Serious young couple, woman with head in hands

What We're Learning About Relationship Obsessive-Compulsive Disorder (ROCD)

“During the holidays my obsessions are the worst. Doctor, I must know whether I’m in the right relationship! I cannot go on like this. Every little thing triggers my relationship doubts. When I see couples buying each other holiday gifts or families going shopping with their kids, I think ‘Do I love my partner that much? Is he the one I want to have kids with?’ Even everyday experiences such as seeing other interesting-looking men in the street or someone posting an interesting post on Facebook trigger thoughts such as, ‘This person may be a better fit for me than my current partner.’ These thoughts and doubts have a real negative impact on my life. I do not know what to do! I check and recheck how I feel towards my partner, whether I’m really in love with him and whether I am passionate about him. The problem is my feelings change all the time. At times, I am not sure whether I love him and I obsess about his incompetence and slowness. I fear he will embarrass me in front of my family or friends. Other times, I miss him, want to be with him and I think I love him. Not only that… I get obsessively jealous about him. I check his Facebook page (I have his password) and his phone all the time. I interrogate him about his day, who he spoke with and why. Please tell me, should I stay with my current partner?”

Intense preoccupation with whether one is in the right relationship is the hallmark symptom of relationship obsessive compulsive disorder (relationship OCD or ROCD). Our clients describe hours a day doubting the strength or quality of their feelings towards their romantic partner and the “rightness” of the relationship and their partner’s feelings towards them. Other clients describe being obsessively preoccupied with the perceived flaws or deficiencies of their partners. They spend several hours a day thinking about flaws in their partner’s appearance (e.g., body proportion, hair, facial features etc.), character (e.g., intelligence, morality, social skills) or both. They often describe being extremely distressed by these doubts and preoccupations.

I always ask my clients, “Do you make any attempts to get rid of these thoughts or to reduce your anxiety?” More often than not, they describe a long list of strategies and behaviors they use to reduce their distress. They describe asking others for reassurance regarding their relationship, they monitor their body for feelings of love or passion and compare the qualities of their current partner with the qualities of other potential partners. They also try “not to think” about their partners’ flaws and the relationships and avoid situations where their doubts and preoccupations are triggered. In addition, many clients use self-criticism (e.g., “I’m so stupid for having such thoughts.”), self-reassurance (e.g., ”He is smart – he said something intelligent the other day.”) and many other strategies to reduce their doubts and distress.

Of course, from time to time, we all have doubts regarding our partner or our relationship. Psychological intervention is warranted in cases where such doubts and preoccupations are distressing, time-consuming, and lead to problems in functioning in areas of life such as work, school, or social interactions.

My colleagues and I started investigating ROCD in 2012. We noticed some clients diagnosed with OCD did not respond well to treatment. These clients seemed to have obsessions and compulsions in a very specific domain: romantic relationships. Most of these clients initially sought couple or family counseling, but these interventions did not seem to address their difficulties. Their relationship had problems, but mainly as a side effect of one partners’ doubts and preoccupations. The core of the problem did not seem to be the couple or family dynamics.

Applying cognitive behavioral therapy (CBT) for OCD helped many of our ROCD clients. However, they did not respond as well as we expected. Both ourselves and our clients felt there is something missing in the therapeutic process. We have decided to look for more ROCD-specific targets for CBT. We looked at the professional literature but did not find much research focusing on this presentation of OCD. Therefore, during the last few years, we have started researching ROCD to get a better understanding of ROCD symptoms, what maintains ROCD, and ultimately how to better help our clients. We interviewed clients, developed questionnaires and assessed the impact of ROCD symptoms on peoples’ lives. We found that ROCD symptoms may cause difficulties in sexual functioning and reduce relationship satisfaction. We found that ROCD symptoms are associated with other OCD symptoms but also with depression, anxiety, and symptoms of body dysmorphic disorder (BDD, being obsessed about one’s own perceived physical flaws). In some cases, a person’s ROCD symptoms may lead their partner to obsess more about the relationship as well as their own flaws. Finally, we found that ROCD symptoms may also be associated with obsessive jealousy.

