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Understanding and Treating Relationship OCD

cognitive behavioral therapy treats relationship obsessive compulsive disorder
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Imagine feeling intense anxiety and intrusive thoughts about whether your partner is right for you, or whether you’re truly attracted to them. Or perhaps you’re lost in a spiral about whether or not you should end your relationship with a friend, and you’re plagued by intrusive thoughts related to that person on a daily basis. Maybe you feel full of doubt and anxiety about a relationship with a parent, and it’s caused you to fall into a depressive state.

If this sounds familiar, you may be struggling with a newly-recognized form of obsessive-compulsive disorder called relationship OCD

What is relationship OCD?

CBT Therapy to heal from relationship OCD

Obsessive compulsive disorder (OCD) is a diagnosis given to a person who experiences uncontrollable thoughts (obsessions) and then engages in a behavior (compulsion) to try to reduce the emotional flooding caused by intrusive or disturbing thoughts.

Can you experience OCD about a relationship? Yes: Relationship OCD (rOCD) is a specific brand of OCD that involves intense fears and anxiety related to your relationships, especially those that are of an intimate or romantic nature. Like other forms of OCD, rOCD is characterized by unwanted or intrusive thoughts, feelings, urges and doubts – but in this case, they’re all relationship-driven. Compulsions often include repetitive physical or mental actions performed in relation to a partnership or friendship, in an attempt to relieve the distress and anxiety about whether or not the relationship is “meant to be.”

It’s worth noting that rOCD is not listed in the DSM-5 as a distinct diagnosis; rather, it describes a particular way that a diagnosis of OCD can show up in your life.

Signs & symptoms of relationship OCD

Classic OCD symptoms include:

  • Obsessions related to various worries, for example: germs or contamination; a fear of losing or misplacing something; fear of losing control; and beyond
  • Compulsions, or repetitive behaviors, related to the obsession, like excessive cleaning, praying or repeating words silently, or ordering items in a precise way

People with OCD feel extremely overwhelmed by their obsessions or compulsions, and spend more than an hour each day dealing with these symptoms, according to the National Institute of Mental Health. In order to be diagnosed with OCD, your symptoms must interfere with daily life and your ability to function.

Symptoms of relationship OCD include:

  • Repetitive checking behaviors related to a relationship (like obsessing over one’s internal sensations when you’re with your partner)
  • Comparisons (placing your partner or friend’s qualities in direct opposition to those of other potential partners and friends)
  • Intrusive thoughts related to your partner and whether or not you love them, or they love you
  • Neutralizations (visualizing past happy times shared together as “proof” of a relationship’s success)
  • Near-constant requests for reassurance
  • Excessive concern about your partner or friend’s happiness or well-being.

What can trigger relationship OCD? Noticing perceived flaws, or seeing other potential partners out in public or on social media, can often ignite an rOCD flare-up.

How relationship OCD feels

partners experiencing relationship OCD

Remember: Relationship anxiety is normal, and most people experience anxiety related to their relationships at times. However, relationship OCD is a much more severe form of that anxiety. Often, relationship OCD appears as attachment anxiety across many kinds of relationships. (While relationship OCD most often occurs in romantic relationships, it can also show up related to friendships, parent-child relationships, and even in relationships with deities, like God.)

Most relationship OCD cases are divided into two categories: relationship-centered and partner-centered.

Relationship-centered relationship OCD

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In one recent study, David, a 32-year old business consultant, describes the feeling of living with relationship OCD, noting that he’s been living with his partner for three months and they’ve been in a relationship for over a year. But, he says, “I can’t stop thinking about whether this is the right relationship for me.”

David goes on to describe seeing other women on the street and wondering if he’d be happier with them. He thinks about his relationship constantly, asking friends about their perspective. He compulsively checks in about what he feels for his partner, over and over again. “I check… whether I remember her face, whether I see her enough,” he says. “I feel depressed, I can’t go on like this.”

In this case, David’s compulsions and obsessions are organized around his relationship, and whether or not it’s the “right” one for him. This is relationship-centered rOCD.

Partner-centered relationship OCD

In the same study, a woman named Jane, age 28, explains her obsession with her partner’s body proportions. She loves her partner, but she worries that she can’t marry him because she’s constantly comparing his looks to other men’s. In this case, she’s obsessed with her partner, rather than the relationship they have. This is partner-centered rOCD.

Relationship OCD can make it hard to begin or maintain relationships. It is often linked to heightened anxiety and depression, and can lead to relationship challenges like low emotional or sexual satisfaction. Self-sabotaging behaviors are common for people who have OCD, which can put additional strain on their existing relationships.

What causes relationship OCD?

Exact causes of OCD are unknown, but early research has shown that there are some risk factors, which include:

  • Genetics: If you have a relative who experiences OCD, you have an increased chance of developing the disorder.
  • Biology: Brain imaging studies show that people with OCD have differences in brain structure size, especially in the front lobe, compared to those who do not.
  • Temperament: People who are more reserved, and tend toward negative emotion, may be more inclined to develop OCD. Those who show anxiety and depression during early childhood are also more at risk for developing OCD, compared to those who do not.
  • Childhood trauma: A few studies have shown an association between childhood trauma and OCD. Again, this is a correlation, not causation; we cannot say trauma causes OCD, but people who have been traumatized may be more likely to also have OCD.

