In this 7-part series, we take an in depth look at relationship OCD and its many different facets. Most of the material here is based on different personal recovery journeys; they are not intended to replace sound professional advice. If either you or your partner suffer from rOCD you might find some of this information useful to navigate the many difficulties that it brings. Here is a brief summary of each of part:
- Part 1 (Understanding relationship OCD) – briefly introduces the topic of rOCD, how to start a recovery journey on the right foot and shares some personal notes.
- Part 2 (Understanding the rOCD brain and mind) – explains the mechanics of an rOCD brain from a sufferer’s perspective coupled with psychological models.
- Part 3 (Love and relationship OCD) – tries to answer some of the most difficult questions in rOCD.
- Part 4 (Treatment choices in relationship OCD) – explores the different treatment options available in rOCD.
- Part 5 (Negative behaviours in relationship OCD) – examines what OCD sufferers might be doing wrong in their road to recovery.
- Part 6 (Coping strategies in relationship OCD) – suggests different ideas for developing coping strategies.
- Part 7 (Success stories in relationship OCD) – shares stories of OCD sufferers that have made great strides in their recovery journey.
We have also written a summary post that covers many of the different topics above here.
What is rOCD?
If you are here, most likely you already know that rOCD stands for relationship obsessive compulsive disorder. You have read about rOCD and your biggest question might be “do I really have rOCD?” As we will see in other posts, the best question to ask is “do I have OCD?”. We will park this question for the moment and try to define what rOCD is.
I guess that rOCD is a different experience for everyone because we are all different. However, many stories from rOCD sufferers share similar elements. Similar obsessions, compulsions, behaviours, warped thinking, etc…
There are many different ways of defining rOCD. I really like this definition taken from OCD-UK (http://www.ocduk.org/rocd)
ROCD is commonly used to refer to fears associated with Relationship OCD, where sufferers obsessively question whether their current partner is really the right person for them, and whether they actually love their partner or not, even in the most loving of relationships.
The most striking aspect of this definition is that it happens even in the most loving relationships. Many great relationships are thrown away because of this dreadful condition. It can impact lives strongly and because there are no obvious compulsions those around us do not really understand what is going on inside our minds and how we feel. It takes both a physical and psychological toll. In most cases it is also linked with depression and anxiety which makes it harder to treat.
Where are you now?
A good start on the “getting better journey” is making a plan on how to get better. It does not need to be perfect either but just something that you can use on a daily basis. Most likely this plan will evolve and take many shapes over time.
But before we start this recovery journey, we need to understand where we are. The reason why we need to do this is simple. It will help us decide the next steps to take. Not everyone is at the same stage in their rOCD journey to recovery. Speaking with many different rOCD sufferers throughout the years, I realised that not everyone has the same level of understanding of the condition and how to tackle it.
Knowing where we are in our journey can sometimes be a very difficult thing to do as well. On my road to recovery from rOCD, there were some very distinguishable landmarks:
- Finding out about rOCD
- Figuring out if I had rOCD
- Accepting rOCD
- Committing to daily change
- Learn and develop better coping strategies
- Moving forward with courage and patience
- Accepting and embracing uncertainty
Many rOCD sufferers are stuck in number 2. And the worst thing is that they do not even realise it. What we need to understand is that knowing that we do suffer from OCD is not the end of our journey but just the beginning. And we should treat it as such.
Treating the disease not the symptoms
One of my biggest mistakes, during my rOCD recovery journey, was trying to fix the symptoms and not the disease. Once I realised this, I decided to start spelling relationship OCD as rOCD and not ROCD. The issue was never the relationship but rather my OCD. In other words, the issue never was trying to find an answer to a question or questions but rather being able to accept uncertainty and becoming happy with it. The only certainty that exists is the one that we make happen through our own actions. Everything else are just degrees of probability.
Imagine this, you injured your leg and end up going to see a doctor. The leg is broken but you complain that you can’t run at all. And you want the doctor to fix you. What the doctor might say is that you need surgery, medication, cast, crutches, and plenty of rest. The doctor will not say that you need to stand on your leg, go for long walks and sprints.
Now, think of this. If we do suffer from rOCD and our own thoughts trigger a lot of anxiety and discomfort this will affect our FEELING and THINKING ability. We can’t run (feel or think) as fast as before. Should we beat ourselves up because we can’t run this fast anymore? And continue to push ourselves to try and run faster or just stop and try to fix what is “broken”? I am not saying that the relationship needs to end but rather the opposite. That we need time and proper care to be able to run again. In this case, to feel and think “normally”.