Importantly, our research and clinical work further informed us about the problematic strategies people use to deal with ROCD symptoms and the maladaptive beliefs and self-vulnerabilities that may maintain ROCD symptoms. For instance, we found that people with ROCD often compulsively monitor their own feelings towards their partner. Such increased monitoring reduces their ability to truly experience emotions which further increases their doubts and preoccupations. Clients with ROCD also report extreme beliefs about romantic relationships (e.g., “Being in a wrong relationship will destroy me and I will never be able to get out.”), love (e.g., “If you have any negative feelings towards your partner, it’s not real love.”) and regret (e.g., “I will never be able to cope with feelings of regret.”). Holding such beliefs increases relationship-related anxiety and negative interpretations of daily events. For example, believing one should never have negative thoughts or feelings towards a partner may lead people to interpret everyday fluctuation in mood and naturally occurring critical thoughts as indicating something is wrong with their relationship. Our experience suggests that using CBT techniques to address extreme beliefs regarding romantic relationships and self-vulnerabilities may improve therapy outcome.

Unfortunately our understanding of ROCD is not complete and requires more research. At the relationship OCD research unit (ROCD-RU), we are doing our best to learn more about ROCD and disseminate our knowledge. On our website, we provide full access to papers/book chapters on ROCD. We have developed mobile applications to help with the treatment of ROCD (for iPhone and Android) and other OCD symptoms (for iPhone; for Android), and we are working on an ROCD treatment manual. Our goal is to enhance and disseminate knowledge of the causes and consequences of ROCD symptoms to reduce misdiagnosis and improve existing evidence-based treatments.

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When My Date Tried to Make OCD a Punchline

I went on a date recently, and this guy was awesome. It was going great, and the thought had crossed my mind that I would like to go on a second date until he told his favorite joke. It involved mention of bubble wrap, repetitive hand-washing, and obsessive compulsive disorder (OCD). He laughed loudly, and I forced an uncomfortable half-smile as I tried not to make eye contact.

The joke hit way too close to home, but I couldn’t tell him that. I was still coming to terms with my diagnosis, and I was certainly not ready to share this intimate detail of my life with the guy I had just met who found the whole thing to be oh so laughable. I just wanted to tell him that it really, really wasn’t funny.

I wanted to say my mental illness is not a joke. Yet, here I was, expected to laugh about OCD, which was right then the heaviest burden in my life. This social situation demanded I laugh, but mental illness is not a joke.

We’ve all heard it. They laugh and say, “I’m so OCD about _____.” Then, they go on about how they like to alphabetize their DVDs or how they like to load the dishwasher a certain way. They say it when they talk about how they like to keep their dresser tidy or how they like to have their socks match.

I can’t really blame them. I mean, I used to say things like that, too. I even used to watch a television show called “Monk,” which was about this wildly successful private detective who had OCD, and I used to laugh at his little compulsions. I thought it was amusing how everything had to be in multiples of 10 or how he had to put his clothes on in a certain order. I thought it was hilarious how he would get side-tracked and have to touch every point on a picket fence or how he always had to have hand wipes nearby.

I laughed. I thought it was funny. However, his mental illness was not a joke either.

I used to do it, too. Believe me when I say I am sure they say it because they don’t know better, and I am sure they don’t mean to irritate me or make me feel like less of a person. However, that doesn’t change the fact that it’s not OK to say stuff like that. Just because you’ve never had to actively regard your mental health does not mean you get to joke about people who do. Yet, I can’t open my mouth and tell you this because I will be met with awkward stares and the ever-so-belittling, “Can’t you take a joke?”

No, not this one. Because mental illness is not a joke.

