Relationship OCD and what you can do about it
Relationship OCD or R-OCD is a common label for a subtype of OCD that tends to show up as repetitive, ineffective relationship behavior. I’ve written before about why I don’t like all of these X-OCD labels. H-OCD could be homiocide or harm OCD or homosexual OCD. It’s too much. It’s all OCD and a lot of these subtypes tend to be simple topics-of-focus in “purely-obsessional” OCD (also a misnomer in my opinion as well because there are compulsions in pure-O). But I digress…
Getting back to (FINE we’ll call it R-OCD). R-OCD: What is it and what can you do about it? I find that I learn best in stories so I’m going to share some fictional story excerpts that illustrate how R-OCD might show up in a relationship:
Person A is a college student who struggles with the uncertainty of her relationship with her live-in boyfriend. Rather than overtly face the uncertainty of relationships between young people, she developed a safety-speech about all of the reasons she and her partner will be together forever. Her OCD drives her to repeat this to herself “perfectly” whenever her anxiety gets uncomfortable. She has to start over if she gets any part of the speech wrong. Her triggers include when her boyfriend goes out, when she’s around other girls, or when she feels her boyfriend is “distant” or different in any way.
Person B has intrusive thoughts about his partner cheating on him when they’re out with friends. He texts his partner frequently, all night long. Person B feels temporary relief when he gets a text back but within an hour, he needs another text or call from his beloved to feel “safe.” He gets upset if his partner doesn’t participate in his ritual by returning messages promptly.
Person C notices small imperfections on her partner’s body and then judges herself harshly for thinking anything critical about her partner. She tells herself that she’s a “piece of shit” for being “so, so shallow,” about her appearance. She overall feels attracted to her girlfriend and doesn’t understand why these small things catch her eye and force her into a cycle of hyper focus and avoidance. Almost every R-OCD episode leads to the ultimate conclusion within her own mind that she’s a “terrible person.”
Person D has rigid rules about never being broken up with and therefore, often breaks up with partners before they can break up with them. They monitor every relationship for signs that their partner may leave and they start the departure prior to their partner initiating it. They haven’t had a close relationship with any romantic partner for this reason. They monitor all relationships for the first sign of failure and promptly respond by pushing them away as a way to feel safe. After they get distance, they often find themselves regretting their actions and try, once again, to achieve some closeness.
All of these are examples of relationship OCD patterns. While one story does not make for a diagnosis, each of these vignettes illustrates a typical story for someone with R-OCD. In each case, the OCD sufferer is unwilling to acknowledge the messy and uncertain nature of our human relationships and rather than trying to accept that uncertainty.
The pattern goes as follows: The sufferer’s sense of anxiety is triggered. It may be triggered by something close to the relationship or they may channel other anxieties into R-OCD behaviors. Their anxiety is channeled into a particular area of obsession within the relationship. They then seek to soothe that anxiety by performing safety behaviors or rituals (compulsions), which are often only loosely connected to the relationship itself. Those rituals provide temporary relief and reinforce their belief that they MUST perform the ritual to feel safe. Relief is temporary, however, and they are soon in the cycle of anxiety, obsessions, compulsions, temporary soothing, and intensification. You can map nearly any case of R-OCD onto this cycle. Perhaps I’ll go as far as to say you can map ANY case of ANY OCD onto this cycle.
WAIT - What about attachment and/or trauma?
You make a legitimate point, fellow therapists: Attachment and trauma are perfectly valid ways to conceptualize these types of relationship behaviors. That said, by the time a clinician or client ends up in my practice, it’s often because they’ve already considered both of these angles, done interventions targeted at attachment issues and trauma, and found them not to work. Most therapists are more trained in both attachment and trauma than OCD so usually that’s been looked at already. That’s not to say that attachment and trauma interventions won't work in all cases that look like the above! It’s just that when they don’t work, I start looking at OCD (because of course I do… I’m an OCD specialist).
How do we intervene?
As in all OCD cycles, we must stop the cycle to help the sufferer disengage and (eventually) find a sense of acceptance in uncertainty. This is the Exposure and Response Prevention (ERP) part of treatment. We practice getting out of the OCD cycle over and over again, starting with small triggers and moving onto bigger ones, WITHOUT using safety behaviors.
With R-OCD, because it intersects with something so important to the sufferer (love and connection), we also use ACT to explore their values and develop a valued vision of their relationship future. I also advocate for building more psychological flexibility within their value system, to serve their future relationships. These additional psychological skills can help them more easily identify and pursue a valued future relationship and inoculate them against anti-relationship, pro-OCD behaviors in the future.
Here are some example “very brief treatment plans” for each fictional individual above.
I would help person A talk about how most people do not end up forever-partnered with their college sweethearts and to think about how to create a great love story with her partner, with an open ending. Exposure would be based around being able to handle having those thoughts on her own and perhaps being able to discuss them with others.
With person B, I would have them talk about their core values about independence and trust in relationships. We would verbally sketch out THEIR ideal trusting relationship and perhaps identify valued activities for them to participate in when their partner is out with their own friends. We would focus ERP on discontinuing “checking” behaviors with their partner and teach them to spot their own reassurance-seeking behaviors and stop them.
For person C, I would focus exposure on practicing calling out all of her girlfriend’s imperfections and sitting with that discomfort while also affirming how much she loves and is attracted to her partner. We also might imagine her girlfriend noticing all of the client’s imperfections, even as the girlfriend loves her completely. I would normalize the ability to notice imperfect things about our partners even as we choose to accept them actively.
For person D, I would likely first work on amplifying the client’s values and desires for true partnership with another person and work on accepting the idea of vulnerability and intimacy being inextricably linked. We then would develop strategies for sticking with a relationship, even when the possibility of being broken up with exists and use the client’s own values to inform their dedication to sticking with a relationship beyond the point of perceived sure security. We may have to wait until they’re in their next relationship to practice some of the “sticking with it” skills as this would be a difficult presentation to design direct exposures for.
Exposure + psychological flexibility
In all cases of “pure-O” OCD, we have to work on exposure to OCD triggers so we can practice disengaging from safety behaviors, while also increasing awareness of the client’s core values and defining valued-behavior for each client. Deriving a standard of “non-OCD” behavior from each client’s own values, provides a guiding light for what it looks like to disengage from their OCD cycle.