The funny thing is that because we can’t see a broken brain, we expect it to heal faster than a broken leg. This is one of the greatest tragedies of mental health, particularly OCD.
Notes from a book
There is no such thing as absolute certainty, but there is assurance sufficient for the purposes of human life.
John Stuart Mill
One of the books that helped me understand OCD better was a book called “The Imp of the Mind”. Here are some of the notes that I made from this book:
What is the imp
The word “Imp” is taken from a title of a poem from Edgar Alan Poe “The imp of the perverse”. It describes the natural tendency that our brains have to think and being attracted to evil. Pierre Janet called this “association by contrast” whereas patients feel driven to do the exact opposite of what they want to do.
Bad thoughts happen to everyone. Some people just seem to cling to these more strongly thus in time developing obsessions. These bad thoughts tend to be the most inappropriate things to think at the most inappropriate times. What you consider the most awful or shameful thing to do is normally the subject of these thoughts.
Thought suppression and Rebound effect
The more you try to get rid of something, the more you are aware of it. That is why thought suppression is not a very effective technique. Fighting or avoiding situations where these thoughts might occur is only likely to increase the intensity and frequency of these thoughts. A rebound effect might also occur after we give up on suppressing thoughts i.e. thoughts come to the mind at a higher frequency than before suppressing them. After we abandon control of these thoughts, they become less bothersome and are less noticed. The more you try to avoid situations that trigger unwanted thoughts, the worse your problem will become.
OCD and depression
It appears that depression impairs the normal functioning of the brain and this results in the patients being more vulnerable to bad thoughts. Interpreting these bad thoughts in a wrong way can also lead to further depression. It also appears that people with depression are more 5-6x more likely to have bad thoughts than people without depression (based on a study done on post-partum patients). When we are depressed we tend to think the worst of ourselves.
Some patients with bad thoughts seem to report that these started when everything in life started to go well and happiness was “reached”. Almost like the mind has come up with something to worry about and ruin things.
One of the biggest fears seem to be that of loss of control. That you would snap and do something that you would not normally do. Sexual obsessions seem to be present in more than 1/4 of people with OCD. Self-medication sometimes occurs in the form of alcohol and drugs to try and deaden the obsessions.
Absolute certainty vs. enough certainty
There seems to be a need to feel certainty absolutely before being able to move on. The slightest doubt is a tormentor. The very act of trying to attain perfect certainty is often the worst source of distress. This is why the French call OCD the “doubting disease”. Part of the success consists in stopping reassurance seeking.
What is it like to feel absolute certainty and how will you know you have achieved it? Nobody knows and even if you could, your brain will tell you that it is not true because it is too good to be true. Hence people are tormented by doubt caused by a need of feeling certain.
Common cognitive error for people with OCD:
- attributing too much importance to thoughts.
- thinking that they need to be able to control thoughts (or are capable of doing so!).
- exaggerating the danger of a situation.
- intolerance of uncertainty.
- perfectionism.
- excessive responsibility.
Some personal notes
You can’t stop the waves but you can learn to surf.
John Kabat-Zinn
I would like to share some personal “gold nuggets” that I picked up during my therapy sessions and mindfulness course. They really helped me to understand rOCD and what the first steps are in getting better. Here they are:
- OCD looks for areas of rigidity, where we are not very flexible in our beliefs and targets them.
- A short term goal. Start labelling thoughts.When we have an rOCD thought – “this is an OCD thought about…”.
- A long term goal. We should slowly start to include possibility statements in our self-talk. For example ” I really do not want to break up, my world would end” vs. “It wouldn’t be great, it would hurt but it could be possible”. This shows OCD that we are not afraid of it and once we take away the target, it will have less strength. This also brings flexibility to our thinking.
- Our goal is to be able to observe thoughts without evaluating and judging them or analysing them.
- Do not fight it. Give permission to come in but do not get involved with the thought.
- When anxiety is a dominant emotion it is very difficult to feel everything else. Learn to recognise anxiety feelings.
- I know it is OCD because once I seem to find comfort in a thought, and “solved” my problem mentally, another contradictory thought comes up to discredit the first.
- My favourite – Thoughts are not facts!