Obsessive compulsive relationship disorder

OCD is a disorder characterized by a variety of obsessive themes, such as fear of contamination or fear of harming oneself or others. Relationship obsessive compulsive disorder (OCD), in particular, has symptoms centered on the domain of intimate relationships, an issue that has received increasing research attention in recent years (Doron, Derby, Szepsenwol, 2014).

Symptoms of OCD can occur in various types of relationships, such as with one’s parents, children, teachers, and even God, but research has focused more on the area of romantic relationships with one’s partners.

It is a common experience for everyone to feel uncertain at times about their feelings within a relationship and/or about their partner. However, when the doubts and worries become excessive and cause significant personal and couple discomfort, as well as impaired functioning socially, at work, and in other important areas of life, then we are likely dealing with OCD.

How it manifests itself

OCD manifests as obsessive doubts and worries about romantic relationships, with compulsive behaviors enacted to relieve the anxiety and distress caused by the presence and/or content of these obsessions.

Relationship obsessions may take the form of thoughts such as “Is this the right person for me?”, images of the partner, or they may take the form of impulses (e.g., the urge to leave the partner).

In addition to obsessions, there is also a wide range of compulsions, such as: constantly monitoring one’s feelings and thoughts about one’s partner and the relationship and relying on external feedback to evaluate them (e.g., evaluating one’s partner’s love based on the amount of time spent with them compared to time spent with others); seeking reassurance and self-assurance; comparing one’s partner’s characteristics and behaviors with those of other potential partners; neutralizations (e.g., attempting to nullify obsessions), attempts to neutralize obsessions by visualizing memories of happy moments experienced with one’s partner); avoidance of those situations that can act as triggers for obsessions (going out with couples of friends who are considered perfect, watching romantic comedies, and other circumstances that trigger the sequence of comparisons with one’s relationship).
Just as in OCD, such compulsions only relieve anxiety in the short term, but actually lead to worsening of symptoms. In addition, there are negative effects on the relationship with the partner: for example, the constant pressure exerted by the person concerned to obtain reassurance can be a source of tension, just as the partner’s adaptation to compulsive rituals and avoidance of trigger situations also contributes to the worsening of symptoms.

Relationship OCD manifests in two symptom forms:

  1. with relationship-focused OCD symptoms;
  2. with partner-focused obsessive-compulsive symptoms.

In the first form, relationship-centered, the doubts and concerns are about the person’s feelings toward the partner, the partner’s feelings toward the person, and judging whether or not the relationship is right (“Do I love him/her?” “Am I okay with him/her?” “Does he/she really love me?” “Is this the right relationship for me?”). In the second form, partner-focused symptoms, the obsessive doubts are instead about perceived deficiencies in the partner’s physical appearance, intellectual abilities, social skills, or personality traits such as level of morality. Clinical experience and research suggest that these two forms may often coexist and feed off each other over time.

Intrusive thoughts about the relationship are experienced as egodystonic because they contradict the subjective experience of the relationship as perceived by the person (“I love him/her, but I can’t stop questioning my feelings”) or are contrary to one’s values (“Looks shouldn’t be important in choosing a partner”). These intrusions are therefore perceived as unacceptable and unwanted, and often lead to guilt and shame, promoting self-criticism and greatly reducing quality of life. The time and energy spent on these doubts and concerns also interfere with the person’s daily functioning.

Onset of OCD

Regarding the age of onset of OCD, the first symptoms usually appear in early adulthood and tend to persist throughout the person’s history of romantic relationships. However, some people trace the onset of their symptoms to the first time they were faced with decisions that involved a commitment to their relationship (moving in together, getting married, having a child, …). Although symptoms seem to be most debilitating when they occur within a relationship, symptoms of OCD can also occur outside of a relationship, such as with obsessions about past and future relationships. For example, some people report symptoms at the end of a relationship, reporting that they are obsessively worried that they have lost the one person who is right for them.

To cope with the fear of regret, they make constant comparisons with their current partner, persistently try to remember the reasons for the breakup, or recall the conflicts they experienced to reassure themselves that the breakup was right. In contrast, others report avoiding relationships altogether for fear of experiencing the same symptoms again or for fear of harming others (e.g., “I’ll drive her crazy,” “That would be a lie”).