You haven’t had to deal with obsessions, compulsions, repetitions, intrusive thoughts, the immense stress that anyone with OCD must face on a daily basis, the depression that often accompanies it, the anxiety attacks or that unmistakable feeling of brokenness as you long for the days before you first started feeling any of this. You’ve never had to wonder what it would be like to live without OCD because you’ve never lived with it. You’ve never stayed up at night wondering if it could have all been avoided, thinking that maybe, just maybe, you were in the wrong place at the wrong time when the stars aligned and the universe just nonchalantly dropped this heavy illness in your unsuspecting hands. You’ve probably never kept such a huge secret from so many of the most important people in your life.

My mental illness is not yours to joke about.

People say, “I am so OCD” rather than, “I have OCD.” Yet, here’s the thing. OCD is not a character trait. It is not something you “are,” and it is definitely not something I am. I am compassionate, outspoken, resilient, artistic and sometimes relentless, but I am not OCD. I am a daughter, a friend, a student, a shower-singer and a cat lover, but I am not OCD. I am a lot of things, but I am not OCD.

I have OCD. That is to say, OCD does not define me, but it does affect me. If it were something I am, like a character trait or even a flaw, then I could get rid of it. I could change. Trust me, I would if I could, but it’s not. I can’t change it, and I would like the world, and especially the people I love, to recognize that. Believe me, if I could choose a different kind of struggle, then I would. So please don’t joke about it.

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I Have OCD. This Is What It’s Like to Be in My Mind for 3 Minutes.

OCD is Not Just Neatness

OCD is not just neatness.

drawing of a woman with gears coming out of her head

When It Feels Like the Thoughts Won't Ever Stop

Editor’s note: If you struggle with obsessive compulsive disorder (OCD), the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741-741. To find help visit International OCD Foundation’s website.

Imagine you’re in the car, turning the knob on the radio as you try to find a clear station.

For some reason, no matter how much you search, all you can find is static. Each station blasts a garbled jumble of sound through your speakers and you only manage to catch a few words.

Imagine those words are screamed at you and each one says something that stirs up a sick, guilty feeling within you. One is full of blaring curse words and blasphemous names that make you feel so dirty you have to apologize repeatedly to God to make sure he still loves you. Another screeches out descriptions of various sexual acts that somehow get stuck in your head on repeat, even though you’re disgusted nearly to the point of tears. The next station tells you in a hissing whisper everyone you love is angry at you and they all actually hate you. The station after tells you to meticulously focus on every single part of your body, because what if you’re getting sick and you just haven’t realized it yet? Still another gives you a graphic account of what it would be like to purposefully injure your beloved pet and you’re terrified because now you’re wondering: what if I want to do that?

Now imagine all those stations playing at the same time. Imagine them playing from the moment you wake up until the moment you fall asleep. Sometimes they even play in your dreams.

This is what my obsessive compulsive disorder is like.

Often times, when I have talked about my OCD with mental health professionals, it seems we mostly discuss my recurring obsessions and compulsions — the obsessions and compulsions that are a consistent, unchanging part of my life.

These include things like my fear of getting sick and subsequent need to wash my hands and avoid touching certain objects, as well as my need to tap things like light switches and faucets in multiples of four because otherwise I don’t feel right.

We rarely talk about the static — the never-ending buzzing swirl of intrusive thoughts playing through my brain 24/7. And it’s frustrating. Yes, I want help with stopping the need to wash my hands all the time, but I want just as much help in dealing with the thoughts that attack out of nowhere.

When people talk about OCD, they are typically interested in what a person’s outward compulsions look like — things like washing your hands, organizing things symmetrically, flipping the lights on and off, etc. But there’s so much more to the disorder—so much that no one can see. And to me, that’s the most terrifying part.

My outward actions are far less distressing than the internal thoughts constantly bombarding my brain. Sometimes there’s a loop and I’ll get caught in it for hours or days or weeks or sometimes years. But there’s always static — the endless battle of intrusive thoughts buzzing in my brain, pulling my attention away from the present.