Relationship OCD is a specific manifestation of OCD, which means the risk factors for both are similar. However, early research has suggested that a history of difficulties in close relationships paired with sudden life changes (like moving, or getting married) can make someone higher-risk for developing relationship OCD, specifically.

Tips for partners

If your partner is affected by rOCD, know that you’re dealing with something quite challenging. Your partner’s fears and struggles can impact both of you, and constantly reassuring them of the strength of your relationship can be exhausting. As you navigate this challenging time, it can be helpful to:

  • Set boundaries around reassurance and caretaking: Make clear the manner and scope of your reassurance, so your partner knows what they can expect from you. Nonviolent Communication provides an effective formula for asserting your needs and boundaries in relationships.
  • Acquire therapeutic support for yourself, or your partnership via marriage counseling: Engaging in CBT with a qualified therapist can help you manage the challenges of your experience. Marital counseling can also help you navigate your challenges as a couple.
  • Educate yourself about how rOCD manifests

What treatment options are available for relationship OCD?

Does relationship OCD ever go away? In short: No. Your associations may never fully go away, but treatment will allow you to navigate your relationships in a healthy way, with heightened awareness. OCD can be treated with incredible success.

Exposure and response prevention therapy (ERP) is one of the most effective methods of treating OCD of any kind. The goal is to gradually expose you to your obsessions in a safe and controlled environment, which reduces the likelihood of a patient feeling flooded by sensation. As patients are slowly able to handle their obsessions without taking compulsive action, the therapy intensifies. ERP has been found to be effective for 80% of people with OCD.

Patients with relationship OCD may also benefit from cognitive behavioral therapy (CBT), which can help you reduce your symptoms by challenging maladaptive belief and associated behaviors. Even short, daily CBT training offered by cell phone have been shown to reduce rOCD symptoms.

Help for Relationship OCD

If you think you’re experiencing rOCD, know this: Relationship OCD can be challenging and, at times, debilitating. But you are not alone, this is not your fault, and there are effective treatments available to you when you’re ready to take action.

Our Bay Area, SF therapists specialize in using CBT and evidence-based techniques to help people change their relationship to anxiety and OCD. Our licensed clinicians are experts in the field and offer individual counseling, group therapy, and couples therapy. We also offer in-person and online therapy, groups, and workshops.

Take the schema quiz to identify your core beliefs in relationships

Take the relationship satisfaction quiz to assess your relationship health

Frequently Asked Questions

Evidence-based therapy involves interventions that are scientifically proven to be effective for particular issues. In this approach, a strong partnership based on trust and collaboration is formed between you and your therapist. Within this supportive and unbiased environment, you can freely express yourself without fear of judgment. Over a series of sessions, you and your therapist will work together to address obstacles and set goals aimed at personal growth and fulfillment. This method ensures that the techniques and strategies used are not only supportive but also empirically validated to help you achieve your therapeutic goals.

The Bay Area CBT Center provides therapy services for everyone, from children to adults, and welcomes individuals, couples, and groups. We help with various concerns like anxiety, depression, trauma, relationship issues, and behavior challenges. We value diversity and cultural differences, offering personalized and culturally sensitive care to each client.

Studies show that the bond between you and your therapist, known as the therapeutic alliance, is a key factor in treatment success. This alliance is characterized by the strength of your relationship and how well you both agree on treatment goals. Research indicates that individuals with a solid therapeutic alliance experience better treatment outcomes including greater productivity at work, more satisfying relationships, improved stress management, and decreased engagement in risky behaviors.

You can expect a 15-30 minute phone call with our care coordinator, who is extensively trained in ensuring the perfect match for you. During this conversation, our matching expert will collaborate with you to understand your therapy needs, preferences, and scheduling availability. This discussion builds upon the information you provided during sign-up and offers an opportunity for you to address any personal questions or concerns you may have about therapy or our services at The Bay Area CBT Center. Following your conversation, we’ll pair you with the therapist who best aligns with your needs, goals, and preferences.

At your matching appointment, we will match you with a therapist specifically chosen for you and schedule your first session. Depending on your availability, you can expect to meet your therapist anywhere from one day to a week after this appointment.

Our approach to therapy includes a flexible hybrid model, blending both online and face-to-face sessions. This option is perfect for clients situated close to our clinics in the Bay Area who prefer the flexibility of choosing between virtual consultations or meeting their therapist in person. Our aim with hybrid care is to ensure every client is matched with the ideal therapist and therapy environment, be it from the convenience of your own home or in one of our clinics.

At the Bay Area CBT Center, we accept PPO insurance plans that allow you to use out-of-network providers. This means if your insurance plan is a PPO and it includes mental health benefits, you could get back some or all of the money you pay for our services, depending on what your insurance company allows. When you see one of our therapists, they’ll give you a superbill. You can send this superbill to your insurance company to ask for reimbursement. If you’re not sure if your insurance covers services from providers not in their network, it’s a good idea to give them a call and check.

You may be eligible to have 60-80% of your costs covered by out-of-network benefits.

Also, if you have an FSA (Flexible Spending Account), you can usually use it to pay for individual counseling sessions. It’s wise to double-check with your FSA provider or talk to your accountant to make sure that counseling sessions are considered an allowed expense.

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