Updated: 28 October 2026
“Do I love my partner enough?” “What if I stay in the wrong relationship?” “What if I leave and regret it for the rest of my life?”
These questions can become exhausting when every possible answer leads to another round of checking. A person may spend hours analysing their feelings, comparing their partner with others, reviewing memories, or imagining different futures. The effort to make a responsible decision can gradually take over the experience of being in the relationship.
Treatment begins with understanding this process: what triggers the doubts, what makes them feel threatening, and how attempts to resolve them may keep the difficulty going.
Understanding the problem before choosing a treatment
Relationship doubts alone do not establish a diagnosis of ROCD. Assessment explores the pattern of thoughts and responses, their frequency, the distress they cause, and their effects on everyday functioning and relationships. The person’s actual relationship circumstances also matter.
Particular attention is given to compulsions that happen internally. Repeatedly reviewing whether a partner is attractive enough, testing feelings during intimacy, or mentally rehearsing reasons to stay or leave may be less visible than asking for reassurance, but they can occupy much of a person’s day.
Assessment also considers other OCD symptoms, mood, anxiety, attachment concerns, sexual difficulties, and relevant personal and relationship history. The ROCI and PROCSI questionnaires can help describe symptoms and track change. Their scores contribute to assessment alongside a clinical interview and an understanding of the person’s circumstances.
Explore the ROCI and PROCSI questionnaires or complete the online self-check.
A research-informed, individualised approach
ROCD is a presentation of OCD. Our treatment approach therefore builds on the broader research on OCD, its maintaining mechanisms, and its treatment, particularly cognitive behavioural therapy (CBT) incorporating exposure and response prevention (ERP). Research specifically examining ROCD informs how these principles are applied to relationship-focused symptoms, attachment insecurities, self-worth sensitivities, and beliefs about love, relationship choices, and regret.
The approach developed by Professor Guy Doron and Dr Danny Derby brings together this research with clinical experience accumulated over years of working with these difficulties. It considers both the processes maintaining obsessive doubts and the vulnerabilities that can make relationship uncertainty particularly threatening.
Treatment is guided by an individual formulation using the five Ps:
- Presenting difficulties: what the person is struggling with now.
- Predisposing factors: experiences and sensitivities that may have increased vulnerability.
- Precipitating factors: events or changes associated with the onset or worsening of difficulties.
- Perpetuating factors: responses, beliefs, and circumstances that keep the problem going.
- Protective factors: strengths, relationships, and resources that can support change.
This formulation helps the therapist and client decide what to work on and how different parts of the treatment fit together. Developmental experiences are explored when they help explain the person’s sensitivities and current difficulties.
Exposure and response prevention: making room for new learning
Exposure and response prevention (ERP) is central to the approach. CBT that includes ERP is recommended in clinical guidance for OCD, including work on mental rituals and neutralising strategies. This broader evidence base informs the treatment of ROCD.
Exposure involves approaching situations, thoughts, feelings, or possibilities that trigger the obsessive cycle. Response prevention involves learning to reduce the compulsions used to resolve, neutralise, or escape that experience.
For example, a person might practise spending time with their partner while allowing uncertainty about their feelings to remain, without repeatedly checking whether they feel sufficiently connected. Another exercise might involve approaching the possibility of future regret without mentally reviewing every reason for and against the relationship.
The aim is new learning. Through practice, the person can explore what happens when they allow doubt or discomfort to be present and respond more flexibly. Exercises are planned collaboratively, guided by the formulation and the person’s goals.
Working with the beliefs that make uncertainty feel catastrophic
Alongside ERP, treatment addresses the beliefs that give relationship doubts their urgency.
For one person, uncertainty may mean that their relationship is fundamentally wrong. For another, a partner’s perceived limitation may feel like evidence of their own inadequacy. Someone else may believe that choosing incorrectly would cause an unbearable, irreversible loss.
Relevant beliefs may include:
- “If this were real love, I would always feel certain.”
- “My partner’s qualities determine what I am worth.”