I can be brushing my teeth and I’ll suddenly have a horrific image of grabbing my dog and brutally wounding him. I sit down to write and the thoughts tell me loudly something doesn’t feel right and I physically can’t even begin typing. I’ll be laughing with friends when suddenly alarms in my brain start to sound because what if I unknowingly said something horribly offensive and now they hate me? What if I’m a bad student, even though my grades are excellent? What if I’m gay? What if I’m not a good daughter? What if I didn’t try as hard as I should have on my homework? What if God hates me? What if I’ve committed some kind of unpardonable sin? What if my thoughts make me evil? What if I was accidentally rude to a coworker the other day? What if…

It never ends. I wish it would. In the past four months, it seems I’ve tried so many medications, but so far nothing really truly works – at least not without making me feel exhausted and discombobulated to the point where I physically can’t move. It’s a tiring and discouraging process. I just want a moment of quiet.

While I wait to discover the right combination of medications, my hope is I will find the right therapist. And I hope when I find them, their focus will not only be on my recurrent, consistent obsessions and compulsions. I hope they will give me a chance to explain the thoughts that never stop. I hope they will listen.

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When Obsessive-Compulsive Disorder Meets Religion

When I was 12, I was approached by someone. He introduced himself to me, and since then He always stuck around. He taught me about the way I should feel towards my morals, objects around me, people I already knew and people I’d meet. Most importantly, He taught me about myself. The never-ending flaws that needed correcting. He took it easy at first, always gave me second chances to do ordinary things, sometimes even more chances until I got it just right. He made it so my body would feel incomplete without doing things just the way He liked them, and when I finally did it right, He gave me relief. Sometimes I would become frustrated with him because it would exhaust me to keep doing things the way He liked them. I would feel bound to him as if my mind could not rest until his requests were met. He was controlling and never kept his promises. Sometimes He would promise me if I did everything right the right number of times in the right way He would let me stop for good, but He never did. As time went on, He started to become less lenient with me demanding more, wanting to be in every aspect of my life and doing everything He could to achieve this.

When I got older, my family went through a difficult time. He said He wanted to comfort me. He wanted to make it easier for me so when I knelt down to pray for my family, He wanted to make sure I did it the right way, His way. Sometimes He would make me doubt things, like who I was praying to. I needed to repeat God’s name, and I was reassured by him that now I was indeed praying to God and not the Devil. He was there all the time, whatever the situation. Anything around me could trigger disturbing thoughts in my mind, thoughts that cursed God, thoughts that I was convinced would have consequences that would harm my family. I started to question the sincerity of this man. I wondered why it was so necessary to do things his way and why I always felt so distressed afterwards. If He was helping me, why did the thoughts get worse when I was done obeying his commands? Why did it never end?  I soon realized this man’s promises were lies.

I was being blackmailed. Still, when I tried to fight back, He leaned closer and whispered, “If you curse me, you curse God.”

When I first started having symptoms of obsessive-compulsive disorder (OCD), it was unimaginable to think I could live the rest of my life this way. Completing a set of exhausting rituals with temporary relief followed by more anxiety.

I became trapped in a vicious cycle: Praying not to die for thoughts too unthinkable to mention, thoughts I did not feel in control of but took absolute responsibility for. Praying I would not experience condemnation, hell.

OCD can make you feel like you are never going to be a good enough person because no matter how hard you try, you never feel as if you do anything right or well enough to be truly happy, to find relief. Most disturbingly it can take something pure, enjoyable or important to you and turn it into something ugly and distressing.

The most popular mainstream ideas about what OCD is often include obsessive cleanliness, tidiness, organization and checking. Indeed, these are symptoms of obsessive-compulsive disorder that have a great impact on people’s lives, but there are other manifestations that don’t fit this category, making your obsessive and compulsive patterns less understood, leaving you to feel truly alone.

I’d rarely heard about the role OCD could play in religion, but when I finally did, I found out that it had name. Scrupulosity.

If you are experiencing this, you are not alone. Don’t struggle in silence because you might feel ashamed of your thoughts. They are part of this condition, and there is help available.  For more information about scrupulosity visit this website.

If you or someone you know needs help, visit our suicide prevention resources page.
If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255

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