The OCD Cycle

We live in a society where we do not like to be uncomfortable and where we have difficulty tolerating distress. Anxiety is an emotion that has a lot of negative connotations and leads us to quickly try to find solutions and go into problem solving mode. For some people, the danger signal gets attached to everyday neutral things like other people, social situations, doorknobs, dogs, physical sensations or emotions. The actions we take when anxiety is present are called safety behaviors, or within OCD, they are called compulsions. These actions are intended to decrease our distress, which they do, but only temporarily. Some common safety behaviors are avoidance of anxious triggers, reassurance seeking, researching, substance use, washing, counting, etc. Since these behaviors actually work (but only in the short-term), people continue to use them. Unfortunately, continuing to rely on these safety behaviors causes individuals to get trapped in this cycle and prevents them from learning that the fear was unfounded or tolerable. Ironically, these safety behaviors and compulsions only maintain the fear in the long run while simultaneously preventing growth and learning, which can severely limit an individual’s life. The thought, situation, emotion, or body sensation that creates the anxiety might be different within each presentation of OCD, but the cycle that maintains anxiety is exactly the same. Please see our previous blog entry – Understanding the Cycle of Anxiety – for further information.

What is Relationship OCD?

It is common for many to have worries in intimate relationships with significant others.  Worrying about whether you are in the right relationship or about your partners loyalty to you is common.  However, for some people, these fears can become excessive and time consuming and take over the relationship turning into obsessions and compulsions.  That is when we know relationship OCD is present. Relationship OCD is a subtype of OCD defined by obsessions and compulsions related to a preoccupation with fears of being in the wrong relationship, fear of not truly loving your partner, or fear of not truly being loved by your partner. While many people can be anxious and insecure in relationships, individuals with OCD experience a high level of anxiety and fixate on determining answers to topics and questions that are unanswerable that can create significant distress and impairment in their life.

Common Obsessions in Relationship OCD

Partner-focused obsessions:

• My partner looks less attractive than me. Can I find someone more attractive?
• We have no sexual chemistry. Can I find something better than this?
• Would we be better off as friends?
• Should I look for someone more motivated or career-oriented?
• They aren’t my usual type, maybe that’s why I’m not certain in my relationship?
• They are quiet. What if my support system thinks they are boring or I’m settling for less?

Relationship-focused obsessions:

• The myth of “the one”
• I don’t have butterflies with my partner, does this mean something is wrong?
• They don’t pay the same attention to me that they used to, are they losing interest?
• I cannot be fully aroused when intimate. Are we not sexually compatible?
• Other couples (i.e. friends, family, celebrities) seem so happy. Why don’t I feel like this in my relationship?
• I don’t miss my partner as much as I did in past relationships. Does this mean that I’m not that into this relationship?

These examples are just a few of many doubts that may arise in relationships. These thoughts can create a high level of anxiety for the individual and make them feel a need to engage in compulsions and/or rituals in an attempt to mitigate their doubts. These intrusive thoughts can also impair their ability to concentrate at school or work. Such obsessional thoughts create conflict and concerns in personal relationships and lowers the ability to connect with loved ones. These consequences can create additional obstacles and barriers to overcoming and recovering from OCD.

Common Compulsions in Relationship OCD

Compulsions are defined as any intentional thought or behavior done in an effort to neutralize or reduce the distress caused by an individual’s anxiety. Within the context of Relationship OCD, these can include:

• Checking to see if you are in love enough with your partner
• Checking partner’s attractiveness or physical appearance to see if you’re attracted
• Checking physical arousal during sex to see if you’re attracted
• Checking and comparing your relationship to others or your past relationships
• Seeking reassurance from friends and family members on the “rightness” of your relationship
• Seeking reassurance or repeatedly asking partner if they love you
• Searching online to find signs that your partner may or may not be “The One” (i.e online blogs, tests, quizzes)
• Avoiding intimacy or sex for fears of getting triggered with doubt
• Avoiding committed statements or actions for not being “certain” of relationship
• Avoiding talking about your relationship with others for fear that you don’t sound in love enough or others will tell you it isn’t a good match
• Avoiding spending time with attractive people for fear that you will find them more attractive or appealing than your partner
• Avoiding watching romantic movies, reading romantic books, listening to romantic songs for fear of being triggered
• Mental review of past situations for how they looked/sounded, events attended, reactions, and reviewing feelings in these moments
• Rumination on rightness of feelings or thoughts on relationship (Please see our previous blog entry – Rumination — for more information)

