Relationship obsessive-compulsive disorder (ROCD) is a subtype of OCD characterized by obsessions, or intrusive thoughts, related to relationships. Through exposures, people with ROCD can learn to gradually confront these obsessions, without engaging in compulsions or seeking reassurance.
Most people experience anxiety or doubts about their relationships from time to time. You may find yourself wondering whether you’re truly in love, if your partner is right for you, or whether your relationship will last. While it’s common to wonder about these questions occasionally, or during times of relationship stress, if these thoughts become persistent, you may be dealing with relationship obsessive-compulsive disorder (ROCD)—a subtype of obsessive-compulsive disorder (OCD).
ROCD can be debilitating—overwhelming you with constant worry, and consuming your time with compulsive behaviors like reassurance-seeking or avoidance. However, relief is possible. Exposure and response prevention (ERP) therapy can help you gradually confront your fears, giving them less power over time.
Keep reading to learn more about the signs and symptoms of ROCD, and how you can ERP therapy can help.
What is ROCD?
People with OCD struggle with obsessions, or recurrent intrusive thoughts, sensations, images, feelings, or urges that cause significant distress. With ROCD, these thoughts tend to center on close personal relationships. Possible ROCD obsessions include:
- Wondering if you’re truly in love.
- Fearing that your friends secretly dislike you.
- Worrying about accidentally cheating on your partner, even if you have no desire to.
- Questioning whether you’re still attracted to your partner.
- Excessive concern about whether you’re a good friend.
- Comparing your relationship to those you see on social media.
In response, people with ROCD engage in compulsions—repetitive behaviors or mental acts done in an attempt to reduce anxiety, neutralize a difficult thought, or prevent something bad from happening. ROCD compulsions can include:
- Checking for signs that you’re attracted to your partner.
- Avoiding social interactions out of fear that you or your partner will find others attractive.
- Taking online relationship quizzes to try to assess compatibility.
- Repeatedly asking your partner for reassurance that they love you.
- Constantly analyzing past conversations to find evidence that your relationship is stable.
- Comparing your partner to others, to try to assess whether they are the “one.”
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Compulsions typically provide very temporary relief from anxiety, and prolong the cycle of OCD. Every time you engage in a compulsion, it reinforces your intrusive thoughts, making it harder to resist compulsive behavior in the future.
Treating ROCD: ERP therapy
Obsessions and compulsions can greatly impact your ability to function in daily life. However, ROCD is treatable; exposure and response prevention (ERP) therapy is a specialized form of cognitive behavioral therapy designed specifically for OCD, which is highly effective at reducing symptoms. In fact, 80% of people with OCD who participate in ERP see a significant impact within eight to 16 weeks.
ERP therapy works by helping you confront fears and intrusive thoughts, while resisting the urge to perform compulsions. ERP therapy often begins by creating a list of your fears, ranked from least to most distressing. By identifying your triggers, you can work with your therapist to create a list of exposures—opportunities to intentionally confront the thoughts, situations, or triggers that cause anxiety.
For example, if you constantly seek reassurance from your partner, you and your therapist might design an exposure that requires you to sit with the discomfort of not knowing whether or not your partner is in love with you. Instead of trying to “check” or confirm your partner’s feelings by overanalyzing their words or actions, you would allow yourself to sit with anxiety—without immediately acting on it.
Starting with less anxiety-provoking situations, you’ll gradually work your way up to more difficult exposures as you build confidence managing discomfort. Eventually, you’ll embark on exposures that intentionally provoke more anxiety. The purpose of exposures is to learn new responses, instead of performing compulsions—ultimately regaining power over the things you once feared.
ERP therapy will be tailored to your specific needs, triggers and concerns. So, if you’re dealing with ROCD, your therapist will design exposures that focus on your specific obsessions and compulsions—whether that’s reducing reassurance-seeking, becoming more comfortable engaging in group settings, or refraining from excessive online research.
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All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
What are common ROCD exposures?
