Getting to know someone you really like can be exhilarating but also a bit disorienting. We can’t ever truly know what a romantic partner is thinking or feeling, and it can be hard to tell, after the flush of first attraction fades, if a relationship is really right.

Uncertainty can make a relationship difficult for anyone, but for people with something called “relationship obsessive-compulsive disorder,” or R-OCD, it can feel unbearable.

R-OCD is a subtype of obsessive-compulsive disorder in which a person fixates either on their romantic partner or on the relationship itself. It might look like someone who asks, “Do you really love me?” over and over again. Or a person with R-OCD could worry that they’ll cheat on their partner if they catch themselves thinking someone else is attractive, even if it’s a celebrity they’ve never met.

What is R-OCD?

R-OCD can show up in different kinds of relationships, including parent-child. But it’s particularly important to understand in the context of romantic relationships because it’s common for people to write off their own symptoms of R-OCD as personal failings, says John Wyetzner, LCSW, a social worker in the Anxiety Disorders Center at the Child Mind Institute. People often feel that there is something wrong with them that they can’t identify. They may feel unworthy of their romantic partner or wonder if they are incapable of trusting them — anxieties that can take a serious toll on their relationships and self-esteem.

What are the symptoms of R-OCD?

Clinicians group symptoms of R-OCD in two categories: relationship-focused R-OCD and partner-focused R-OCD.

People with relationship-focused R-OCD might ask questions like, “Is this relationship right?” As in other forms of OCD, where people repeat rituals to achieve a “just right” feeling, Wyetzner explains, “people with R-OCD are searching for a feeling of comfort or certainty, for the ‘just right’ feeling in a relationship sense.”

Partner-focused R-OCD tends to involve a lot of intrusive thoughts. “They kind of get stuck in a cycle of, ‘Oh, do I really like this person?’ Or they start to think of negative attributes and wonder, ‘What else do I not like about them? Is this person good enough for me?’” Wyetzner says.

For people with R-OCD, the relationship or the partner are the obsession. They also feel compulsions that can include:

Mental compulsions: These are endless loops of negative thinking that occur entirely in the mind — replaying past conversations, for example.

Reassurance-seeking: This might look like asking your partner the same questions over and over again: “Are you cheating on me?” “Should we break up?”

Confessing: Confessing is often a compulsion for those who worry about their own behaviors. Wyetzner gives this as an example: “I have to go and tell my boyfriend right away that I thought someone else was attractive, so I’m not keeping any secrets from him.”

How do you know if it’s R-OCD?

While OCD is a formal diagnosis, R-OCD isn’t. So, if you haven’t been diagnosed with OCD, or even if you have, how do you know if what you’re experiencing is R-OCD? Unfortunately, there is no official rubric or standard to be met, Wyetzner says. But he encourages people to consider one important factor: time.

“How much time are you spending thinking about the relationship? Are you spending hours a day just thinking about the relationship or talking with people about it? Or asking people about it? One of the main metrics we use when determining severity of OCD is the amount of time that’s taken up by the OCD —whether it be obsessions or compulsions,” he says.

Also consider the intensity of your emotions. How distressing are your thoughts? Does this distress interfere with your daily life? Your relationship? Is it hard for you to spend time with your partner because all you do is ask them questions about the relationship, or all you do is worry? If any of this sounds familiar, a mental health professional can help you find the right support.

How is R-OCD treated?

Like other types of OCD, R-OCD is best treated through exposure with response prevention (ERP), or exposure therapy.

People with R-OCD can spend a lot of time engaging with distressing thoughts, but for them, thinking itself is an attempt to resolve their distress. Exposure therapy — something done with the support of a specially trained therapist — asks the patient to sit with small amounts of stress or uncertainty without attempting to think their way through or otherwise resolve it. The goal is to understand that anxiety can gradually dissipate on its own.

Adapted from “What Is Relationship OCD (R-OCD)?” by Molly Hagan at childmind.org