Relationship OCD - UK-Based ROCD Specialists 

Relationship instability, commitment problems, reassurance seeking behaviours, continuous worry and patterns of relationship doubt, may not always be a sign that there is a problem with the relationship itself. For individuals with current or past OCD-related problems, Relationship Obsessive Compulsive Disorder (ROCD), may provide an explanation for conflict and relationship dissatisfaction.

We provide specialist Cognitive Behavioural Therapy for ROCD. Our approach combines the latest research into ROCD with established CBT strategies including ERP+, ACT, MCT and IBT. Our therapists are fully qualified and professionally accredited by the British Association of Behavioural and Cognitive Psychotherapy (BABCP) and have extensive experience of working with ROCD.

To book an initial informal call, email This email address is being protected from spambots. You need JavaScript enabled to view it. or complete our contact form. All enquiries are handled on a confidential basis and we will only confirm appointments if we are confident that we can help.

What is ROCD?

Relationship OCD, sometimes referred to as Relationship Substantiation OCD - ROCD, is a special checking sub-type of Obsessive Compulsive Disorder. ROCD involves continuous worry and self-doubt about attraction, compatibility, commitment and potential loss within romantic relationships. 

ROCD can be partner focused and relationship centred. Partner  focused ROCD typically involves obsessional worry and checking behaviours about feelings of love and attraction, physical characteristics or habits and personal attributes such as sense of humour, confidence  and intelligence. 

By contrast, relationship centred ROCD involves worry and doubt about the nature of the relationship itself. This can include  problems with commitment, testing and comparing the relationship with other couples or past relationships as well as maladaptive and irrational beliefs about how relationships should work. 

ROCD doubts and checking behaviours lead to high levels of psychological distress for both partners, contributing to cycles of avoidance, conflict, rejection and withdrawal. ROCD behaviours cause relationship instability and propagate further feelings of uncertainty. This creates a vicious cycle of worry and checking behaviours in an attempt to escape feelings of anxiety, guilt, responsibility and uncertainty. 

According to the latest research, ROCD is primarily maintained by an over-estimation of threat, perfectionistic thinking and a high intolerance of uncertainty. ROCD can often present as the primary OCD presentation, however relationship obsessions and compulsions are frequently seen alongside other OCD behaviours. 

The ROCD cycle follows the same psychological pattern observed in other checking and perfectionistic forms of Obsessive Compulsive Disorder. Whilst the psychological process is largely the same as other forms of OCD, there is evidence that early formed maladaptive relationship beliefs and attachment factors may predispose some individuals to relationship checking / avoidance behaviours, as the primary focus for their OCD. You can find out more about the four-part Unified Model of OCD here.  

Typical ROCD Obsessions Include:

• Repeatedly ruminating about relationship compatibility problems.
• Fixating on physical imperfections, characteristics or habits.
• Questioning whether the partner is interesting, funny or intelligent enough.
• Worrying about commitment when someone “better” might be out there.
• Overthinking sex or experiencing anxiety about variable levels of intimacy.
• Obsessional worry about potential rejection, abandonment or infidelity.
• Worry about being unable to tolerate feelings of relationship doubt and anxiety.
• Continuously questioning whether the problem is ROCD or just the wrong relationship

Typical ROCD Compulsions Include:

• Oversharing and repeatedly seeking reassurance from friends or family members.
• Googling relationship problems or scouring online relationship groups.
• Testing and comparing your level of attraction with friends, exes or strangers.
• Checking and Analysing physical characteristics, features, body size  and  shape.
• Internally checking for feelings of love, passion, intensity or excitement.
• Avoiding intimacy and small acts of physical contact such as holding hands.
• Avoiding romantic movies or material that trigger doubts about the relationship.
• Constantly questioning and picking at otherwise trivial aspects of the relationship.
• Commitment avoidance or procrastination when facing relationship decisions such as moving in, engagement, marriage or children.
  

Whilst some of the above patterns can also be found in healthy relationships, the frequency and  intensity of these thinking and behavioural habits is significantly higher in Relationship Obsessive Compulsive Disorder. People who experience ROCD report obsessional relationship doubts and intense distress about whether their relationship is right. Paradoxically, the doubt and anxiety caused by ROCD can lead to feelings of uncertainty, insecurity, conflict, rejection or withdrawal. ROCD checking behaviours create a vicious cycle in which temporary relief from relationship doubts are set against reinforcement of unhelpful relationship behaviours. This vicious cycle can become so severe that the ROCD sufferer ultimately seeks to end the relationship in an attempt to escape the uncertainty, doubt  and anxiety.

The ROCD Treatment Process

Contrary to many outdated online references and unreliable internet articles, Exposure Response and Prevention ERP is not the single gold standard for ROCD. In fact classic ERP has largely been replaced by more recent research into a process known as inhibitory learning which updates the behavioural habituation model with evidence reflecting cognitive reappraisal and change. Like other OCD subtypes, Relationship Obsessive Compulsive Disorder – ROCD is most effectively treated using a combination of specialist Cognitive and behavioural therapy strategies. These approaches reflect the current research evidence for ROCD and include cognitive reappraisal, cognitive defusion / acceptance, focus of attention / mindfulness and Exposure Response and prevention (ERP Plus) strategies. 

Research into ROCD also provides strong evidence that early maladaptive attachment experiences can profoundly affect the development and maintenance of ROCD. This means that treatment strategies should address underlying maladaptive beliefs about relationships, cognitive and metacognitive processes responsible for the maintenance of obsessional patterns and conditioned and operant behaviours responsible for compulsions. For many individuals visiting this page, many of these technical terms will feel complicated and opaque. 

The key to organising effective therapy for ROCD, is therefore to find an experienced  therapist trained in these approaches and able to transfer them into practice in a relatable way. In our experience, this means therapists with advanced training and professional experience in mainstream CBT, Acceptance and Commitment Therapy (ACT), Inference Based Cognitive Therapy (ICBT), Focus of Attention training, Mindfulness, ERP and ERP Plus. Clients struggling with ROCD are encouraged to use this as a checklist of relevant therapeutic terms when discussing treatment options with other therapists offering ROCD therapy.

Our Treatment Strategy Includes:

• Psychological assessment of the presenting problem including relevant background data, childhood attachment factors and psychometrics.
• Case formulation of the ROCD to identify and map out the different factors that cause and maintain relationship problems.
• Identification and restructuring of maladaptive relationship beliefs that sustain rigid and unhelpful relationship behaviours.
• Work on ROCD Inferential confusion and the process of relationship doubt and worry.
• Cognitive defusion and acceptance techniques to unhook from intrusive ROCD thoughts and obsessions.
• Behavioural experiments to identify and test out alternative helpful behaviours.
• ERP and ERP plus to support habituation of relationship anxiety and learn new emotional coping strategies.
• Lapse planning to identify and pre-empt future ROCD traps and resilience strategies.

We also encourage participation and involvement from the client’s partner where this is appropriate and relevant.

Specialist ROCD sessions are charged at £125 per session. This includes a written assessment report, treatment plan and relevant psychometric measures. We are also professionally registered with most of the major insurance providers. 

To arrange a brief informal call to discuss ROCD therapy options, email This email address is being protected from spambots. You need JavaScript enabled to view it. or send a message via our secure contact form.