Differences Between Relationship Anxiety (RA) and Relationship OCD (ROCD)

Both Relationship Anxiety and Relationship OCD can feel very real and create significant distress. The biggest difference in these two anxieties is if the individual meets the diagnostic criteria for an OCD diagnosis, or presence of both obsessions and compulsions, with anxiety related to relationships that create significant impairment and distress in the person’s life. Regardless of the label of the symptoms, the treatment for both presenting issues would be the same (see below).

Treatment of Relationship OCD

The most evidence-based treatment for Relationship OCD is Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT). Through ERP, individuals can engage in exposure to fears in order to help them to learn to tolerate uncertainty, discomfort, and doubt that their OCD creates, especially because these thoughts and questions often do not have answers. Exposures can include anything that triggers uncertainty about the relationship or future relationships. Other examples include observing stimuli that targets uncertainty related to attractiveness, quality of connection in relationships, creating worry statements or written scripts of worst-case scenarios, watching movies or shows (The Timer, Black Mirror episode Hang the DJ), reading articles, or posting on social media about the relationship. ERP focuses on exposing individuals to these thoughts and having them refrain from engaging in compulsions. In doing so, individuals are able to teach themselves a new way to respond and will likely experience a reduction in anxiety. If their anxiety does not decrease, they will at least learn that they can handle the anxiety and uncertainty that these thoughts create. Please see our previous blog entry — What is Exposure and Response Prevention (ERP) – for more information about this treatment.

Within ACT, individuals are introduced to the concepts of mindfulness and acceptance, helping them to be present with these thoughts without trying to change them or engage in compulsions. Interventions focusing on increasing acceptance of uncertainty and doubt are necessary to supplement ERP work in the treatment of Relationship OCD. Acceptance is making space for the thoughts and worries to be present without feeling the need to react or respond to them. Struggling against painful and distressing thoughts is likely to create more emotional suffering. Using ACT-based strategies, individuals are better able to differentiate their thoughts and values from their OCD and identify if the behaviors they are engaging in provide them joy and pleasure (which is the goal), or if they are behaving in response to anxiety and uncertainty stemming from their OCD. They are able to learn to be aware of their thoughts and fears while not paying more attention to and/or over-engaging with them. The goal is to learn to live life and participate in activities that are important, even if the thoughts are present. Thus, ACT is employed to increase psychological flexibility and reduce the cognitive rigidity seen in OCD by helping people to defuse from their obsessive/intrusive thoughts and maintain a present-focused awareness. Outside of therapy, individuals with Relationship OCD can also benefit from medication.

Need help or support?

If you or a loved one are struggling with OCD or any other mental health concerns, know that you are not alone. If you are a parent or a caregiver and are seeking additional information about these diagnoses and how you can best support your child, our office provides parent training with the SPACE program. Please see our November 2021 Newsletter for more information on SPACE.

For these or any other mental health concerns, please contact The OCD and Anxiety Center at (630) 522-3124 or info@theocdandanxietycenter.com. We have offices in Oak Brook and Orland Park that specialize in helping individuals overcome anxiety. We provide telehealth services that are available in Illinois, Indiana, and Iowa.

At The OCD and Anxiety Center, we can provide treatment both in the office and at off-site locations (your home, mall, school, etc.). We will work closely with you to create an individualized treatment plan and discuss the frequency of visits, having the ability to meet with you once a week or more if needed. We look forward to hearing from you!

Click here for more information on OCD Treatment.

Stephanie Pruefer is a Licensed Clinical Professional Counselor at The OCD & Anxiety Center in Oak Brook, IL and Orland Park, IL. She specializes in treating all forms of OCD and anxiety in children, teens, and adults. She provides Exposure and Response Prevention Therapy and is comfortable working in and outside the office, wherever anxiety happens.