Relationships between partners and friends are typically a source of pleasure and comfort. However, some people may experience persistent anxiety when in a relationship.

Doctors call this relationship anxiety, or relationship-based anxiety.

This article will explore the signs and causes of relationship anxiety, as well as some treatment and management options for couples.

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Common symptoms of relationship anxiety can include excessive reassurance-seeking and self-silencing.

Relationship anxiety involves feelings of intense worry about a romantic or friendly relationship. Although health professionals are aware of this type of anxiety, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not include it.

Unlike other forms of anxiety, such as generalized anxiety disorder and panic disorder, doctors do not have specific guidelines to diagnose or treat relationship anxiety.

Relationship anxiety encompasses some features of social anxiety disorder. More specifically, both conditions can cause a person to experience significant discomfort about rejection.

Although many people may worry about acceptance and reciprocal feelings in a relationship, anxiety tends to develop when a person experiences excessive fear or worry.

For example, anxiety can lead a person to worry about the future of a relationship. People with relationship anxiety may end their relationships out of fear, or they may endure the relationship but with great anxiety.

The effects of this anxiety may hinder a person’s ability to function in the relationship.

Researchers describe three common symptoms of relationship anxiety:

  • excessive reassurance-seeking
  • self-silencing
  • partner accommodation

The sections below will discuss each of these in more detail.

Excessive reassurance-seeking

Excessive reassurance-seeking is also common in social anxiety disorder and depression.

Some researchers suggest that excessive reassurance-seeking is related to interpersonal dependency. Interpersonal dependency refers to a person’s reliance on others for constant evaluation and acceptance.

People who exhibit excessive reassurance-seeking behavior may fear receiving a poor evaluation or not being accepted.

Self-silencing

Self-silencing is another symptom shared across many mental health conditions. One study published in the Journal of Experimental and Social Psychology showed that women who are sensitive to rejection may be likely to engage in self-silencing to please their partner.

People who self-silence may not express their tastes, opinions, or feelings to their partner — especially when these thoughts are different to those of their partner.

People tend to engage in self-silencing behavior to appear similar to those whose acceptance they seek, and in an attempt to prevent rejection.

Over time, a person may silence themselves and make sacrifices to preserve the relationship. However, this has the potential to lower relationship satisfaction.

Partner accommodation

Partner accommodation is a response from the other partner toward the anxious partner. This is a common effect observed in relationships where one or more people have obsessive-compulsive personality disorder.

Some experts suggest couples therapy, such as couples-based psychoeducational sessions, to help treat and manage relationship anxiety.

In a study published in the journal Family Process, researchers tested the effectiveness of a single psychoeducational session. The session focused on addressing the patterns of behavior associated with relationship anxiety, including self-silencing, partner accommodation, and excessive reassurance-seeking.

The researchers found that after one session, partners with relationship anxiety had decreased levels of reassurance-seeking and self-silencing. The non-anxious partner also demonstrated lower levels of accommodation for the partner with anxiety.

Different types of couples therapy include:

  • behavioral couples therapy
  • cognitive behavioral conjoint therapy
  • cognitive existential couples therapy
  • psychodynamic psychotherapy

Since relationship anxiety shares similar symptoms with other anxiety disorders, some doctors may suggest working only with the partner with anxiety.

Others might recommend treatments that are effective for anxiety disorder, including cognitive behavioral therapy (CBT), acceptance and commitment therapy, and mindfulness.

Some studies have demonstrated a wide range of results following individual CBT. Researchers suggest that this response range may be associated with the level of hostility and criticism observed during some couple interactions before treatment.

Doctors may still ask the non-anxious partner to be part of the treatment plan. The role of the partner is typically co-therapist.

Some people may require medication. Drugs for anxiety include selective serotonin reuptake inhibitors and selective noradrenaline reuptake inhibitors.

Doctors do not yet have guidelines for treating relationship anxiety. Further investigations into this type of anxiety are necessary to better diagnose and treat it.

Relationship anxiety is a form of anxiety that health professionals may find challenging to diagnose and treat. However, many of the symptoms reported by people with relationship anxiety are common in other forms of anxiety.

Symptoms of relationship anxiety may include self-silencing and excessive reassurance-seeking. People with relationship anxiety may also crave acceptance from their partner and fear rejection. These symptoms can negatively impact the relationship over time.

Couples therapy and psychoeducation are different strategies that doctors may offer to people with relationship anxiety. In severe situations, some doctors may need to prescribe medication.