Phoebe’s experiences in the novel are grounded in clinically recognized conditions: panic disorder, emetophobia, and relationship OCD (ROCD). Her intense physical reactions to the prospect of intimacy—nausea, a choking sensation, hives, thought spirals, a racing heart—are classic panic attack symptoms. Her specific fear of vomiting, known as emetophobia, is a phobia that frequently co-occurs with panic disorder and OCD. Researchers from the International OCD Foundation note that “because the most prominent symptoms [of emetophobia] often meet the criteria for obsessive compulsive disorder, OCD may be the more appropriate diagnosis […] In both cases, there is obsessional thinking, hyper-awareness and reactivity, avoidance, compulsive rituals, and safety behaviors,” all behaviors Phoebe engages in throughout the novel (Weg, Allen H., EdD. “International OCD Foundation | Emetophobia: Fear of Vomiting as an Expression of OCD.” International OCD Foundation. 2017).

Phoebe’s arc also reflects key features of ROCD (Relationship Obsessive Compulsive Disorder) a subtype of OCD that Averick names explicitly in the epilogue. The International OCD Foundation asserts that ROCD presents two ways, either “relationship-centered or partner-focused […] In addition to obsessive preoccupation and doubts, both presentations of ROCD are associated with a variety of compulsive behaviors aimed to reduce feelings of uncertainty, anxiety, and distress, or to reduce the frequency of [intrusive] thoughts,” (Doron, Guy, PhD and Derby, Danny, PhD. “Relationship OCD.” International OCD Foundation). Such behaviors include reassurance-seeking, fixating on positive experiences with romantic partners, or constant comparisons to other couples.

Phoebe’s obsessive uncertainty about Matthew and her fear that her feelings are not reciprocated highlight traditional symptoms of ROCD. Where many romance novels depict anxiety as a generalized concept, Averick specifically details Phoebe’s avoidance behaviors, physical symptoms, and intrusive thoughts, each of which correspond to specific, diagnosable features of these disorders. She also incorporates Phoebe’s sessions with her therapist, Sandy, as well as moments when Phoebe reflects on and applies advice Sandy has given her: “Sandy once told me that gray areas can feel like active war zones to people with anxiety and OCD. They’re a lawless land, filled with uncertainty, ambiguity, and worst of all, the unknown. […] In order to function properly, I need clarity. […] A or B. Left or right. Black or white. Anything else is chaos” (165), illustrating the integration of therapeutic resources that root Phoebe’s fictional journey in real-world experiences of these diagnoses.