​I have had an interest in treating OCD for more than 25 years and seen it take many forms. Common obsessions have included concerns about contamination from chemicals, sticky substances or germs; being infected with AIDS or herpes, accidentally harming or attacking loved ones or strangers, questioning one’s sexual orientation, being possessed, being a paedophile or rapist, flooding or burning the house down, being burgled, losing valuables, things being out of order or not “feeling right”. 

These intrusive thoughts then lead to all sorts of rituals including excessive hand washing; checking appliances, belongings, taps, lights, locks, seeking reassurance about what just happened; ritualised excessive praying; repeating behaviours a certain number of times and retracing ones steps or movements (either physically or in one’s mind) or re-reading emails, assignments, text books and letters.
 
The lives of these tortured souls become more and more narrow as they start to avoid situations that could trigger their obsessions. It can get to the point where some sufferers become unable to leave their room or perform basic activities we take for granted. The obsessions can limit behaviours such as showering, shopping, reading or writing, catching up with friends, preparing food or eating out, driving or catching public transport, using public toilets and cleaning the house. 
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​OCD tends to both wax and wane for the sufferer, becoming worse at times of increased stress. The tendency to obsess often arrives before the subject of its attention does.  If you have a mind inclined to obsess, it tends to look for a place to land – and relationships are a rich place for it to find a landing ground.
 
“Relationship obsessive compulsive disorder” or ROCD is a relatively new phenomenon. It was first described as recently as 2012.  However, it is receiving increasing attention by researchers and clinicians. When I started working in the OCD field, this condition was unheard of. However, recently, in one week, I had three clients who were referred for ROCD!
 
Essentially, ROCD is excessive ruminating about your feelings towards your partner or your partner’s feelings towards you, or the “rightness” of the relationship experience. ROCD, can cause you to spend hours analysing your feelings, or your partner’s flaws. It can lead to fears about your own inadequacies and whether you are about to be dumped or fears about future regrets. ROCD also leads to a great deal of reassurance seeking from your partner, friends and family or through internet searches. 

It's all about Doubt
It is doubt that gives ROCD oxygen. So why has ROCD arrived now? Is it because the current generation have witnessed so many parents separate that they worry about making the same mistake?  They are acutely aware of the impact on the rest of their life and the lives of children they might have.
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Combine this with easy access to the internet with a plethora of YouTube videos, quizzes and articles by relationship therapists and dating coaches. All offering advice to guide you in working out if you are with a “quality” partner or in a good relationship. While it is important to learn what we can about relationships and how to choose a healthy one, if you have a tendency to obsess, it may be better to see these experts in person than trawl the net and feed the doubt.
 
And then you have social media encouraging you to compare yourself and your partner with everyone else, promoting feelings of inadequacy and self-consciousness. And finally, we are now living in a world of internet dating and dating Apps where the options for choosing a partner have increased exponentially. Research has long demonstrated that the more choice you have, the harder it is to make a decision. This is known as the “paradox of choice” where more choice leads to less satisfaction. Again, it feeds us doubt. 
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All of these factors have created the perfect storm for those with the psychological and biological factors which predispose them to develop OCD, to have ROCD.

​Some warning signs of ROCD include:

• Spending a lot of time (more than an hour a day) ruminating about it
• Trying to counter the doubts by suppressing them or having thoughts to counteract them
• Constantly monitoring your feelings about and sexual attraction for your partner (nothing will kill this more quickly!)
• Excessively comparing your partner with others, or past relationships or characters in movies and novels
• Avoiding situations and people that might trigger your doubts
• Avoiding physical or emotional intimacy with your partner for fear he/she may end up being hurt
• Excessive time spent doing things designed to relieve your doubts like seeking reassurance from others
• Repeatedly asking your partner to confirm their love for you
• Confessing your doubts to your partner
• The doubts are unwanted and distressing
• The doubts are interfering with other aspects of your life (like work, study, family, socialising)
• The intrusive thoughts conflict with your values (e.g. you would not normally be concerned about this “flaw” in a person)
• The intrusive thoughts conflict with a part of you that knows that you have a reasonably good relationship
• The worries may be in the form of images, thoughts and urges, rather than just a verbal thought
• Other OCD symptoms or a past history of OCD
• A history of similar ruminations in previous relationships

​It can be very tricky if you have both ROCD and real concerns about your relationship. If this is the case, I suggest you postpone any decisions about ending the relationship until after you have had treatment for your ROCD, so your decision can be more reality based.
 
ROCD is treated with a combination of psychological strategies. These include learning about problematic beliefs which turn normal intrusions into obsessions; ways of challenging and managing intrusive thoughts; imaginal and real exposure to feared situations while stopping compulsive behaviours (like reassurance seeking) that maintain the ROCD.  Training in mindfulness skills to make it easier to let the thoughts come and go without engaging with them can also be helpful.
 
For more comprehensive information about ROCD and treatment, I recommend this website which was developed by the leading researchers in this field and contains numerous resources including information about the App they developed to assist ROCD sufferers.

There are many theories about what causes OCD. However, the cause of OCD is not fully understood as multiple factors – both environmental and biological, may be involved. These include brain functioning (for example, certain brain circuits (that help you decide to ignore or turn off urges) are not functioning. Also lower levels of serotonin (chemicals in the brain that help send messages between the brain cells) have been found with OCD. This is why medications which increase amounts of Serotonin like SSRI’s help. 

