessive thoughts. Any time you have OCD in any form, the O is the obsession. That’s the uncontrollable thought. And the C is the compulsion, which is the nearly involuntary behavior to try to satisfy the thought. The classic example for OCD is hand washing. So the obsession is with germs or cleanliness and the compulsion is to try to keep washing them to satisfy the thought. When it comes to ROCD, there are two main types[ii]: Relationship-centered: obsessive doubts about whether the relationship is working, whether your spouse really loves you and fears about being with the wrong person. This could occur with a fiancée or boy/girlfriend but we’ll just talk about spouses from now on. Partner centered: obsessive thoughts about possible flaws in your spouse, or constantly comparing your spouse to others (often with regards to flaws) So those are the obsessions. The compulsive behaviors that follow are actions a person feels they need to take in order to reduce the anxiety caused by the obsessive thought. Often the behaviors may be mental acts like checking or reviewing in your mind whether you really do feel in love with your spouse. Maybe you’ll list their good qualities or make yourself remember positive experiences or you may perseverate over their flaws. You may also compulsively read marriage books or listen to marriage podcasts (*cough*). There can also be verbal compulsivity where you talk extensively to others about your spouse in order to attempt to soothe the obsessive thoughts or even constantly reviewing the pros and cons of your relationship with your spouse or else constantly asking your spouse if s/he loves you. How Does ROCD Form? ROCD often forms when a person is considering a major relationship commitment, such as getting married or having their first child. When most people experience doubt around these kinds of major commitments, they are able to deal with the doubts and anxieties fairly quickly and without undue distress. But some people end up over-estimating how important and significant these doubts are. They assign tremendous value to them. People in this situation believe that their doubts and worries are highly significant, and so feel the need to deal with them using compulsive actions (such as mental checking, reassurance seeking and so on). A mental link (or, neural pathway) therefore forms between the obsessive thought and the need to perform the compulsive action (e.g., when someone worries if their spouse is right for them, they feel the need to mentally compare their spouse to other men/women or seek the opinion of others). The more a person uses the compulsive action in response to the obsessive thought, the stronger the neural pathway becomes and the harder to get off it. So why can some people deal with these doubts easily while others fall into ROCD? Well a research study done in 2013[iii] identified several predisposing factors which make a person more likely to enter this cycle include: Perfectionism: the belief that your relationship or your spouse need to be perfect makes you more prone to these worries. Intolerance of uncertainty: people who find uncertainty distressing feel more of a need to be "sure" about a relationship, which is tricky because love and affection are hard things to be 100% sure how they work. Catastrophic thinking: a tendency to imagine worst case scenario consequences to your worries will contribute to ROCD. For example, "If I marry someone I'm not sure about, my life will be horrible" or "If I'm not sure my spouse loves me, he will have an affair." Insecure attachment: being raised in a home where parents were absent, abusive or inconsistent in their parenting leads to higher anxiety around relationships as an adult. "Illusion of availability”: this aspect may be more common during dating but can still be present for married folk. If you believe you have lots of alternative choices for a spouse (e.g., due to spending lots of time looking at other men or women on social media, or due to having a high opinion of how desirable you are), this may trigger obsessive comparisons or anxieties about whether you are with the right person. Having any of these factors makes you more likely to get stuck on your worries and begin to obsess over them. Often there are also specific triggers which cause the person to experience the obsessive thoughts. Triggers can include seeing other happy couples (leading to worries about whether you are with the right person), or negative feelings such as anger or even boredom[iv]. How ROCD Impacts Marriage As you might imagine, these kinds of thoughts and actions being a big part of your life can impact your marriage. ROCD can negatively impact marital quality in several different ways[v]: Negative perceptions: the more you have obsessive worries about whether your spouse is right for you, the harder it is for you to think of them positively. This increased negative view of your spouse can reduce your own satisfaction with the marriage and cause you to withdraw. Conflict: if your compulsive actions involve comparing your spouse to others, or constantly asking them for reassurance, this can become very taxing for your spouse. This can reduce their marital satisfaction and make conflict more likely. Reduced personal well-being: people with ROCD often experience high levels of anxiety and distress around their condition. They also often feel ashamed of their thoughts and distressed by the fact that they know the obsessions are irrational but can't help but think them. This leads to lower mood and lower self-esteem. It’s hard to deal with your own ROCD. Key Recovery Concepts ROCD Has Nothing To Do With Relationship Quality Couples where one spouse is experiencing ROCD should know that the condition is not caused by the marriage failing. People who experience ROCD often know that their marriage is great and yet still experience the obsessive thoughts all the same[vi]. If a person has some of the risk factor personality traits listed above, they can develop OCD in relation to anything. It's not the content of the obsessive thoughts that matters: it’s the fact that these thoughts keep appearing, cause the person distress and so lead to the compulsive actions. So the couple should not worry about whether their marriage is not working and instead focus on treating the condition. Look At the Personality Risk Factors Some of the risk factors which can lead to the development of ROCD can be healed, reducing the hold obsessive thoughts have. For example, training yourself to become comfortable with uncertainty will help reduce the obsessive need to be certain. Our bonus guide will take a deeper look at this. Exposure and Response Prevention The main treatment for OCD is about breaking the link between the obsessive thought and the compulsive action. If the person with ROCD learns to experience the obsessive thought WITHOUT then needing to perform the compulsive action, then they see that the obsession actually has no power to affect anything. The association then breaks and the obsessive thoughts become less and less common[vii]. So for example, if your obsessive thoughts are around whether you are in the right relationship, and your compulsion is having to mentally list all the good things about your marriage. When you experience the obsessive thought, do not perform the mental check and instead focus your mind on something else, such as your work or some other task that requires your full attention (prayer or meditation could also help here). Over time the link between the obsession and the compulsion will weaken until the obsessive thought no longer causes you any distress[viii]. That’s the theory anyway: in reality, it’s tough to resist those compulsions and requires a lot of practice. Professional help is often a good idea with this one, so don’t be afraid to look for help if this is affecting you. References [i] Guy Doron et al., “Relationship Obsessive–Compulsive Disorder: Interference, Symptoms, and Maladaptive Beliefs,” Frontiers in Psychiatry 7 (2016): 58. [ii] Doron et al. [iii] Doron et al. [iv] Gabriele Melli et al., “Maladaptive Beliefs in Relationship Obsessive Compulsive Disorder (ROCD): Replication and Extension in a Clinical Sample,” Journal of Obsessive-Compulsive and Related Disorders 18 (July 1, 2018): 47–53, https://doi.org/10.1016/j.jocrd.2018.06.005. [v] Doron et al., “Relationship Obsessive–Compulsive Disorder: Interference, Symptoms, and Maladaptive Beliefs.” [vi] Patricia Thornton, “Relationship OCD,” 2018, https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/relationship-ocd. [vii] Doron et al., “Relationship Obsessive–Compulsive Disorder: Interference, Symptoms, and Maladaptive Beliefs.” [viii] Guy Doron, Danny S. Derby, and Ohad Szepsenwol, “Relationship Obsessive Compulsive Disorder (ROCD): A Conceptual Framework,...