Types of Relationship OCD

There are two common manifestations of this symptomatology: relationship-centered OCD symptoms and partner-centered OCD symptoms.

Relationship-centered

In the first case, people feel haunted by doubts and worries about how they feel about their partner, how their partner feels about them, and how “right” the relationship is. They may have recurring thoughts such as “Is this the right relationship for me?” or “What I feel is not real love?” or “Am I okay with him/her?” or “Does my partner really love me?”

Partner-centered

In partner-focused symptomatology, on the other hand, the core of the obsession is represented by physical characteristics of the partner (e.g., a body part), social qualities (e.g., not possessing the prerequisites for success in life), or even aspects such as morality, intelligence, or emotional stability (“He is not smart enough for me,” “He is not a sufficiently stable person with whom I can carry out a family project”).

The relationship between the two types of symptoms

The two types of symptoms are not mutually exclusive in the same person. Clinical experience and research have shown that relationship-centered and partner-focused OCD symptoms often occur together.

Many people describe first worrying about a perceived flaw in their partner (e.g., physical appearance) and then being plagued by thoughts about how “right” the relationship could be given that same physical limitation.

The reverse may also occur: one begins to have doubts about the relationship and only later becomes concerned about some defect in the partner. In this case, the intrusive thoughts about the partner’s defect could be seen as a sign that something is wrong with the relationship.

Relationship OCD: behavioral strategies

Compulsions

As a prerogative of any form of OCD, doubts and worries are associated with a variety of compulsions, the purpose of which is to attempt to suppress/reduce the frequency of these thoughts, as well as to reduce uncertainty about their content.

The most common compulsions that people with obsessive-compulsive disorder (OCD) tend to engage in are the following

Monitoring and controlling their own feelings (“Do I feel love for my partner?”) and behaviors (“Am I looking at other women/men?”);
Comparing one’s relationship with others, such as friends, co-workers, or even the romantic relationships of TV personalities (“Am I as happy as they are?”);
reassuring oneself by recalling experiences with one’s current partner in which one felt certain about one’s feelings.

Avoidance

People with relationship OCD often try to avoid situations that might trigger their unwanted thoughts and doubts about the relationship.

For example, they may avoid social gatherings with friends who are perceived as “the perfect couple. If these circumstances were not avoided, they would spend all of their time comparing their own behavior to that of their friends and noting the differences, which would then be taken as confirmation that their relationship is not “right.

Similarly, pleasurable activities, such as watching a romantic movie, may be avoided for fear of discovering a discrepancy between how they feel about their partner and the passionate and overwhelming love that may characterize the movie’s protagonists.

Relationship OCD: the cognitive elements

It is widely recognized that different reactions to internal events play a role in the development of OCD.

In the specific case of relationship OCD, for example, individuals may attach great importance to the couple’s relationship as a fundamental part of their being, of who they are.

Thus, if one’s self-esteem and self-worth are closely tied to the relationship domain, one will inevitably be hypervigilant about everything related to the relationship, to the point that a normal feeling of boredom in the relationship with one’s partner may have a significantly negative impact on one’s sense of self.

Similarly, these people will be more sensitive to thoughts about their partner’s qualities if some flaw in the partner is perceived as a reflection of their own self-worth.

Here, how the partner compares to others and how he or she is viewed by the rest of the world can reverberate through the person’s self-image, resulting in negative emotions (e.g., shame, guilt).

Dysfunctional beliefs

Certain beliefs about relationships may also be particularly relevant to the maintenance and development of relationship OCD. For example, catastrophic thoughts about the harm of being in a relationship in which one has doubts, or about the negative consequences of breaking up an existing relationship for the other (e.g., “Ending a relationship with a partner is one of the worst things that can happen in a person’s life”) and for oneself (“The thought of living my life without him/her terrifies me”).

These people usually have rigid beliefs about how they should feel in a “right” relationship, such as “If you don’t think about your partner every moment of the day, it means he/she isn’t the one” or “If you’re not always happy when you’re with him/her, it’s not true love.

Finally, perfectionism, intolerance of uncertainty, the importance of thoughts and their control, and hypertrophic responsibility, which are some of the typical beliefs in obsessive-compulsive symptomatology, are also present in relationship OCD.

