Everyone has doubts about their relationship from time to time.
But usually they’re fleeting thoughts, not prominent enough to take seriously.
However, for people with relationship obsessive compulsive disorder (ROCD), their doubts and fears blur reality, causing them to obsess about whether they’re happy with their partner.
“I was with my ex-wife for 12 years. Through that entire time, I was constantly checking to see if my love for her was as founded as I believed it was,” Aaron Harvey, founder of the OCD resource Intrusivethoughts.org, told Healthline.
“Every single time another woman was in the room, I would test my level of attraction to them compared to my attraction to my partner,” he said. “It was so distracting. I couldn’t engage in conversations. I also spent years and years evaluating one small curve or line on my wife’s face to determine whether or not I found that attractive. It became an endless cycle of doubting thoughts and I felt a slave to it.”
Harvey also obsessed about intellectual standards, wondering if his partner was smart enough for him or smarter than other people around them.
“Ultimately what is happening is that you really love the person and you’re trying to prove to yourself that you actually do or that they’re enough for you. This constant obsession causes major anxiety. That in itself is the essence of OCD,” Harvey said, who struggled with various symptoms of OCD his entire life.
More than vanity
Could Harvey’s behavior be chalked up to superficiality?
Not quite, says Jonathan S. Abramowitz, Ph.D., clinical psychologist, and professor of psychology at the University of North Carolina at Chapel Hill.
“People with OCD have obsessional thoughts about things that are most important to them. This means that normal everyday doubts end up escalating into clinical obsessions in the context of that need for certainty and intolerance of uncertainty,” Abramowitz told Healthline.
Relationship obsessions are just one of many presentations of OCD, he notes.
For some people cleanliness is important to them, so they worry about contamination and germs. For others, it may be safety, so they worry about being harmed or harming others.
In terms of relationships, Abramowitz says, a person with OCD can be in a relationship and it’s clear that the relationship is going well, yet the person obsesses about knowing for sure that they’re in love with their partner, they’re doing this because the relationship is so important to them that even thinking about ending it is incredibly distressing.
“The senseless thoughts and doubts about the relationship don’t make sense to the person and they get upset that they’re thinking them. They might say, ‘if I love my partner, why would I have these thoughts? Maybe I don’t love them,’” Abramowitz explained.
People with these thoughts start to resist them and begin to seek out a guarantee that they really are in love.
“This makes them engage in all sorts of compulsive behaviors to try to put things right or reduce their stress. Just like other manifestations of OCD, this is what drives people to do rituals and seek reassurance that their doubts are wrong,” Abramowitz said.
For instance, if cleanliness is a concern for a person with OCD, they may wash their hands hundreds of times a day.
If harm is their concern, they may constantly check that their door is locked.
If they’re worried about their relationship, they may ask their partner if everything is OK, again and again.
“However, those behaviors make the person focus on the fears and doubts, and the person gets themselves into a vicious cycle. Trying to wiggle out of these doubts by performing rituals actually makes them intensify,” said Abramowitz.
How is ROCD treated?
Abramowitz says that the biggest sign of ROCD is having senseless worries and doubts about whether you love your partner, despite being happy in the relationship.
He says some people with ROCD may only obsess about their relationships, while others may obsess about more than just their relationships.
“The thing is that the stuff that people with OCD have an obsession about you can’t have a guarantee about. You can’t see germs. You can’t see love. Love is something that you just know when you’re in love,” he said.
Still, treatment for all presentations of OCD is similar.
“It’s a very treatable problem that takes hard work because you have to face your fears, but people can and do overcome it,” Abramowitz said.
While a class of drugs called selective serotonin reuptake inhibitors can be used to treat OCD, Abramowitz says the most effective form of treatment is cognitive behavioral therapy (CBT), a type of psychotherapy that focuses on understanding the relationship between a person's thoughts, feelings, and behaviors.
The type of CBT that Abramowitz says works best with OCD is called exposure and response prevention (ERP).
During therapy, one is exposed to thoughts, images, objects, and situations that make them anxious and initiate their obsessions. The response prevention teaches the person how not to engage in a compulsive behavior or ritual when they are exposed to what makes them feel anxious.
“So you’re teaching the person how to lean into their doubt and anxiety and see that they can go on with life even if they don’t know for sure that they, say, really love the person,” Abramowitz said. “They learn that they are not allowed to ask for reassurance from their partner since doing so amplifies the doubts.”
One exercise Abramowitz asks a person to do who questions if they’re in love or if they’ll leave their family, is to write down the scenario.
For instance, they may write down that they come home from work, have doubts, and tell their family they’re leaving. Then drive away, and the family is heartbroken.
Then, Abramowitz asks the patient to read what they wrote down to themselves several times in the day so they can feel their fears. They are not allowed to ask their family for reassurance, however.
“Everyone in a relationship gets frustrated with their partner. That’s normal. We can all relate to thoughts of what if I just ran away from my family? A person with OCD has to learn that it’s OK to think that, and it doesn’t mean that they are a bad person or that they are going to actually do it,” Abramowitz said.
ERP is exactly what Harvey practiced to face his fears.
After years of struggling with OCD symptoms, he was finally diagnosed with the condition in his early 30s. He went on to try half a dozen medications over a period of a year and a half. He chose to stop medication and focus on therapy and mindfulness strategies.
“ERP helps me not worry about how many thoughts I’m having or the nature of them and helps me pass the thoughts. So when the thoughts come up instead of letting them overwhelm me, and think that they represent my true beliefs or character, I learn to say ‘that was a weird thought’ and move on. More like the general population behaves when they have weird thoughts,” he said.
When it comes to Harvey’s relationships, he says mindfulness also helps. When thoughts about whether he should leave his partner arise, he asks himself if he’s willing to leave them today.
“It’s powerful because you’re not asking yourself to answer questions like do you love them or if they’re good enough,” Harvey said. “It helps to calm my mind and perspective and reduce my expectations of what it means to be in a relationship. When thoughts pop up and I begin to judge my attractiveness to them or whether I love them or not, I let them pass, and try to be mindful by telling myself to revisit the thoughts a week from now. OCD is a chronic condition I’ll always have, but I’ve learned to live with it.”