A number of my patients seek treatment for OCD for the first time when they are faced with making a major life decision, such as getting married. They are consumed with doubt and anxiety about making “the right choice.” Since OCD typically waxes and wanes over one’s life, the content of the obsessions usually changes, and symptoms can range from mild to severe, these folks may not be aware they have OCD. Important transitions in one’s life can set OCD into motion. The decision to get married is one of life’s major transitions and often OCD will manifest itself around needing certainty about the relationship.
Regarding the decision to get married, OCD demands that there be no doubt in a person’s mind whether he/she has chosen the right person to marry. To the OCD sufferer, their obsession is, “I must know for sure that my fiancée is the perfect person for me to marry.” Because no person is perfect and life is uncertain, this thought creates loads of anxiety in people with OCD. The anxiety in turn compels the person to engage in compulsive behaviors in a futile attempt to arrive at certainty.
Many people will have passing doubts, or get “cold feet” when they decide to marry. However, a person with OCD will persist in seeking evidence that they are marrying the “right” person. They may do this by repeatedly asking family and friends as to whether they like and approve of the intended spouse. They will compare their relationship with others. They take online relationship surveys and read blog posts on finding the perfect mate. They assess their day-to-day interactions with their fiancée, often rewinding and replaying conversations, to determine if they are a good fit for each other.
By the time patients with relationship OCD seek treatment they have often been engaged in compulsive checking, reassurance seeking, and rumination for many hours a day and for many months. And even though they are exhausted from this behavior, there is often reluctance on their part to see their fear of making this decision as just another form of OCD. They say, “But this is really important! I’m making a major life decision.” And I respond by saying, “Yes, but life is unpredictable. You have no idea how things will turn out. Do you want to carry on with constantly assessing whether this person is the perfect person for you, or do you want to get on with your life?”
Since most of these patients have never sought treatment for OCD in the past, I explain how the content of their obsessions is irrelevant. I ask if there were other times in their lives when they had intrusive thoughts that demanded safety and certainty that bad things wouldn’t happen. And did they try to alleviate the anxiety caused by these thoughts by performing mental or behavioral rituals. Typically, I’ve found that they’ve struggled with OCD in the past, but had no label for it. Usually my patients come around to understand how OCD has impacted their lives in other ways outside of their relationship OCD.
When my patients understand how OCD demands certainty, regardless of the content of the intrusive thought, tackling their relationship OCD makes much more sense. I help them to stop checking with others about the suitability of their intended partner. I ask them to refrain from reading anything about choosing a spouse. I help them to limit ruminating (compulsive mental checking) about the pros and cons to marrying their fiancée. I ask them to embrace uncertainty and be willing to sit with the anxiety caused by the thought that they may not be marrying the “right” person. I emphasize that life is unpredictable and to live life fully one has to take risks. Once my patients understand this and stop engaging in a futile quest for certainty, they are able to move on with their lives.