Medications for Relationship OCD (R-OCD)
Find yourself struggling with persistent, distressing doubts and uncertainty about your romantic relationship, your partner, or other figures in your life? Dr. Holly Betterly MD, Board-Certified Psychiatrist in Weston, FL explains Relationship OCD (ROCD) and the available treatment options.
This post is provided for educational purposes only, and is not intended as a substitute for professional medical advice. If you have questions, always reach out to your doctor for more information.
Struggling with your mental health? Reach out for professional support. Dr. Betterly is a board-certified psychiatrist and member of the International OCD Foundation. She is dedicated to helping people overcome OCD. She offers appointments at her office in Weston, FL, conveniently located in Weston Town Center, as well as via telehealth for patients across Florida. Request an appointment today to start your journey to better mental health.
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What is Relationship OCD (ROCD)?
Relationship Obsessive Compulsive Disorder, or “ROCD” for short, is an informal subtype of OCD in which the theme of obsessions and compulsions centers around aspects of one’s relationships, or the people in one’s life. While relationship OCD can focus in on romantic partners, it can also focus in on other individuals, such as family members, friends, colleagues, or acquaintances.
Relationship OCD, just like other subtypes of OCD, are more of an informal way of referring to OCD symptoms that center around a specific theme. You won’t find any formal subtypes of Obsessive Compulsive Disorder in the DSM. Why is this? OCD can latch on to just about anything! It’s the process and patterns of OCD that define the diagnosis, not the content. OCD loves to trick us into focusing on the specific content of the obsession, but we have to remember, obsessions are like junk mail- they might sound urgent and important when taken at face value, but when we strip away the content, they’re just “junk.”
It’s also important to point out that many people with OCD experience obsessions and compulsions that span multiple themes. For example, a thought that your partner may die in a car crash because you forgot to kiss him goodbye involves both harm and relationships.
You could also experience symptoms that span multiple themes separately, but consecutively. For example, over the course of a day, you may experience doubts about whether your partner is really the one for you, and later that day experience doubts about whether your lunch was contaminated with something.
It’s common for OCD symptoms to shift over time, so perhaps your symptoms largely centered around “just right” in the past, but are now becoming more focused on a relationship after recent talks about marriage.
Common Obsessions in Relationship OCD
No two cases of Relationship OCD look exactly alike- and neither do the obsessions! With that said, here’s some common examples.
Relationship-Focused Obsessions
Is my partner really the one for me?
How do I know if my partner is the one? Can you know?
Am I really in love with my partner?
Is my partner really in love with me?
Do I really love my parents?
Does my friend actually like spending time with me?
How do I know if I’m attracted enough to my partner?
How attracted should you be to a partner?
Is it cheating on my partner if I look at other members of the opposite/same sex in public?
What if we fall out of love?
Partner Focused Obsessions
Is my partner smart enough for me?
What do I think about my partner’s social skills?
Is my partner pretty/handsome enough for me?
Is my partner actually an ethical person?
What if I don’t find my partner attractive ten years from now?
Common Compulsions in Relationship OCD
There are many different ways that compulsions can show up in Relationship OCD. Here’s just a few common examples:
Reassurance Seeking from Partner
Asking repeatedly whether they really love you, and feeling unable to accept their answer, asking again with slightly different phrasing or hypothetical scenarios, and closely monitoring for any signs of a different answer
Reassurance Seeking from Loved Ones
Repeatedly calling your best friend to ask whether they think your partner is really the one for you, and feeling unable to accept their answer, asking again with slightly different phrasing or hypothetical scenarios, and closely monitoring for any signs of a different response
Reassurance Seeking from Internet Forums and AI Chatbots
Repeatedly asking questions on online forums, social media group pages, or AI chatbots about whether it sounds like you are actually in love with your partner
Online “Researching”
Repeatedly searching for certainty through social media postings, blog posts, psychology journals, etc. and feeling like you’re “reaching the end of the internet,” unable to accept the information as valid
Checking
Repeatedly checking your body for physical signs of arousal to prove that you are actually attracted to your partner
Mentally Replaying
Repeatedly analyzing past interactions with your partner in search of “evidence” that could support or refute your doubts
The distress and anxiety brought on by obsessions can drive not only compulsions, but also avoidance behaviors. One may find themself avoiding people, places, objects, or situations that trigger the obsessions in an effort to avoid the associated distress. This could look like avoiding spending time with your partner, avoiding spending time with members of the opposite sex, avoiding movies or books involving romantic themes, avoiding weddings and engagement parties, etc.
How is Relationship OCD Diagnosed?
It’s really important to note that it’s normal to experience doubts and uncertainty about relationships, and many people who experience such doubts do not have OCD. So how do we know when it does cross the line into Relationship OCD? Like we mentioned earlier, with OCD, the important part is the process, not the content, so we use the same criteria to diagnose OCD regardless of theme: the diagnostic criteria specified in the DSM.
