Relationship OCD and intrusive thoughts

What is relationship OCD & how to overcome it?

What is relationship / relational OCD?

Obsessive compulsive disorder (OCD) is a long-term mental health condition that includes recurring unwanted thoughts or impulses (“obsessions”), which lead to unwanted repetitive behaviours (“compulsions”). Clinically, it is classified as a form of neurodivergence (ND), and often someone will have OCD with another ND presentation such as ADHD or autism. 

These unwanted thoughts or obsessions are also called intrusive thoughts or Automatic Negative Thoughts (ANTs). Typically, they can be loud and repetitive thoughts that fill the mind with noise, much like nearby traffic. On a good day, it might seem like the soft hum of distant passing traffic, on a bad day, you’re stuck in a rush hour traffic jam with roadworks and honking horns.  

Intrusive thoughts can be difficult to overcome in everyday life, such as about your body or career success. Or, for example, if someone has hygiene-related ANTs, they may feel the need to wash their hands multiple times per hour, which can interfere with their work, sleep, and family time. 

Similarly, intrusive thoughts about our personal relationships (rOCD) can be damaging and have negative consequences for us, our relationship(s), and partner(s). It can be very confusing to someone who feels they love their partner(s) but also has violent, vile, or desperate thoughts about them. How do you know what is real and what isn’t?

To be clear, it’s normal and natural to have doubts and insecurities in a relationship – we all do that. So, what’s the difference with relational OCD, you might ask? This video is a great overview of rOCD and this video gives a personal account of someone’s journey to overcoming it. 

4 main types of relationship OCD

It seems that relationship ANTs fall into 4 main categories, which are: 

  • Fortune telling & predicting the worst without actual knowledge or evidence:
    My partner’s going to forget our anniversary because they don’t love me and because they know how much it matters to me.
  • Violence & wanting to hurt our partner, even if we don’t consciously feel that way:
    If I tell my partner they’re ugly when we’re having sex it’ll really hurt them.
  • Mind-reading what our partner is going to say rather than asking and listening: 
    I just know my partner doesn’t care about…(something I’ve not asked about). 
  • Blaming them for our own behaviour: 
    It’s your fault I’m so overweight and unfit because you won’t exercise with me.


At its most simplistic, relationship OCD is a request for reassurance and confirmation of love and connection. Put simply, “do you love me?” or “do you really want to be with me?”. This can manifest in repeatedly requesting reassurance, having sex more frequently that your libido wants in order to feel connected, testing your partner in terms of undivided attention or remembering special occasions or shared memories.  

These seemingly needy or demanding behaviours can be distressing both to the person with OCD and to their partner(s). It can also put strain on the relationship and give it a transactional or performance-based feeling. 

Often, as this article explains, relationship OCD can also lead to, or increase the chances of, sexual dysfunction. 

two people holding hands

What causes relationship / relational OCD?

Short answer: we’re still not sure, but we have some good ideas and are gathering evidence to substantiate these hypotheses. 

As with all neurodivergent traits, there is a wide range physiological and behavioural aspects including brain chemistry, hormones, and the typical socialisation of children displaying ND behaviours. There may also be individual causes at play, such as a history of abusive relationships, an anxious attachment style, or the loss of a partner.  

As a therapist, I’m more interested in what my clients feel and experience. What I’m told is that OCD feels like a sense of incompleteness or things just not being quite right. This is often linked to a strong sense of wrong and right or a black and white worldview that many ND folks hold.

Moreover, relationships, particularly at the beginning or in times of rupture, can create especially high levels of anxiety in ND people. This anxiety can fuel the wrong/right thinking and turn up the volume on intrusive thoughts. 

What Can help relationship OCD?

person holding hands

Of course, every person with OCD is different and experiences rOCD in their specific and nuanced way. But if symptoms of OCD are posing a serious challenge to your intimate life, there are ways of coping. The good news is that various forms of therapy and other healing modalities do have a good track record of curbing or diminishing intrusive thoughts. Here are 3 steps someone can take to address these thoughts, the related anxiety, and the behaviours they lead to in our relationships. 

3 steps to get started: 

1. Notice and name your ANTs
This can feel like trying to turn the tide with a teaspoon at the start. The quicker you can recognise them when they arise in your mind, the better. Naming them, even saying them out loud and recognising they’re not your true feelings, are huge steps. 

2. Focus on the wins, let go of the rest
Celebrate when you do recognise and name the thought. Notice the improvement pattern over days or weeks. Let go of the times you’re not perfect in this practice and allow yourself to be human and cut yourself some slack. 

3. Rewrite the thought to make it more accurate
This often means removing words like always or never and “should”, as well as softening your perspective. For example, “When we’re kissing I always kill the mood and should say sexier things” to, “I’m getting a bit better at working out what turns my partner on when we’re kissing and I’m willing to keep practicing”. 

This is a simple and effective approach to getting started with addressing intrusive thoughts. If you do these three steps consistently, it is very likely to quieten your mind. However, this is unlikely to work deeply enough to address the deeper underlying beliefs. This is where working with a therapist, counsellor, or OCD specialist may help you unravel your unique patterns and relationship needs. 

If you can afford it or you have access to free mental health support, I encourage you to reach out to your provider. As with any life changes, receiving the right sort of help can make the process easier and increase the chances of successful change occurring. 

What Should I say to my partner?

Let’s take a deep breath, relax, and drop the should, shall we? This is your journey with yourself. You may well find it helpful to explain to current or prospective partner(s) what is going on in your head and what behaviours you’re trying to change. 

Assuming they are supportive, they may be able to help you by witnessing when you do the three steps listed above. 

If you want to, rOCD is a great issue to take to relationship therapy or couple’s counselling, so you have the support of both your partner and a therapist. 

What other help is available?

Relationship OCD is an issue I work with, both at the more superficial level as described above, and at the deeper level, addressing attachment styles, chronic anxiety, and healing trauma held in the body. To be clear, I have no desire to make you less yourself or less neurodivergent, but I do want you to suffer less and to thrive more in your intimate relationship(s).

Although this is a sweeping generalisation, you may find that a neurodivergent therapist is easier to work with in terms of their own understanding and experiences of intrusive thoughts. There is a UK register and a US register of ND therapists and counsellors. 

Google and Youtube are overflowing with people wanting to talk to you about and support you with relationship OCD. As always, please do your due diligence and check that the person you’re learning from, or working with, meets your personal criteria for relevant expertise. 

If you’re not sure if you need help, let me remind you that you deserve it anyway. Your mental health and wellbeing are important for you and those you’re in relationship with. I invite you to reach out to me or another mental healthcare professional to get the help and support you need and deserve.