There can also be an inherited predisposition to develop OCD which maybe triggered (not caused) by environmental stressors. While many sufferers of OCD report a gradual onset and cannot identify a trigger, a large proportion of clients report acute onset following a significant life event. For example, some report the onset or worsening of symptoms coincided with pregnancy or the post-partum period.

Even though the exact cause of OCD is not known, it is clear what maintains this condition – rituals and avoidance. Thus, therapy can teach the OCD sufferer ways of managing and reducing this chronic condition. For more information about the best treatments for OCD, see my article.

Established psychological treatments
When it comes to psychological treatment, research suggests the most effective treatment is some form of Cognitive Behaviour Therapy (CBT). This would usually involve Exposure and Response Prevention (ERP) which means the OCD sufferer is asked to repeatedly confront the triggers of their OCD behaviour and refrain from doing any neutralising rituals.

For example, someone who compulsively checks locks when they leave their house would be asked to leave the house and only check once. Someone who fears contamination and washes repeatedly would be asked to touch something dirty and not wash, and to allow the anxiety to go down with time. While this may initially cause considerable anxiety, OCD sufferers soon learn that the anxiety goes down even when they do not ritualise. By repeatedly doing the ERP, they will create new pathways in their brain and the urge to check or wash will decrease.
 
Cognitive Therapy
Because ERP is a challenging task, often seeming too scary to even contemplate, it is broken down into manageable steps, sometimes beginning with delaying the ritual, or changing it in some way, before being able to resist doing it all together. Cognitive Therapy (CT) is often used before ERP to help reduce any anxiety about doing ERP.
 
Cognitive therapy with obsessional thoughts differs from traditional CT with “negative thoughts” as  instead of questioning the evidence for and against the obsession, (eg “I might harm someone”) and  trying to convince  someone they would not harm anyone,  it challenges the thoughts about the obsession (eg, “Having these obsessions means I need to take precautions because it could happen"). Learning to step back and observe obsessions rather than argue with them or try to stop having them is key to managing them.  

Involving Family
Family members can get unwittingly caught up in the OCD. Attempts to help, while calming the OCD sufferer in the short term, may end up making it worse in the long run. Moreover, hostility from relatives toward the OCD sufferer can lead to a poor response to treatment. Thus, educating family members about OCD and how to assist with ERP is also very important. 
 
Newer psychological treatments
While CBT is a well established treatment for OCD, more recent developments in psychotherapy are also being trialled with some success. For example, Acceptance and Commitment Therapy (ACT) has been found to help with OCD. A new form of Cognitive Therapy, called Inference based Therapy (IBT) has also been effective with OCD.

IBT sees doubt as the basis of OCD. Persons with OCD may doubt their senses (“Even though I can see it is locked, is it really?“ ) and themselves (”Could I be someone who sexually abuses children?"). IBT helps the OCD client distinguish between “normal” doubt and “obsessional” doubt and understand how they have been confusing real probabilities with imagined possibilities.  

OCD is an anxiety disorder with symptoms of obsessions (intrusive and persisting upsetting thoughts, ideas, images or impulses) and compulsions (behaviours and rituals designed to undo the anxiety caused by the obsession). Sometimes the rituals are behaviours you can see (e.g. checking, ordering, washing, cleaning, counting, asking for reassurance) and sometimes they are mental rituals (like counting, repeating special words, numbers or phrases silently, praying).

At times the person with OCD will do these rituals on their own and try to hide them from you. At other times, they may try to involve your help (e.g. get you to do some checking too). The obsessions can be about anything and may include themes involving health, sexual behaviour and identity, safety, aggression and religion.

Common Examples
For example, someone may have the intrusive thought that they have germs on their hands, so they will feel compelled to wash their hands repetitively (sometimes a certain number of times, sometimes in a certain ritualised way).  This may take up a considerable amount of time as they do not rely on their senses to decide when to stop or start washing. Instead, they rely on whether they “feel contaminated” or “feel better” rather than any visible signs of contamination. The washing ritual will reduce their anxiety in the short term, but keep the OCD going in the long term as it reinforces the belief that the way to undo the obsessions is to wash in this way.

Vicious cylces
Thus, people with OCD get caught in vicious cycles of trying to reduce their anxiety by giving into obsessions with behaviours that only end up keeping their anxiety and obsessions going. Usually they are aware that the obsessions and compulsions are irrational or excessive, but they have not learned other ways of dealing with these distressing obsessions. This is why it is very important to seek some professional help with this very challenging and upsetting disorder.

Getting Help
People with OCD often have a lot of shame about their condition and so hide much of what they are doing and thinking from others and are reluctant to seek help. There are very effective treatments for OCD, particularly Cognitive Behaviour Therapy (CBT), and it is unlikely to get better without some intervention. In fact, while some obsessions or compulsions may reduce, they are often replaced by different obsessions or compulsions.

Getting treatment early is important as the longer OCD runs the  sufferer’ s life, the  more restricted their life can become as the OCD infiltrate’s more areas of their  life and leads to more avoidance of situations that are involved in the OCD system. Learning ways of gaining back control of your life so that the OCD does not control you is a big feature of therapy. For more information on treatment for OCD, see my article.