This document discusses relationship obsessive compulsive disorder (rOCD) and provides strategies for managing it. It defines rOCD as having obsessive doubts and fears about one's relationship that are magnified due to OCD. Common signs include obsessive thinking about the relationship, seeking frequent reassurance, avoidance behaviors, guilt, and atypical behavior driven by obsessions. Cognitive distortions that fuel rOCD include intolerance of uncertainty, emotional reasoning, and thought-action fusion. The document recommends mindfulness techniques like thought and feeling awareness exercises to manage rOCD. It also suggests limiting reassurance seeking, recognizing patterns of past relationship doubts, and using imaginal exposure scripts.

1. Relationship OCD
and the
Doors Of Uncertainty
Annabella Hagen, LCSW, RPT-S
Utah Therapy for Anxiety Disorders
3325 North University Avenue,
Suite 350
Provo Utah 84604
801-427-1054
azhagen@gmail.com
www.annabellahagen.com

2. Relationship OCD
and the
Doors of Uncertainty
• Chuck Story
• The Doors of Uncertainty Metaphor
• Linda Story

3. Relationship OCD
and the
Doors of Uncertainty
Remember that doubts about one’s
relationship can be normal. The problem
is that when you struggle with OCD, these
doubts are magnified and you become
obsessed with them.

4. Some major red flags that may
indicate you have rOCD:
• Obsessive thinking. Are you making lists? Are you
writing down the pros and cons about your relationship?
Do you keep trying to figure out whether you really love
him/her? Are you obsessing about her/his physical and
personal characteristics?
• Seeking reassurance. Do you try to find reassurance
from your friends, family, or yourself? How long does the
effect of reassurance last?
• Atypical behavior. Notice your behavior and whether it’s
atypical of who you are. Your behavior may be driven by
your obsessions.

5. Some major red flags that may
indicate you have rOCD:
• Believing that you can control your thoughts and
feelings. Is your mind tricking you and telling you that
you can do this?
• Avoidance. Do you keep trying to avoid triggers that
will make you anxious and question your love and
loyalty? Is avoidance working for you?
• Guilt. When OCD sufferers feel guilty, their partner
may wonder about their behavior and feelings. This in
turn may backfire.

6. Common Cognitive Distortions in rOCD
• Intolerance of Uncertainty: When an individual
experiences OCD, the most common thinking error is the
inability to tolerate even a minuscule sign of doubt. You
can learn skills to help you learn how to embrace and
accept the uncertainty that rOCD brings.
• Emotional Reasoning: Individuals struggling with rOCD
use their feelings as evidence that their thoughts about
their relationship “must” be true because it feels that way.
• Polarized (All-or-Nothing) Thinking: When individuals
begin to doubt their love toward their special person, they
believe their relationship will fail. Their thinking goes from
one extreme to the other.

7. Common Cognitive Distortions
in rOCD (continued)
• Mind Reading: Individuals who experience rOCD may
worry about what their loved one is thinking and may end
up making wrong assumptions about their relationship. In
turn, the loved one may notice their partner’s anxiety and
begin mind reading as well.
• Comparing and Contrasting: In our modern world,
rOCD sufferers may experience a lot of anxiety and
uncertainty when they use electronic media as a source
of reassurance. For example, they may notice how happy
their friends and their partners seem to be on Instagram
or Facebook. Their thinking errors may lead them to
believe others are happier and don’t have problems or
doubts in their relationships because “they look so happy!”

8. Common Cognitive Distortions
in rOCD (continued)
• Thought-Action Fusion (TAF): This distortion can affect
the relationship especially when OCD sufferers also
experience scrupulosity OCD. For example, individuals may
experience intrusive thoughts or images of being with
another partner. They may believe that they “should” not be
having those thoughts and consequently feel guilty about it.
They consider the thoughts as if they were facts or actions.

9. Common Cognitive Distortions
in rOCD (continued)
• Excessive Concern About the Importance of
Controlling your Thoughts: Most OCD sufferers
believe that they should be able to “control” their
thoughts. This thinking error may be prevalent in
rOCD when the sufferer also experiences other
intrusive thoughts related to another type of OCD
such as scrupulosity.

10. What can you do?
• Become aware of how often you seek reassurance
regarding your loved one. You may seek
reassurance from anyone who will give it to you.
Unfortunately, this is a compulsion, and it will only
strengthen the ODC thinking patterns. Start limiting
this compulsion one step at a time.
• Remember that you cannot control your thoughts. It
may appear that you can, but you may recall that
when you’ve tried this in the past, it only backfires
with more obsessions and compulsions.

11. What can you do? (continued)
• Notice your past relationships. How often have
you had similar doubts show up in your life? If
there is a pattern, do not break off your current
relationship until you have consulted with an
OCD specialist.
• Invite your loved one to come to some of your
therapy sessions. Both of you will learn
communications skills and how to handle the
OCD moments in the relationship.

12. What can you do? (continued)
• Remember that the thoughts are not the problem.
What you do once they show up is what matters.
Keep in mind that pushing them away and reacting
with catastrophic thinking activates the fight-or-
flight response.
• When you notice thoughts that aren’t helpful, it’s
best to learn to gently shift your focus to the
present moment.
• Learn Mindfulness skills to help you manage rOCD.

13. Mindfulness Practice:
1. Thought Awareness Exercise
• *“Attending to the Thinking Process”
2. Feeling Awareness Exercise
• **“Awareness of Feelings and Sensations”
3. Learning to be open to feelings and sensations
• ***“Working with Difficult Emotions”
* Adapted from: Hooker, K. & Fodor, I. (2008). Teaching Mindfulness to Children. Gestalt Review, 12(1):75-91.
** Adapted from: Harris, R. & Aisbett B. (2014). The Illustrated Happiness Trap: How to Stop Struggling and Start Living. Boston: Shambhala
Publications.
*** Adapted from: http://marc.ucla.edu/body.cfm?id=22. —04_Meditation_for_Working_with_Difficulties.mp3.

14. Imaginal Exposure
• Short and mild script

15. Mindfulness Practice
• One more mindfulness exercise