Relationship OCD: A form of OCD that often damages the relationships where we most seek to be certain

Relationship OCD: A form of OCD that often damages the relationships where we most seek to be certain

Relationship OCD, or ROCD, refers to Obsessive Compulsive Disorder (OCD) symptoms centered around relationships with partners, family members, friends and co-workers. As can be seen from the symptoms below, ROCD sufferers obsess over fears that they’re not in the right relationship or that taking some step in the relationship will be the wrong step. In an attempt to protect themselves from relationship failure and ensure their happiness, individuals with ROCD may sabotage their relationships or inadvertently damage them over time.

 

Common Triggers
Relationship OCD symptoms are typically triggered by an event or situation in a relationship, such as asking a partner to move in together or getting married. It can also be triggered by something a partner does or doesn’t do. For example, if your partner has been spending more time with friends and family than with you, you might start questioning your place in their life. Or if they don’t respond to a text message right away, you might begin worrying about whether they still love you. If you have ROCD, any change in your relationship could potentially cause anxiety. This is because when it comes to relationships, certainty is everything. The idea of not knowing what will happen next is terrifying for someone with ROCD. Often ROCD suffers will chose to end relationships they truly value, in order to be certain not to harm the other person or to be sure they aren’t making a wrong choice that cannot be undone at a later time.
First Steps
If you suspect you have Relationship OCD, seek help from a professional with speciality in OCD. Clinicians without experience treating OCD may often inadvertently worsen the condition by providing reassurance or engaging in debates with clients that cannot come to real ‘certainty.’ This may also lead to a tendency for clients to seek out clinicians to make the important decisions in their lives for them, in order to feel more certainty or less responsibility for the outcome of their decisions. This condition should not be managed on your own. Your therapist will help you use Exposure and Response Prevention therapy to work on facing relationship fears without resorting to reassurance seeking or other safety behaviors. Don’t let Relationship OCD become a barrier to finding a healthy relationship. Recovering means learning how to face uncertainty without fear—you can do it! And remember, treatment works!

Dealing with your Anxiety
Step 1 – Reaching out for help. The first step in dealing with relationship OCD is to reach out for help. You may want to reach out to an OCD specialist prior to discussing ROCD in detail with the individuals whom it involves in your life. For example, loving partners often have great difficulty understanding why doubt exists and can sometimes take offense or behavior in ways that worsen the doubt with the best intentions. If ROCD exists, an expert clinician is likely to be willing to support you in explaining your symptoms to the individuals whom your doubt targets in ways that better help you potentially preserve the relationship and gain real support from your relationships that help you reduce your ROCD symptoms. One thing that is not typically recommended, is ending relationships simply to feel more certainty in the moment – ROCD typically attaches itself to different relationships. Therefore, ending relationships to reduce momentary discomfort can set up a cycle where symptoms arise again with a new relationship which in turn causes the individual to again end the relationship.

Moving On Through Treatment
Relationship OCD is an insidious condition in which sufferers are plagued by thoughts about their relationship. These thoughts almost always focus on whether or not their current partner is the right one, and thus cause ROCD sufferers to have a difficult time moving forward with intimacy in their lives. It is possible, however, for those suffering from Relationship OCD to move on with their lives if they address their symptoms early enough. The first step toward doing so is recognizing that you may have Relationship OCD. Treatment for ROCD with an expert therapist should involve exposures to help you face your uncertainty and may involve meetings with family or important relationships, should you want these, to help your supporters understand what you are going through.
OCD: How to Overcome Your Fears

OCD: How to Overcome Your Fears

OCD: How to Overcome Your Fears

Obsessive compulsive disorder (OCD) is an anxiety disorder where people have unwanted thoughts and behaviors that feel out of control and cause significant distress or difficulty functioning in daily life. The condition often runs in families, suggesting that there may be some genetic component to it, but environmental factors like childhood trauma can also contribute to the development of OCD. People with this condition often develop rituals as a way to cope with the anxiety they experience; many of these rituals are repetitive behaviors, including hand washing or checking that no one has been in the house while they were gone.

What Is Obsessive Compulsive Disorder?
Obsessive compulsive disorder (OCD) is an anxiety disorder that can cause significant distress, as well as sometimes difficult to understand behaviors. In short, OCD is characterized by obsessive thoughts and behaviors that are performed in order to reduce or neutralize obsessions. For example, you may have an obsessive fear of germs, which leads you to perform excessive hand-washing or cleaning rituals. This behavior provides temporary relief from your anxiety but increases over time until it dominates your life and interferes with daily functioning.

What Causes Obsessive Compulsive Disorder?
OCD is a serious mental illness. Triggered by severe anxiety, it affects about 2.2 million American adults and impacts people of all races, ages, socioeconomic backgrounds and education levels. It’s generally treated with a combination of behavioral therapy and prescription medications (antidepressants or anti-anxiety medications). OCD may be caused by a myriad of contributing factors, including biology and environment. In many cases, no single cause can be identified. In some instances, OCD symptoms are related to an underlying medical condition that needs treatment. Regardless of the cause of OCD, a mix of behavioral and pharmacological treatment is usually most effective. Exposure Response Prevention Therapy is one type of behavioral treatment used in treating obsessive-compulsive disorder.

Are There Treatments For OCD?
Yes. There are a variety of effective treatments for OCD, with behavioral therapy being one of them. Exposure and response prevention (ERP) is an effective and common treatment that focuses on gradually exposing you to fearful situations that trigger your obsessive thoughts and compulsive behaviors, allowing you to learn how not to respond out of fear.

