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  • Writer's pictureAdam O'Neill

Relational OCD (rOCD).

Updated: Aug 3, 2023

Relational OCD (rOCD).

A young man’s new engagement is plunged into confusion with a confession from his betrothed. She said it so simply as if it was not a devastating thing for him to hear, “Sometimes I worry that you might not be the right one for me.” His blood ran cold and he thought about how cruel it all sounded. How could she say that? They were meant to be married. What he could not see was the war that raged inside her head, the fear and anxiety it caused her and the cry for help her abrupt statement was. It would not be the last time she would say something like this. It seemed a shred of doubt, a basic fear, had grown—constantly nagging her, unrelenting. Relational Obsessive Compulsive Disorder (rOCD) does not look like the other forms of OCD we see displayed in popular culture, but it is very real and can be devastating for the sufferer and their loved ones. Many suffer from this subset which has only recently been described in literature.

Relational OCD takes many forms, most commonly I have observed two primary types: “Am I with the right person” and “Is there something wrong in our relationship?” As is true of all OCD subtypes they are rooted in a distressing intrusive thought accompanied by a physical or mental compulsion that is used by the sufferer to relieve their anxiety. In relational OCD the compulsion may take the form of asking clarifying questions of the loved one such as: Is everything ok between us? Do you think we are meant to be together? For the loved one this may be quite distressing, as mentioned above, during an engagement it can seem catastrophic. In other cases it may start out as seemingly innocuous, the loved one may appear to want to make sure everything is fine in the relationship. But as time goes on, the question, “Are we ok?” leads to a sinking feeling, “It must not be if they keep asking.” Conflict arises.

Treatment must, as in almost all psychiatric disorders, be holistic and can include elements of both counseling and medication. The most effective therapy for OCD is Exposure and Response Prevention. This method asks the client to expose themselves to anxiety-provoking triggers, notice how their anxiety level increases, wait in the anxiety until it decreases by a certain percent, only after which they may perform their compulsion. It may seem counterintuitive to allow a patient to perform a compulsion when the goal is to stop them altogether. Repeated trials, however, result in an overall decrease in baseline anxiety when presented with the same triggers in the future. The key is to wait for anxiety to decrease before performing a compulsion. Anxiety is telling the sufferer that if they do not perform a compulsion, something bad will happen. Waiting for anxiety to decrease, if only just a little, proves this association false. Patients should first rank their obsessions from most to least anxiety-provoking, and therapy begins with the least. This form of therapy should be practiced only under a trained professional. Introducing the wrong triggers, especially of the wrong intensity, can exacerbate obsessions and compulsions.

What must be remembered by both the patient and more importantly, by the community that supports them, is that the sufferer is feeling real psychological pain and does not desire to subject their loved ones to compulsions. It is not something they cay “just stop” doing. In most cases, the spouse/friend/family member should become a part of the treatment team. Occasionally, they may be asked to refuse to comply with compulsive questioning and thereby assist in the eventual remission of symptoms. They may instead answer with some variation of, “I know you are seeking reassurance or confirmation; this is just the OCD, I’m not going to engage with it”. Above all, these situations require grace and love. If empathy is defined as the ability to sit in and understand the feelings of another, it requires us as clinicians, clergy, family members and friends to enter the discomfort of relational OCD. We must take those moments we have all felt unsure in relationships, afraid of rejection, and the discomfort of conflict and imagine what it must feel like to have it multiplied and prolonged over weeks, months, and years. As a Christian the question is not, “How can someone suffer from this condition?” but “By what miracle do we all not suffer in this way?”. If you or someone you love is experiencing these types of symptoms, I encourage you to reach out to a trained therapist, psychologist, or psychiatrist. There is hope for relational OCD.

For more visit the International OCD Foundation.

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