In the early days of Aaron Harvey's first serious relationship, he found himself "constantly assessing" every aspect of his partner's physical appearance. One day the shape of her chin might be cause for alarm, the next a line on her face.
"I had anxiety around whether or not I found a particular physical feature attractive," says the 35-year-old. "I felt actual relief when I did find it attractive, then panicked when I didn't. This could happen 100 or more times a day."
The scrutiny went beyond facial features. Harvey monitored how funny he found his partner, and how funny other people found her. And when they were alone he quality-controlled their interactions, scanning for signs that might reveal once and for all how deep their connection was—or wasn't.
The comparison tests were the worst: If his partner stood next to another woman, he would contrast his overall interest levels for both, panicking if he found the other woman more appealing. Attempting to reverse this panic, he would then spend "hours and hours and hours and hours" trying to identify off-putting things about the other woman that would convince him of the opposite: that his own partner was the best choice.
"Basically," Harvey says, "my whole life was like a science experiment. Just constantly doing market research to determine whether or not I had enough affection for the person that I was with."
Harvey is a high-functioning creative who owns a successful branding agency. He doesn't need to be told that a chin line is unimportant, or unworthy of anguish. He knows. "It's not that I even have anything against that person's facial feature, necessarily," he says. "It's just this obsessional thought."
In fact, this obsessional thought and those like it are increasingly viewed by experts as their own obsessive-compulsive subcategory: namely "Relationship OCD", or ROCD. It's thought that ROCD sits within the OCD subtype commonly known as "Pure-O", which describes obsessive thoughts and rumination coupled with self-soothing rituals and compulsions that take place in the mind, as opposed to observable actions like constant hand-washing.
The term "Pure O" was coined in 1989 by Dr. Steven Phillipson, who describes a two-pronged process: "the originating unwanted thought (spike), and the mental activity which attempts to escape, solve, or undo the spike, called rumination".
The common "spikes" that consume people with ROCD, sometimes up to ten hours every day, are: "What if I don't actually love my partner?" And: "What if they aren't the 'right' person for me?" The mental rituals that follow, Phillipson writes, "are an attempt to shut off the anxiety, either by attempting to solve the question or avoid having the thought recur."
"ROCD can strike at any time, but I've seen it most often in people in their 20s and 30s," says Dr. Jordan Levy, a clinical psychologist at the Center for Cognitive-Behavioral Psychotherapy in the US who specialises in Obsessive-Compulsive Disorders, including Pure-O. "Choosing to potentially spend the rest of your life with someone creates a sense of 'needing to be really sure', which amplifies anxiety."
Levy has worked with people who experience intense anxiety about things like the length of their partner's toe, or the way their partner pronounces certain words. "I was working with one patient who urged his partner to undergo plastic surgery to address an imperceptible imperfection," he says.
Karen*, a twenty-something illustrator, felt the first nauseous waves of panic roughly two months after her wedding to Robert*. Objectively, nothing in their relationship had changed, save for it becoming enshrined in law. But within weeks Karen felt like her brain was pickling in cold dread.
"I began to fixate, absolutely fixate—day and night—on whether I was actually in love with him, and why on earth I hadn't tried to figure that out before I got married," she recalls. "It was stuff I'm ashamed about, like: Would I be more attracted to a guy with broader shoulders? Is his sense of humour sophisticated enough for me?"
She couldn't concentrate at work, or get to sleep at night. "Even conversations with him were impossible," she says. "I'd just be looking at his face trying to analyse how 'in love' I felt, so I couldn't engage."
Two years later, the rumination isn't as acute (something Karen attributes to "getting used to" marriage). But it's still there. On bad days, her thoughts centre on whether she failed to marry her preferred physical "type", and if she can live with that. Like Harvey, she compares her attraction to Robert to her attraction to other men, and when the other man "wins" she feels like throwing up.
Last year, Karen threw some keywords into Google and there, among the lifestyle articles about cold feet and divorce, was a blog about ROCD. As she read deep into the night, Robert asleep and oblivious beside her, she felt her first sense of calm in months. She had known all along that she adored him, underneath it all—maybe this was the answer?
"But then it got even more complicated," Karen says, "because how do you know if you've really got ROCD, or if you've just convinced yourself—and your doubts are real?"
People with ROCD tend not to believe "with 100 percent certainty" that they have ROCD, Dr. Levy says, because even if on some level they know their thoughts are irrational, there is still the fear of being with the "wrong" person.
But there are some differences between ROCD-doubt and the standard kind, he says. For a start, "someone confronted with a significant relationship challenge doesn't need to know with absolute certainty that their romantic partner is their 'one true love'." Similarly, people with ROCD focus on the trivial, whereas non-OCD doubt "tends to stem from meaningful relationship challenges, such as having different values or life plans."
Mental health providers who are unfamiliar with ROCD can misinterpret the symptoms as real relationship problems, which can in turn lead to "counterproductive or harmful" guidance, Levy says.
Untreated, he adds, it has the potential to take over the sufferer's life. Unfortunately there is no cure as such, but ROCD can be managed and minimised through various therapeutic models. Levy recommends Exposure and Response Prevention Therapy (EX/RP), a type of cognitive behavioural therapy (CBT) that involves facing unwanted fears head on and "resisting the urge to engage in relief-seeking behaviour such as mental rumination".
Harvey, who since he was a teenager has battled other forms of Pure-O, and in 2012 set up the site intrusivethoughts.org, is undergoing EX/RP. He uses "mental flashcards" designed to minimise the impact of his intrusive thoughts: eight times a day, an alert goes off on his phone that reads: X is not pretty. That way, when he's sitting across from a date and X is not pretty pops into his head—"and the fucking snowball starts"—the thought strikes with less force.
He says breaking time into chunks helps, too. "Ask yourself, 'Are you willing to leave that person today? 'Are you willing to leave this person between now and next Wednesday?' If the answer is no, it's just [telling yourself]: 'This is what we're going to do: we're going to commit to being with that person between now and next Wednesday.'" It brings him relief because you're not committing to "some huge fucking thing. You're literally saying, 'I like this person, maybe I love this person, and I want to spend time with them—and I can do a week.'"
Living with ROCD raises all sorts of amorphous, existential questions: about the future, the concept of love, the concept of 'in' love, the finiteness of time. Harvey describes a hypothetical scenario that haunts him:
"There's an old couple," he says "and they're sitting on a bench in front of the ocean and they're holding hands. I would go through this scenario so many times a day, with my partner in my head. I'd try to figure out whether that would be this beautiful moment or whether it's this really horrifying situation; a moment of complete and utter panic about how we arrived on this bench."
Karen's worst nightmare has the same nagging, anxious shape. "I look at Robert a few times a week," she says, "and imagine that we're 70 or 80. I monitor how I feel about still being with him: Am I content, or is it a horrific scenario where I'm still uncertain—and I feel sick about how we ended up here? That's my fear. That this will be me forever, and I'll die wondering."