- “Staying in the wrong relationship would ruin my life.”
- “Leaving the right relationship would be a mistake I could never recover from.”
- “I must eliminate the possibility of regret before I decide.”
Exposure, behavioural experiments, and Socratic dialogue work together to examine these beliefs and loosen their influence. The therapist helps the person explore their assumptions, consider their costs, and learn through experience.
This work also examines the role of compulsions themselves. Does repeatedly testing a feeling help someone experience closeness? Does another hour of mental comparison improve their ability to make a decision? These questions become opportunities for collaborative investigation.
Attachment, self-worth, and developmental sensitivities
The meaning of relationship uncertainty differs from person to person. It may touch on fears of abandonment, concerns about being worthy of love, or the sense that having a particular kind of partner is essential to one’s identity.
Where relevant, treatment explores how these sensitivities developed and how they become activated in present relationships. Experiential techniques drawn from schema therapy may be integrated when the formulation indicates that they could help address enduring emotional patterns.
The selection of techniques follows the individual formulation. Understanding a sensitivity and changing the responses that maintain it are connected parts of the work.
What does progress look like?
Progress includes recognising that compulsions, particularly mental compulsions, are not helping the person experience their relationship or make decisions, and learning to reduce them to a minimum.
It also includes greater flexibility in the beliefs surrounding a potentially “wrong” choice. As the catastrophic meaning of uncertainty becomes less dominant, the person has more room to participate in the relationship, recognise their needs, and make decisions.
Treatment supports the person’s agency. Its purpose is to help them approach their relationship and their choices with less compulsive analysis and less fear of making an imperfect decision. The therapist does not determine whether they should stay or leave.
Research, clinical experience, and the limits of the evidence
The approach combines established treatment principles for OCD with a formulation informed by ROCD research and clinical experience. Although this complete combination of ROCD-specific adaptations has not yet been evaluated in a randomised controlled trial, its core treatment methods draw on the evidence base for OCD treatment.
Its clinical development has also been informed by case material and experience accumulated over the years. Clinical cases have been documented with ROCI and PROCSI assessments at the beginning, midpoint, and end of treatment. These assessments help track symptom change; uncontrolled clinical observations do not establish treatment efficacy.
Published clinical illustrations contribute to this understanding. In Sexual dysfunction in relationship obsessive compulsive disorder, Derby, Tibi, and Doron discuss ROCD, sexual functioning, and treatment implications through a clinical illustration. The article notes that the character’s details are fictional and the interventions represent examples from work with different clients. It should therefore be understood as a clinical illustration rather than a controlled treatment-outcome study.
Research on particular digital interventions should likewise be interpreted in relation to the specific intervention, population, and outcomes studied.
Seeking help
For information about Dr Danny Derby’s clinical work in English, visit Dr Danny Derby’s professional website. For ROCD information and clinical services in Hebrew, see Cognetica’s ROCD resources in Hebrew. Dr Derby is the founder and director of Cognetica; these are affiliated professional resources.
If relationship doubts and attempts to resolve them are taking up substantial time or interfering with your life, a professional assessment can help clarify the pattern and identify appropriate treatment.
You do not need to settle every question about your relationship before seeking help. Those questions, and the way you have been trying to answer them, can be explored as part of the assessment.
Learn about the ROCD model · View the questionnaires · Contact us
Selected references and further reading
Doron, G., Derby, D. S., & Szepsenwol, O. (2014). Relationship obsessive compulsive disorder (ROCD): A conceptual framework. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 169-180. https://doi.org/10.1016/j.jocrd.2013.12.005
Derby, D. S., Tibi, L., & Doron, G. (2024; published online 2021). Sexual dysfunction in relationship obsessive compulsive disorder. Sexual and Relationship Therapy, 39(3), 711-724. https://doi.org/10.1080/14681994.2021.2009793
National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31). Treatment recommendations.
Earlier chapter on ROCD assessment and treatment (PDF). This historical resource is retained for reference; the page above provides the updated overview.