OCD in relationships: a look at the research

From the research to date, symptoms do not appear to be significantly related to relationship length or gender. The etiology and maintenance of the disorder appears to be a combination of factors. Studies to date have found that vulnerability in the relationship domain, coupled with anxious attachment, may lead to increased susceptibility to the development of OCD symptoms. For example, vulnerability to intrusions that challenge self-perceptions in the relational domain (e.g., “I am not okay with my partner right now”) may lead to catastrophic beliefs (“Staying in a relationship I am not sure about will make me unhappy forever”) and even other dysfunctional beliefs (“I should not have such doubts about my partner”), which may be followed by behaviors that attempt to neutralize these intrusions (e.g., constantly seeking reassurance that the relationship is going well).

Similarly, if a person’s self-esteem depends on the value placed on his or her partner, any thoughts related to his or her possible shortcomings may lead to partner-focused obsessive-compulsive symptoms. Such intrusive thoughts in this case may trigger beliefs such as, “He is not smart enough. He will never be able to take care of our family,” with associated neutralizing compulsions, such as monitoring the partner’s grammatical errors.

In addition, there may be social factors at play, such as increased access to social networks and dating sites and platforms that result in extensive exposure to other potential partners. An increased availability of alternatives, along with a tendency to want to make the perfect choice, may contribute to increased doubts about one’s relationship choices.

In addition, many people with OCD report a family history characterized by intense and overt conflict between parents, so it seems that this may also be a vulnerability factor for OCD.

Treatment of relationship OCD

The need for therapy in these patients often comes at a time of relationship instability, when OCD is often comorbid with other disorders, such as depression, other anxiety disorders, or other obsessive-compulsive symptoms, making the diagnosis of OCD often difficult. According to the authors (Doron, Derby, Szepsenwol, 2014), in addition to good assessment, treatment should include psychoeducation and identifying and challenging dysfunctional thought patterns and self-perceptions, as well as attachment-related fears and defenses.

Psychoeducation helps the patient understand the conceptual model of OCD and the influence of symptoms on decision-making processes. It is also important to explore with the patient the impact of OCD symptoms on his or her ability to feel, and to agree to postpone any decisions about the relationship being experienced until the symptoms subside.
Regarding the cognitive component of treatment, maladaptive beliefs typical of OCD, such as intolerance of uncertainty, importance of thoughts, perfectionism, etc., need to be identified and challenged. In addition, catastrophic beliefs about relationships (“If I’m insecure about my relationship, I’ll be unhappy forever,” “If I commit to this relationship, I won’t be able to get out of it,” “If I leave my partner, I’ll regret it forever”) should also be challenged.

Experiments and behavioral exposures can be very useful, such as written elaborations on the fear of regret and feared scenarios (such as marriage), and in vivo exposures to websites and movies that trigger relationship obsessions (romantic comedies, …). It is also important to highlight the consequences of strong monitoring of one’s own internal states, for example through experiments in monitoring feelings of closeness to the therapist to be done in session.

Fear of abandonment and the link between the value attributed to the self and the relationship with the partner should also be explored with the patient in order to promote other sources of self-esteem. In addition, the symptoms of OCD may cause conflict, but the conflict itself may also cause obsessive doubts about the relationship, so training in communication and conflict resolution skills through role-playing may also be useful.

Again, with the patient’s consent, one might consider involving the partner in the therapy to assess the partner’s reinforcement of symptoms and to suggest strategies for reducing harmful reciprocal influences.

The goal of therapy is not to save the relationship, but to help the patient reduce symptoms. Symptom reduction is often associated with a better understanding of one’s own feelings and improved decision-making skills. If these do not improve, the introduction of problem-solving techniques and decision-making strategies is suggested to help the patient make important relationship decisions (Doron, Derby, Szepsenwol, 2014).

Guy Doron and colleagues, in their 2014 review, also point to the importance of continued research to improve understanding of the factors associated with relational OCD, in part because many of the studies to date have not been conducted in clinical samples.

Recently, Doron and his colleague Guy Ilany also reported that they are working on the development of an innovative app to aid in the treatment of symptoms of OCD. The app is expected to be available for download next June and would include 30 levels related to various difficulties present in OCD, such as relationship doubt, intolerance of uncertainty, perfectionism, fear of commitment, and embarrassment.

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