Marriage advice: My husband’s anxiety has always taken a particularly strange form. But things have escalated beyond what I can handle.

Every week, exclusively for Slate Plus MembersPrudie discusses a new letter with a Slate colleague. Do you have a question for Prudie? Submit it here.

Dear Prudence,

My husband has pretty severe anxiety/OCD, mostly focused on health and medical situations. Nothing can be a minor illness: it is a sign of something much more serious and sinister. He takes medication for this and he reports that it helps, but I think he probably needs a higher dose or something for more support. He’s regularly (probably four times a year) convinced he has an STI because of relatively mild symptoms like a dry rash or bruise near his genitals. When this happens, he usually asks me several times if I think he could have (completed the STI form blank). Usually I just ask him if he’s had sex with anyone else or if he thinks he has, he says no, and I say “then I don’t see how you could have an STI” and refuse to answer him again (initial advice from his doctor/advisor when starting OCD treatment).

But this last time was different.

About a week after traveling for work, he asked again what an eczema patch actually was. I responded as I usually do, but a few days later he told me he was really worried and was going to contact his doctor to order blood tests for STIs. I said I thought it was unnecessary. He took the tests and everything was negative, so he went back to his usual self.

But now I’m convinced he cheated on me on his work trip. Since he started taking his medication, he has never needed more than verbal confirmation that he would not have an STI. I never thought he would cheat on me, but he went out with some people one night and I know they all drank a lot. When he travels he normally calls me either before bed or in the morning while I’m getting ready for work and he didn’t do that this time, instead he texted me to let me know he was out and then around lunchtime the next day to tell me it had been a rough night/morning. What do you think would be the best way to approach him about this? I worry he’ll just explain it away because his OCD is more severe this time and needs more reassurance, but I also think that’s a reasonable reaction on my part. I feel like I always support him in the issues he struggles with and the one time I have a concern (which actually has some evidence!) it will just be brushed aside.

—Now I’m anxious

Jenée Desmond-Harris: I don’t know why I initially misinterpreted this as it being his brother (I really just pulled it out of nowhere) and was so happy to say “You don’t have to worry about that! It’s none of your business.” Now that I’m right, things have gotten a lot heavier. Yeah, that’s totally his business.

Lizzie O’Leary: I’m a little stunned by the lack of trust here. And maybe it’s not fair, but it’s crazy to repeatedly ask your spouse if they’ve had sex with other people, even if most of that information comes from mental illness! I think that’s where these two should start.

Jenée: That’s right, if you want to have ideas about STIs that have no basis in reality, you might as well go all the way to irrational thinking and imagine you contracted them from a toilet seat or something.

I agree with you that lack of trust is a big problem. And in fact, it would help if the letter writer would remove all the mental health history and ideas about what kind of support she is owed and how her husband will receive her concerns and focus on the main problem: she thinks he cheated on her! And he will lie about it! So maybe the goal is not to get her to take this concern seriously, but to decide what it means if she wants to be in this marriage.

Do you think a digital surveillance investigation is warranted here? Because I know that no one wants to get divorced just based on a weird feeling.

Lizzy: I think advice is warranted. Digital surveillance is so complicated, and even if she finds evidence of his affair, actually doing it is horrific and upsetting. And puts her on the wrong foot. I think she needs to tell her partner how she feels, AND she’s so upset about it all that she doesn’t know if she should trust him. It sucks, but I don’t think it’s possible to say, “hmm yeah, I think you might be lying again,” without really trying to figure out what that means about marriage.

Jenée: Well, I’m glad there is a reasonable and mature person in this conversation. I don’t know why I suggested the 19 year approach. Counseling would be great because maybe things could be repaired (I know an Esther Perel or Dr. Orna wouldn’t see this as a compromise even if the cheating allegations were confirmed – maybe there’s a better relationship on the other side!) and if not, it would be nice to have someone to guide the couple in wrapping things up. Oh, and maybe the therapist would suggest more individual work for the husband, which might lead to an adjustment in medications, which might make STI worries no longer play as big a role in this relationship.

Lizzy: Yeah, at a bare minimum, repeated allegations of cheating because of random rashes is not a great way to live! Jenée, maybe if I see Dr. Orna in the neighborhood walking her little dog I should ask her? Obviously I won’t, because I’m a New Yorker and we mind our own business. But still. LW, it’s not about this one-off accusation, it’s about the fact that your marriage needs more support! Dealing with mental illness can be incredibly difficult in a relationship, but I don’t think it’s impossible. You just need to be able to trust yourself. And right now, you can’t.

Jenée: Yes please. Dr. Orna and his dog have enough couples to deal with.

Anyway, letter writer, sorry to pass the buck to a therapist here, but it really is the best way forward. Pretend you’ve never heard me talk about espionage. I wish you a future with more confidence and fewer suspects skin rashes.