This post is a continuation of an interview I conducted with Prof. Guy Doron and Dr. Danny Derby, renowned pioneers in the exploration and definition of Relationship OCD (ROCD). ROCD is a specific type of obsessive-compulsive disorder (OCD), characterized by individuals grappling with persistent and distressing doubts concerning the compatibility of their romantic relationship or partner.
Drawing from their extensive research and expertise, Prof. Doron and Dr. Derby have authored numerous research papers on ROCD and have formulated a tailored treatment framework for the condition1-7. In this portion of the interview, we explore the facets of diagnosing ROCD, its onset, how it affects people’s lives and their romantic partners, and the cultural ideals and technological advancements that could play a role in the proliferation of ROCD.
Q: How can one distinguish between ROCD and normal doubts within a relationship? What are the criteria used to diagnose someone as suffering from ROCD?
Doron: To diagnose someone with ROCD, they must meet the DSM-5 criteria for a diagnosis of OCD. This involves having obsessions, which are persistent, distressing, and intrusive thoughts, images, or urges, alongside engaging in compulsions which are repetitive behaviors or mental acts performed to alleviate the anxiety and distress triggered by the obsessions. Additionally, the preoccupation with these obsessions or compulsions should consume more than an hour per day or cause significant distress or functional impairment.
It’s essential to recognize that everyone encounters doubts and questions in relationships. However, when these doubts begin to dominate a person’s life, cause prolonged distress and interfere with daily life, it’s important to consider and clinically evaluate the possibility of ROCD. Furthermore, distinguishing ROCD from unhealthy relationship dynamics requires a close examination of the presence of ROCD and how the person responds to relationship-related doubts and questions.
Q: What causes ROCD to emerge? When does it usually erupt?
Derby: Many individuals experience heightened ROCD symptoms when facing significant relationship decisions, like deepening commitment, ending other relationships, cohabiting, marrying, or embarking on parenthood. Such transitional phases often trigger or intensify ROCD symptoms and result in considerable distress. This doesn’t necessarily mean that ROCD can’t emerge earlier, but people tend to seek help during these times of heightened distress.
When we started investigating ROCD we focused on people who were already in relationships, but today we know that some obsess over entering into a relationship. These individuals may avoid relationships due to the difficulty in deciding whether they should or shouldn’t enter into a relationship or whether to commit. For them, pinpointing when ROCD begins is more complex, as they might never enter a relationship at all.
Q: How does ROCD impact peoples’ lives and their romantic partners?
Derby: When struggling with ROCD, a person might be with their partner and constantly consider other people who might be a better fit for them. When spending time with other people, they may constantly compare them to their partner. When watching a romantic movie or viewing pictures of other couples on social media, they might think, “Wow, that’s the way other people feel in a relationship, but I don’t.” The more someone becomes entangled in such thought processes of doubting and comparing, the less present they become in their relationship and are unable to enjoy spending time with their partner.
Doron: Additionally, in severe presentations, ROCD can extend beyond relationships, affecting overall life satisfaction. These people are preoccupied with relationship-related doubts constantly, from the moment they wake up until they go to bed. It feels like a cloud hanging over them, seeping into every area of their lives including work, leisure, and time spent with family and friends. These people don’t only have trouble enjoying and being present in their relationships, but also enjoying and being present in their lives. Successful treatment of ROCD can lead to increased presence and life enjoyment.
In our clinical experience, we’ve observed the detrimental impact of ROCD on partners as well. ROCD can undermine partners’ self-esteem, causing them to doubt their appearance, intelligence, and overall value. This, ironically, can create a self-fulfilling prophecy, influencing the partner’s behavior in ways that align with the doubting partner’s fears. For example, constantly inspecting a partner’s intelligence might prompt the partner to feel under scrutiny, resulting in a hesitancy to communicate openly and consequently appearing less expressive, clever, and knowledgeable.
Q: What unique challenges do people with ROCD face?
Derby: A major challenge is our cultural and social ideals, which portray the notion of “the one” that’s waiting for us out there, and if we only try hard enough, we’ll eventually find them. This message is conveyed through movies, songs, social media, and the people around us. Seldom do these sources acknowledge the process of natural habituation within relationships, the gradual waning of intense emotions, or the reality that people can experience closeness, attraction, and even romantic love for more than one person.
At times, stressful notions such as “true love has no doubt” or “you should always feel in love with your partner” from family or friends can trigger severe doubts and compulsions, such as continuously inspecting whether intense feelings of love are present or dissecting the significance behind experiencing doubts (for more examples, see here).
Additionally, when we compare ourselves to the often-misleading images we see on social media of other couples constantly having a great time together, it’s easy to feel that we’re missing out on something better out there.
Doron: To add to that, technology may also pose a challenge. The best example here is dating apps like Tinder, which introduce an abundance of potential partners and create an illusion of endless possibilities. One thing social psychology taught us years ago is that the more choices we have, the less satisfied we are with our decisions — what we call “the paradox of choice.”
For people with ROCD, the experience of constant availability and endless possibilities can easily feed the concept of something better waiting out there, challenging people’s ability to remain present and fully experience their relationships.
References
https://rocd.net/
Doron, G., Derby, D. S., Szepsenwol, O., & Talmor, D. (2012). Tainted love: Exploring relationship-centered obsessive compulsive symptoms in two non-clinical cohorts. Journal of Obsessive-Compulsive and Related Disorders, 1(1), 16–24.
Doron, G., Derby, D. S., Szepsenwol, O., & Talmor, D. (2012). Flaws and all: Exploring partner-focused obsessive-compulsive symptoms. Journal of Obsessive-Compulsive and Related Disorders, 1(4), 234–243.
Doron, G., Derby, D. S., & Szepsenwol, O. (2014). Relationship obsessive compulsive disorder (ROCD): A conceptual framework. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 169–180.
Doron, G., Mizrahi, M., Szepsenwol, O., & Derby, D. S. (2014). Right or flawed: Relationship obsessions and sexual satisfaction. The Journal of Sexual Medicine, 11(9), 2218–2224.
Doron, G., & Derby, D. S. (2017). Assessment and Treatment of Relationship‐Related OCD Symptoms (ROCD): A Modular Approach. The Wiley handbook of obsessive compulsive disorders, 1, 547–564.
Derby, D. S., Tibi, L., & Doron, G. (2021). Sexual dysfunction in relationship obsessive- compulsive disorder. Sexual and Relationship Therapy, 1–14.
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