What Role Does Exposure And Response Prevention Play In Treating OCD?
Exposure and response prevention (ERP) is an important part of behavioral treatment for obsessive compulsive disorder (OCD). It’s a long and involved process that involves gradually exposing yourself to things that scare you until you get used to them, which allows your brain to rewire itself so you can deal with whatever it is you’re scared of without needing excessive reassurance or avoidance. Think of exposure as desensitization therapy.

Differences in Early and Late Onset OCD

Differences in Early and Late Onset OCD

Pinto et al. (2006) defined OCD as “a neuropsychiatric condition characterized by recurrent intrusive thoughts (obsessions) and repetitive behaviors that the individual feels driven to perform (compulsions)” (pg.1 ).  The researchers sought to investigate predictors of remission/relapse among those treated for OCD.

Over five years, 293 adults were monitored and researchers measured their OCD symptoms. Researchers found those with early and late onset symptoms experience an increase in symptoms over time without effective treatment. Additional findings show a considerable amount of time between symptom onset and first initiation of treatment. Individuals in the study reported an average of 17 years from initial symptom experience to treatment initiation and 11 of delay from meeting diagnostic criteria for OCD until treatment initiation. Many clients reported spending a number of years misdiagnosed before initiating appropriate treatment for OCD.  

Researchers found the average onset for early onset OCD was 11-12 years old, while late onset OCD was 25-26 years-of-age. The first clinical symptom(s), obsessions and compulsions, 53% of participants indicated an obsession and 47% experiencing a compulsion. Interviews also found aggressive content obsessions, hoarding obsessions and compulsions as primary themes in distress. Contamination was shown as the most frequently reported subcategory for obsessions. Those with earlier onset symptoms also experienced higher rates of panic symptoms and disordered (Pinto et al., 2006).

Written by Perry Leynor, MA, LPC Associate supervised by Paula Maloney, LPC Supervisor.

Pinto, A., Mancebo, M. C., Eisen, J. L., Pagano, M. E., & Rasmussen, S. A. (2006). The Brown Longitudinal obsessive COMPULSIVE Study. The Journal of Clinical Psychiatry, 67(05), 703-711. https://doi:10.4088/jcp.v67n0503

Postpartum OCD

Postpartum OCD

When we hear “postpartum” it is usually followed by “depression”. While the postpartum period IS often associated with depression, other disorders are overlooked. Outside the scope of obsessions harming infants, the effects of Obsessive-Compulsive Disorder (OCD) have limited investigation into pregnancy and the postpartum period. This is concerning for two reasons. One, research shows that obsessive compulsive symptoms (OCSs) can be as severely debilitating as other disorders, including schizophrenia. Two, clinical research reflects psychological disorders, commonly depression, cause poor infant outcomes. It is alarming OCD is often overlooked due to the potential impact on infant outcomes. Pregnancy and parenthood constitute major events that create major life obstacles. Studies show these periods can create a greater risk of causing and increasing the severity of OCSs. OCSs are associated with the overall well-being of the infant (House et al., 2015).

House et al. (2015) examined if preexisting OCSs increased throughout the perinatal period. Researchers followed 56 women diagnosed with OCD over a period of 52 weeks postpartum. The study relied on assessment measures for OCD and follow-up with clinicians. Researchers found the severity of OCSs did not increase or fluctuate throughout the pregnancy and postpartum period, unlike other disorders. Maternity age and delivery method were both associated with predictors of increased OCSs. Women who gave birth having a cesarean section showed an increase in OCSs postpartum, and younger woman were associated more with OCSs. Future studies would replicate this data and include comorbid disorders.

By Perry Leynor, MA, LPC-A – Behavior Therapist with Better Living Center for Behavioral Health

House SJ., Tripathi SP., Knight BT., Morris N., Newport DJ., Stowe ZN. (2015). Obsessive-compulsive disorder in pregnancy and the postpartum period: Course of illness and obstetrical outcome. https://pubmed.ncbi.nlm.nih.gov/26173597/

Contamination OCD in Adolescents: Treatment with Acceptance and Commitment Therapy

Contamination OCD in Adolescents: Treatment with Acceptance and Commitment Therapy

Obsessive-Compulsive Disorder (OCD) describes a condition in which an individual has uncontrollable thoughts and/or behaviors (i.e., compulsions) that are problematic on an ongoing basis (National Institute of Mental Health), and these symptoms can be experienced by adults as well as children and adolescents. Common treatments for OCD involve exposure therapy, which is sometimes combined with a selective-serotonin reuptake inhibitor (SSRI) medication (International OCD Foundation). However, recent advances in treatment for OCD are now including Acceptance and Commitment Therapy (ACT), which is a form of therapy that encourages individuals to accept unwanted thoughts without judgment, separate themselves from their thoughts, engage in activities that move the individual toward life values, and mindfulness (see contextualscience.org/act for more information). Although there is growing evidence for ACT as a component of treatment for OCD, the majority of these studies have been conducted with adults. Therefore, Armstrong and colleagues (2013) evaluated the effects of ACT for three adolescents (ages 12-13 years old) diagnosed with OCD.

Participants in this study reported fears about contamination and dying which were linked to problematic behaviors such as excessive hand washing, frequent reassurance-seeking, and lengthy bedtime routines. Treatment occurred weekly over the course of 8 weeks and involved a variety of components. A few examples of treatment components were 1) identifying differences between obsessions and compulsions; 2) drawing activities; 3) education about and activities surrounding the futility of fighting thoughts; 4) identifying life values; 5) accepting unwanted thoughts; and 6) mindfulness. Each treatment session was 50 min and included related homework assignments. The results of this study showed that self-reported compulsions decreased by 40%, and these effects were maintained at a 3-month follow up, and treatment was rated as highly acceptable by participants as well as their parents.

Armstong, A. B., Morrison, K. L., & Twohig, M. P. (2013). A preliminary investigation of acceptance and commitment therapy for adolescent obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 27, 175-190.