Exposures are the first step of ERP therapy, where you’ll face your intrusive thoughts head-on to learn new ways of coping with discomfort. According to Dr. Keara Valentine, a clinical assistant professor at Stanford University School of Medicine in the Psychosocial Treatment Clinic and OCD Clinic, “ROCD exposures allow you to lean into your unwanted thoughts and subsequent uncomfortable feelings, and learn how to tolerate uncertainty.”
Often, ERP for ROCD involves “imaginal exposures,” a type of exposure that requires you to use your imagination. In contrast to exposures that may require you to take immediate action—like driving a car, going to a party, or riding public transport—imaginal exposures require you to envision situations, like your partner cheating, or a breakup. The goal of these exposures, as with all exposures, is to sit with the distress they may provoke, without engaging in compulsive behaviors.
Here are some possible ROCD exposures:
Obsession: Let’s imagine your intrusive thoughts center on the question: “What if I’m with the wrong person?”
Compulsion: In response to these intrusive thoughts, you might check to see if you’re attracted to your partner, or review past interactions for evidence of compatibility.
ROCD exposure: Instead of engaging in compulsions, your ERP therapist might ask you to try acknowledging that you might never be sure you’re with the right person. You can say to yourself, “What if I am with the wrong person? I can’t be certain about anything, so, I’ll sit with the possibility that I may be with the wrong person.” You might even try writing down a worst-case scenario and reading it aloud in therapy.
Obsession: Perhaps your intrusive thoughts center on worries that your partner doesn’t love you anymore, or may break up with you.
Compulsion: In response, you may seek constant reassurance.
ROCD exposure: Instead of asking for reassurance, your therapist might work with you to visualize future uncertainties, such as your relationship changing due to difficult life challenges. You can imagine the possibility of a breakup and the anxiety that comes with it—learning to sit with this discomfort, rather than immediately respond.
Obsession: You may have thoughts like, “what if I cheat on my partner?”
Compulsion: These intrusive thoughts might cause you to avoid talking to other people out of fear of finding someone new attractive. You might end up limiting social interactions, avoiding parties, or excessively monitoring your behavior.
ROCD exposure: Instead of practicing avoidance, your therapist might have you purposefully allow yourself to notice someone’s attractiveness without acting on it, or feeling the need to control the situation. In time, this exposure might help you learn that feeling attracted to someone else doesn’t automatically mean you’ll cheat.
Obsession: You may compare your relationship to others and think: “That other couple seems so happy. Is something wrong with us?”
Compulsion: As a result, you might spend hours on social media, analyzing other relationships, and obsessing over what you “should” be feeling.
ROCD exposure: Your therapist may ask you to gradually refrain from checking social media, perhaps by setting an increasing time limit on your screen usage or social media apps. When feelings of anxiety arise, you would focus on accepting that you don’t have all the answers about your or others’ relationships.
Imaginal exposure can be uncomfortable, but a trained therapist will work with you every step of the way to help you with response prevention—the part of ERP therapy where you resist the urge to perform compulsions in response to exposures. This can be tough work at first, but in time, you’ll learn healthier coping mechanisms for managing your negative feelings. These exercises can help you break free from the cycle of OCD.
Bottom Line
ERP therapy is integral for the treatment of ROCD, because it can help you fully confront intrusive thoughts, rather than responding with fearful reactions, or compulsive behaviors. If you’re struggling with ROCD or any form of OCD, working with a therapist who specializes in ERP can provide you with the tools and support you need to break free from the grip of compulsions.
Key Takeaways
- It’s not uncommon to experience occasional anxiety about your relationships, but if you find that your concerns are constant, you may be experiencing ROCD.
- ROCD is characterized by obsessions about interpersonal relationships that cause distress; in response to this anxiety, people with ROCD engage in compulsions.
- ERP therapy is the most effective treatment option for ROCD; you’ll work through exposures with a trained therapist while resisting the urge to do compulsions .
- Many exposures for ROCD require you to use your imagination instead of taking immediate action.