Relationship OCD (ROCD)

What is relationship OCD?

By Prof. Guy Doron and Dr. Danny Derby, Relationship OCD Research Unit. Reviewed November 2026.

Relationship obsessive-compulsive disorder (ROCD) is a presentation of obsessive-compulsive disorder (OCD) in which obsessions and compulsions center on a close relationship, most often a romantic one (Doron et al., 2012a; Doron, Derby, et al., 2014). It is not a separate diagnosis. When the criteria are met, it is diagnosed as OCD, in the same way as OCD focused on contamination or harm.

Most people have doubts about their relationship at times. In ROCD, a doubt such as “Do I really love her?” or “What if he isn’t the right one?” returns again and again, causes marked distress, and sets off attempts to resolve it: checking one’s feelings, comparing the partner with others, replaying conversations, or asking for reassurance. These attempts may bring brief relief, but they keep the doubt at the center of attention. ROCD describes how a person responds to doubt. It cannot tell anyone whether a particular relationship is right.

Read the introductory guide: What is ROCD?

Two forms of ROCD

Research describes two main presentations, which often occur together (Doron et al., 2012a, 2012b):

• Relationship-centered symptoms: doubts and preoccupation about one’s own feelings toward the partner, the partner’s feelings, and whether the relationship “feels right.” They are measured by the Relationship Obsessive-Compulsive Inventory (ROCI).
• Partner-focused symptoms: preoccupation with a partner’s perceived flaws, for example in appearance, sociability, morality, emotional stability, intelligence or competence. The trait may be real. What marks ROCD is the repeated preoccupation with it and the need to keep checking what it means. These symptoms are measured by the Partner-Related Obsessive-Compulsive Symptom Inventory (PROCSI).

For one person, a quiet evening at home brings the thought “I don’t feel anything right now,” and the rest of the evening goes into checking whether the feeling is still there. For another, the way a partner laughs at a party becomes something to watch, compare and replay, together with shame about noticing it at all.

How the ROCD cycle works

Most people have unwanted thoughts about their relationship from time to time. In ROCD, these thoughts get caught in a cycle (Doron, Derby, et al., 2014). An ordinary trigger brings an intrusion, such as “I’m bored with him.” The intrusion is read as a sign that something is wrong, which brings distress, guilt or shame and a pressing need for certainty.

The person then tries to settle the question. Some responses are visible, such as asking friends or the partner for reassurance. Many are mental: monitoring feelings, comparing, reviewing memories, or listing reasons to stay or leave. Each round can bring brief relief, but it also makes the doubt seem more important, so the next trigger meets a more watchful mind. This is why treatment works on the cycle itself, rather than trying to settle the question about the relationship.

Dr. Ran Littman, a former member of the unit, writes about ROCD on the Relationship OCD blog on Psychology Today.

What research has found

Since the first ROCD studies were published in 2012, research teams in several countries have studied these symptoms. Most of the evidence comes from questionnaire studies, many in community samples. It shows which patterns tend to go together, not what causes what.

• Measured across languages. The ROCI and PROCSI have been translated into several languages and tested by other research teams. In Italy, the three-factor structure of the ROCI and the six-factor structure of the PROCSI held in a community sample of 820 people and in 310 people who reported an ROCD diagnosis (Melli, Carraresi, et al., 2018). In Turkey, the original structure of both held (Trak & İnözü, 2017). In Germany, the ROCI’s three-factor structure held in two samples of 409 and 248 people in relationships (Brauer & Borchardt, 2025). In Iran, researchers built a version of the ROCI adapted to Iranian culture, keeping the original items and adding new ones (Ghomian et al., 2021).
• Comparable in severity to other OCD. In a clinical study, 22 people with ROCD and 22 people with other presentations of OCD did not differ in the severity of their main symptoms. The ROCD group held stronger maladaptive beliefs related to OCD and to relationships (Doron et al., 2016). The groups were small.
• Beliefs that raise the stakes. With colleagues in Italy, we studied 124 people who reported an ROCD diagnosis from a clinician. Concern over mistakes, doubts about actions, and catastrophic beliefs about being in the wrong relationship or being alone were linked with relationship-centered symptoms (Melli, Bulli, et al., 2018).
• Costs for the relationship. ROCD symptoms were linked with lower sexual satisfaction, over and above depression, general worry, other OCD symptoms and attachment orientation. Lower relationship satisfaction accounted for this link (Doron, Mizrahi, et al., 2014).
• What is still missing. A systematic review of 12 studies published between 2012 and 2022 found that most research has examined individual and relationship correlates. Its authors called for cross-cultural studies, treatment studies in clinical samples and more randomized trials (Mısırlı & Karadayı Kaynak, 2023).

See all our ROCD papers · Download the questionnaires

Treatment, and what the evidence shows

ROCD is treated as OCD: with cognitive behavioral therapy (CBT) that includes exposure and response prevention (ERP), adapted to relationship themes. Treatment aims to reduce checking, comparing and reassurance-seeking, and to loosen the beliefs that make uncertainty feel catastrophic. It does not aim to persuade anyone to stay in a relationship or to leave it.

The work is guided by an individual formulation. Where the formulation points to long-standing emotional patterns, such as fears of abandonment or of not being worthy of love, experiential techniques drawn from schema therapy may also be used.

The evidence behind this comes in three layers, and they should not be confused:

• Evidence for OCD treatment in general. Behavioral and cognitive therapies for OCD are supported by many randomized trials (Skapinakis et al., 2016), and CBT with ERP is recommended in clinical guidance (National Institute for Health and Care Excellence [NICE], 2005). These trials included people with many OCD themes and did not report results for ROCD separately.
• Evidence specific to ROCD. This is still limited. It includes a published case report of ERP adapted for ROCD (Lombardi & Rodriguez, 2019), a clinical illustration of ROCD and sexual functioning (Derby et al., 2024), and reviews that describe how CBT strategies are applied (Praško et al., 2024). Controlled trials of a dedicated ROCD protocol in people diagnosed with ROCD are still needed.
• Evidence on particular apps. Two randomized studies tested the relationship track (GGRO) of ocd.app, an app co-developed by Prof. Doron. One included 50 students with subclinical symptoms (Cerea et al., 2020); the other included 103 couples from the community (Gorelik et al., 2023). Their results apply to this app and these samples, not to therapy or to people with a clinical diagnosis.

Read about ROCD assessment and treatment

Looking for help

If relationship doubts, and the attempts to resolve them, are taking up a lot of time or interfering with your life, an assessment by a professional who treats OCD can help clarify what is going on. You do not need to settle the question about your relationship before you seek help.

Talking about ROCD symptoms

A conversation about ROCD hosted by the International OCD Foundation.

Frequently asked questions about ROCD

This site offers information, not a diagnosis or a substitute for assessment by a professional who knows OCD.

Take part in ROCD research

Our research depends on people willing to share their experience. See the studies currently looking for participants.