When Therapist Becomes Patient: My Story with Relationship OCD

Learning I Have OCD

I couldn’t have imagined how much a casual suggestion would change my life. My graduate school classmate Rivka was telling me about her clinical placement at a center that specialized in Obsessive Compulsive Disorder (OCD), a diagnosis I had never taken an interest in. Rivka, who saw my relish for active and effective therapy, suggested that I would enjoy learning how to treat folks using Exposure and Response Prevention (ERP), an engaging cognitive behavioral therapy (CBT) modality that is the standard treatment for OCD. Little did I know that our conversation wouldn't just reshape my career—it would provide me the opportunity to learn about and finally treat the disorder I had been struggling with all my life. 

My classmate’s suggestion couldn't have been more spot on. The clinical placement ignited a passion in me for ERP—its effectiveness, its active approach, and the tangible results it produced for clients. At the center, amid clinical discussions and case studies about different forms of OCD, I discovered something profoundly personal: I had been living with undiagnosed OCD my entire life—specifically, relationship OCD (ROCD), a form of OCD that involves obsessively worrying about whether one is or is not in the right relationship.

Relationship Anxiety or ROCD?

Despite years of undergraduate and graduate studies, ROCD had never once appeared on my academic radar. The absence of psychoeducation about this form of OCD is unfortunately not unusual. When most people think of OCD, they picture someone washing their hands repeatedly or arranging items in perfect symmetry. While these manifestations exist, they represent just a fraction of how OCD actually presents. What I discovered during my training was illuminating: most OCD manifests as what is colloquially called "Pure-O" OCD, meaning that the compulsions that folks engage in are most frequently in their own mind, rather than observable actions. 

My form of OCD manifested just this way: I had spent years of my life trapped in my own mind debating back and forth about the potential outcome of relationships I was in or considering. It was not mere anxiety I was experiencing, which can often be resolved through thinking rationally or speaking with a friend. All along, I'd been experiencing a recognized condition without knowing it existed.

Learning I had ROCD was like finally finding the missing piece to a puzzle I'd been struggling to complete since adolescence. Every bit of relationship anxiety, every spiral of doubt, every moment of paralyzing indecision suddenly had a name and—more importantly—a treatment approach.

ROCD Signs and Symptoms

I had been living with a tortuous belief: everyone else possessed some innate ability to judge relationship compatibility that I somehow lacked. I imagined that random strangers on the street could answer questions like "What makes a good relationship?" or "Is this relationship right for me?" with an intuitive clarity I could never access. I was simply missing that part of my brain.To compensate, I developed elaborate mental routines—analyzing every interaction, replaying conversations, and examining feelings from every conceivable angle.

This mental process was both exhaustive and exhausting. My journals from ages 20 to 30 are filled with duplicative circular thought patterns, repeating fears, and ceaseless desperate attempts to reach definitive conclusions about relationships. Each time I delved into this thought process I believed I was on the verge of achieving certainty, only to find myself back at the starting point within a few days, hours, minutes, or seconds.

ROCD Self Treatment

The realization of my disorder propelled me into treatment. I dove into the world of OCD therapy with newfound purpose, committing fully to specializing in the field while simultaneously seeking help from a cognitive behavioral therapist who utilized exposure and response prevention (ERP) and acceptance and commitment therapy (ACT), another standard CBT treatment for OCD which focuses on mindfulness-based techniques and making choices based on one’s values rather than their intrusive thoughts and emotions.

Through my own treatment, I experienced firsthand how exposures worked and fell in love with the treatment. When I confronted triggering content without trying to figure it out, my OCD symptoms gradually diminished, giving way to genuine insight. I still needed medication to reduce my anxiety enough that I could power through with my therapeutic skills, but I did feel better. However, I never fully trusted myself, and stayed in therapy to “double check” my guesses about my relationships with my therapist.

Thus my transformation was significant, though incomplete. I progressed from being completely incapacitated by relationship anxiety to finding it merely uncomfortable—manageable enough that I could push through with a combination of medication, ERP, and ACT techniques. The ACT component proved especially valuable, teaching me that I wasn't obligated to assign meaning to every thought that surfaced and could instead choose actions aligned with my values. However, I could never have predicted how much this strategy would come back to haunt me years later.

When ROCD Treatment Fails

These clinical tools sustained me for some time, and eventually I entered a relationship where I was able to use my CBT skills to push through discomfort, make value-based decisions, and commit to marriage.

But here's where my story takes an unexpected turn: despite being a recognized specialist in OCD treatment, and despite employing gold-standard interventions exactly as prescribed, my OCD symptoms intensified dramatically over time. What was once a back-of-the-mind feeling of dread became an unignorable wall of distress.  My mind produced an unrelenting stream of intrusive thoughts questioning my relationship choice. Panic attacks seized me without warning. Twice I had to excuse myself from a conversation to vomit out of anxiety. Sleepless nights stretched into weeks. 

What was I missing? From my ACT training, I had believed that I was making a choice based on my values and my goals. I had a value to not judge my partner, so I tried to ignore all of the ways in which her actions and her personality traits brought significant unhappiness to my life. I had a goal to be in a relationship, and as a result, I tried to power through my commitment. From my ERP training, I had made a best rational guess, and ignored my fears of uncertainty that it could be the wrong one, ascribing irrelevance to distressing thoughts and feelings. 

Getting Divorced with ROCD

I would love to say that my decision to get divorced was made through calm clinical reasoning, but oh boy dearest reader, it was not. My body essentially forced my hand, sending signals so powerful they couldn't be mindfully tolerated or rationalized away. I was forced to reckon that this relationship was one in which I was so unhappy no amount of CBT techniques could fix it, and eventually made the painful decision to leave.

My worst fear was true all along: my decision making process was missing some crucial element and had led me astray. It wasn’t until months later that I was able to piece together where I went wrong. 

After my divorce, I made what proved to be a crucial decision—seeking therapy with someone who didn't specialize in OCD. This clinician helped me identify a massive blind spot in my treatment approach, one shared by many OCD specialists I'd worked with and learned from. This revelation would fundamentally change my understanding of relationship OCD treatment and my approach to helping others with similar struggles.

To learn about the effective conceptualization of ROCD treatment that I finally developed, read on here.