ERP Therapy Stories: Relationship OCD (ROCD)
I created this “ERP Therapy Stories” series to share a glimpse of how the application of ERP therapy could look within the context of different OCD subtypes. I hope to provide some examples of ERP therapy while channeling my creative and imaginative side. The stories and characters that I write about are fictional, but the ERP strategies depicted are ones that I teach and use in therapy with my clients. This particular post focuses on illustrating symptoms of Relationship OCD (ROCD), including commonly seen ROCD obsessions and ROCD compulsions. As an OCD therapist who enjoys storytelling, I hope these vignettes can help you feel less alone and see hope in ERP therapy.
Laura is a 30-year-old accountant living and working in San Diego, CA. She is in a relationship with Adam, an amazing man who treats her well. They have been together for over a year and talking about the future. They are planning to move in together when Laura’s lease is up. It’s been exciting talking about everything from décor to how they’ll handle each other’s funny little habits. Laura has never been so happy in a relationship, and so doubtful at the same time. She suspects that she is experiencing symptoms of Relationship OCD (ROCD).
She decides to seek ERP therapy with an OCD therapist in San Diego.
It’s another Monday morning at the North Park office. Laura is there extra early; it’s tax season and there is much to do. She hasn’t been getting much sleep lately, and relying on coffee more than usual. Since starting ERP therapy, she has been self-monitoring and therefore much more aware of her triggers. Laura is fully aware that lack of sleep tends to increase the likelihood of her OCD obsessions showing up. She keeps this in mind as she starts her work day. Laura sees a good morning text from Adam come into her phone. She is drafting a lengthy email to a client and doesn’t want to interrupt her workflow. She decides to reply to Adam’s text when she’s done.
Suddenly, a thought enters her mind. “You’re ignoring Adam,” her mind says. “Maybe you’re just pretending to love him.” Laura pauses for a moment as this catches her attention. “You did the same thing yesterday when Adam texted while you were grocery shopping. You could’ve answered him that moment, but you made him wait. Maybe you don’t care about him.” Laura has now momentarily lost her focus. More ROCD doubts continue to fill her mind “What if deep down you don’t love Adam? What if you’re stringing him along and pretending to be happy about moving in with him?” Laura’s heartbeat starts to pick up in pace and there is a heavy feeling in her stomach as her anxiety rises. Could this be true? Could all this excitement about moving in together all be an act? If so, she would be making a huge mistake. And that wouldn’t be fair to Adam either.
Laura stops what she’s doing. She thinks about texting Adam to prove to herself that she loves him- but she knows that this would be giving into her OCD. She and her therapist have identified this as a compulsion. Her mind quickly jumps to figuring out her true feelings.
There is a sense of urgency that overtakes her.
She wants to find evidence to indicate that her feelings toward Adam are real and that she’s not faking them. Moving forward in this relationship without feeling certain about her love for Adam would be catastrophic. An incomplete email sits on her computer screen as she begins to mentally replay their dinner last night in Little Italy. Laura’s mind starts to trace back to various moments throughout the evening to remember how she felt and whether it was “love”. And then she realizes what’s happening.
ERP therapy has helped Laura catch and interrupt her mental compulsions.
Laura frequently engages in mental reviewing to look for evidence against her ROCD obsessions. She also engages in checking behaviors to monitor her feelings. Catching these “invisible” compulsions has been tricky because they happen in her mind and feel so automatic. She has done some ERP exercises in therapy, starting with activities that she’s been avoiding due to her ROCD obsessions being triggered. She revisited her Pinterest board and began adding more apartment décor ideas. She went on social media and shared photos of her and Adam after their weekend in Los Angeles- with a loving caption. She went back to planning their upcoming NYC trip later this year. Laura started watching episodes of “Love is Blind” again, a mindless pastime she once enjoyed. All this was done without allowing her mind to engage in mental compulsions like comparing, checking her feelings, or reviewing past situations to find “proof” that she is in love. She’s also been showing Adam more affection without getting caught up in doubtful thoughts about whether her behavior is genuine.
Laura’s at her desk, realizing that her mind is getting engrossed in her obsessions and starting to engage in mental compulsions. She is compelled to keep going but knows that she needs to stop. “This has never been helpful in the past, you can let this go,” she says to herself. This response helps her pivot back to her client’s email without giving herself any certainty about the questions in her mind. OCD wants a sure answer and wants her to figure it out right now. But Laura knows that giving in will continue to reinforce this cycle. It’s hard resisting the compulsions, the anxiety is intense. Laura knows from her work in therapy sessions to hold grace for herself as she experiences uncomfortable feelings and sensations.
Laura stays focused on her client’s email and reminds herself of her values. She values being trustworthy and reliable in all areas of her life, including her work with clients.
Giving OCD her undivided attention takes her away from these values.
By the time she’s wrapping up the email, Laura notices that her anxiety feels more manageable. What she once believed to be completely unbearable feels more bearable now. Each of these ERP Therapy successes helps to reinforce the belief that she is capable of working through tough moments like these. She takes a moment to document this in her self-monitoring log. Once the sense of urgency has passed and she has sent her email, she turns to Adam’s text and sends him a reply.
