Can repetitive questioning of a partner about substance use due to a past family history of substance use issues be a manifestation of reassurance seeking obsessive-compulsive disorder (OCD), an other specified anxiety disorder, or codependence?

Reassurance-Seeking OCD: Clinical Presentation and Differential Diagnosis

Your patient's repetitive questioning about her partner's substance use, driven by past family trauma, most likely represents an anxiety disorder (other specified anxiety disorder or generalized anxiety disorder) rather than OCD, unless she experiences these concerns as intrusive, unwanted obsessions that she recognizes as excessive and performs the questioning as a compulsion to neutralize anxiety rather than to obtain genuine information.

Core Features of Reassurance-Seeking in OCD

Reassurance-seeking is a common compulsion in OCD that follows a specific pattern 1:

• Short-lived relief: Individuals seek reassurance from others and experience temporary relief, but the doubts invariably return, creating a repetitive cycle 1
• Multiple forms: Reassurance-seeking manifests as questioning others, self-reassurance, confessing to others, and compulsive internet searching 1
• Adverse relational impact: Excessive demands for reassurance negatively affect family members and friends 1
• Ego-dystonic nature: The thoughts are experienced as intrusive, unwanted, and anxiety-provoking, with the individual recognizing them as excessive or unreasonable 2

Critical Diagnostic Distinctions for Your Patient

Key Questions to Determine OCD vs. Anxiety Disorder

Assess the nature of her thoughts 2:

• Does she experience intrusive, unwanted thoughts about her partner's substance use that feel like they're "intruding against her will"?
• Or are these worries that feel more like realistic concerns she wants to think through?

Evaluate the questioning behavior 1:

• Is the questioning performed as a rigid compulsion to neutralize specific obsessive fears (OCD pattern)?
• Or is it driven by genuine uncertainty and a desire for information (anxiety pattern)?

Examine insight and distress 2:

• Does she recognize the questioning as excessive while feeling unable to stop (OCD)?
• Or does the questioning feel justified given her past experiences (anxiety/trauma response)?

Why This Likely Represents Anxiety Rather Than OCD

Several factors suggest an anxiety disorder or trauma-related response:

• Context-specific trigger: Her behavior is directly linked to past family trauma with substance use, suggesting a learned fear response rather than an obsessive-compulsive pattern 3
• Reassurance-seeking spans multiple anxiety disorders: Research demonstrates that reassurance-seeking occurs across social phobia, generalized anxiety disorder, panic disorder, and OCD, with distinct patterns for each 3
• Relationship security concerns: Reassurance-seeking about "attachment and the security of relationships" is a distinct factor that appears across anxiety disorders, not specific to OCD 3

Diagnostic Algorithm

Step 1: Assess for true obsessions 1:

• Are the thoughts about substance use repetitive, persistent, intrusive, and unwanted?
• Does she attempt to suppress or neutralize these thoughts?
• Are they time-consuming (>1 hour daily)?

Step 2: Evaluate compulsive nature 1, 2:

• Is the questioning performed according to rigid rules?
• Does she feel "driven" to ask these questions in response to specific obsessive thoughts?
• Are there mental rituals (counting, praying, repeating words) accompanying the questioning?

Step 3: Determine clinical significance 1:

• Do the obsessions and compulsions cause clinically significant distress beyond what would be expected from realistic concern about substance use?
• Is there functional impairment independent of relationship concerns?

Step 4: Rule out better explanations 1:

• Is this better explained by generalized anxiety disorder (excessive worry about multiple domains)?
• Is this a trauma response to past family experiences?
• Could this represent codependence or relationship anxiety?

Most Likely Diagnosis: Other Specified Anxiety Disorder

Given the context you've described, this presentation most closely aligns with:

• Other specified anxiety disorder with predominant features of relationship-focused reassurance-seeking driven by past trauma 4
• Generalized anxiety disorder if she exhibits excessive worry across multiple life domains beyond just substance use concerns 3

The key differentiator is that OCD requires ego-dystonic obsessions that the person recognizes as excessive, coupled with compulsions performed to reduce anxiety from those specific obsessions 1. Your patient's behavior appears more consistent with hypervigilance and anxiety stemming from past trauma rather than the obsession-compulsion cycle characteristic of OCD.

Treatment Implications

If anxiety disorder 4:

• SSRIs remain first-line pharmacotherapy (effective for both anxiety disorders and OCD if diagnostic uncertainty exists)
• Cognitive-behavioral therapy focused on anxiety management and trauma processing
• Address underlying attachment concerns and relationship security

If OCD were confirmed 4, 2:

• Exposure and Response Prevention (ERP) would be the gold-standard psychotherapy
• SSRIs at higher doses than typically used for anxiety disorders
• Focus on preventing reassurance-seeking compulsions

Common Pitfall to Avoid

Do not diagnose OCD based solely on repetitive behavior 5. The repetitive questioning must be part of an obsession-compulsion cycle with ego-dystonic intrusive thoughts, not simply anxiety-driven information-seeking or hypervigilance related to past trauma 1.