Everyone experiences intrusive thoughts from time to time, and most people are able to brush them off quickly with minimal impact on their day. In OCD, these thoughts can become “sticky”- they’re persistent, repetitive, and can feel impossible to brush off. They can feel pressing, urgent, and important, like something must be done immediately to find certainty. They bring up intense feelings of distress, anxiety, and doubt. When intrusive thoughts fit this pattern, they are known as obsessions. In response to the intense distress that follows obsessions, people with OCD perform compulsions, or repetitive physical behaviors or mental acts aimed at reducing the distress. While compulsions may provide temporary relief, finding 100% certainty is unattainable, and the obsessions return as the cycle of OCD repeats itself.
It’s important to note that in order to meet DSM criteria for an OCD diagnosis, one must experience obsessions and/or compulsions, which must be time consuming, typically taking up an hour or more of one’s day, or cause clinically significant distress or impairment in functioning in important aspects of one’s life, such as work, school, or relationships.
OCD is a clinical diagnosis, which means that there is no one specific test that can provide a definitive diagnosis in the way that some other medical conditions may be diagnosed. While the flu virus may be diagnosed with a nasal swab, or high blood pressure may be diagnosed with a measurement from a blood pressure cuff, OCD can only be diagnosed after a comprehensive evaluation by a mental health professional licensed to provide a diagnosis, such as a psychiatrist or psychologist.
A comprehensive psychiatric evaluation, conducted by a psychiatrist, involves a thorough assessment of many different factors.
Some factors that may be included in the evaluation include:
Checking your vital signs, such as your heart rate and blood pressure.
Questions about your current and past mental health concerns.
Questions about various aspects of your daily functioning, such as your sleep patterns, appetite, and energy levels, your performance at work or school, or your social relationships.
Questions about various different mental health symptoms in order to screen for various mental health conditions
Questions about your medical history, such as your medical conditions, medications, allergies, and any surgical procedures you may have had
Questions about your family’s medical history
Questions about your mental health history, including any past diagnoses or treatments, such as medications or therapy
Questions about current or past drug or alcohol use
Questions about various aspects of your background, such as developmental milestones, childhood, education, employment, living situation, relationships, religion, and traumatic events or abuse.
A psychiatrist may also administer screening tools or instruments aimed at taking a closer look at specific symptoms and the ways that they may be impacting you. Some common tools which may be used when assessing for OCD include the Obsessive Compulsive Inventory (OCI) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
There are also some tools that have been developed specifically for use in diagnosing Relationship OCD, such as the Relationship Obsessive Compulsive Inventory (ROCI) and the Partner Related Obsessive Compulsive Symptom Inventory (PROCSI).
After a psychiatrist has finished gathering all of the information that they need, they consider all of the different potential causes for the mental health symptoms that you are experiencing in order to provide a diagnosis. They consider whether the symptoms that you are experiencing meet the DSM-5 diagnostic criteria for a specific mental health condition, such as OCD.
In some cases, they may need to obtain additional information before they can provide a diagnosis. This may include blood tests, imaging, or referrals to medical specialists, such as a neurologist. It may also include a referral to a psychologist for the administration of formal psychological testing measures.
Treatments for Relationship OCD
The treatments for Relationship OCD are the same as the treatments for any other type of OCD.
The evidence-based, gold-standard treatments for OCD include a specialized form of therapy known as Exposure Response Prevention, also known as ERP, as well as prescription medications, and some people choose to combine the two.
To learn more about Exposure Response Prevention, visit the International OCD Foundation.
Medications for Relationship OCD
The medications used to treat Relationship OCD are- you guessed it- the same type of medications that are used to treat all types of OCD, regardless of the specific “theme” of the content.
Selective Serotonin Reuptake Inhibitors, or SSRIs, are typically the first choice category of medications used to treat OCD. These medications come as tablets, capsules, and liquids. SSRIs are prescription medications, which means that they should be taken only under the supervision of a doctor, and exactly as prescribed.
There are multiple different SSRIs available, such as sertraline, paroxetine, fluvoxamine, and fluoxetine. They are all considered to be equally effective in treating OCD- in other words, there isn’t one “best” SSRI for OCD, and the decision of which one to use is personalized based on factors such as differences in side effect profiles, the other medications that someone may be taking, their medical problems, and their preferences.
When SSRIs are prescribed to treat OCD, higher doses are often required than when prescribed to treat other conditions, such as anxiety or depression. While some people may begin to see an improvement in their symptoms earlier than others, it often takes a few months to see the full response to a given dose. While some people find relief from OCD symptoms with their first SSRI, others may try a few before they find one that is a good fit for them.
Finding Treatment for Relationship OCD
If you’re interested in learning more about Relationship OCD, reach out to a board-certified psychiatrist.
To locate a psychiatrist near you, check out these free online directories from leading professional organizations:
Located in Florida? Dr. Holly Betterly is a Board-Certified Psychiatrist who is dedicated to treating OCD. She offers telehealth appointments for patients across Florida, as well as in-person appointments in Weston, FL. Request an appointment to start your journey to better mental health.
