Sexual Obsessions
Sexual OCD: A Misunderstood OCD Subtype
Sexual OCD Symptoms
Tragic consequences can result when sexual orientation themed OCD is misdiagnosed by medical professionals.
Obsessions about sexual orientation differ from an individual who is actually LGBTQ because the straight person with OCD does not generally feel attraction or sexual arousal to members of the same sex. The individual with sexual orientation obsessions fears becoming gay or discovering that he or she was unknowingly gay all along. In recent years there has been new research examining sexual orientation obsessions in OCD (SO-OCD), sometimes called HOCD for “homosexual OCD.”
Sexual Orientation Obsessions (SO-OCD)
…also called Homosexual OCD
The obsessions in SO-OCD may take the form of worry about becoming or being LGBTQ, engaging in same-sex sexual behavior, and being ridiculed by others for being gay. This type of OCD is often characterized by excessive doubt. The individual may first experience sexual orientation fears when noticing that a member of the same sex is attractive. The individual then questions why they had the thought and mentally panics, leading to more questioning. These fears are more than just fleeting thoughts; they become powerful obsessions that keep coming back.
In an effort to make the thoughts stop, the individual performs compulsions, which may present as checking for indications of physical arousal when around attractive members of the same sex. Symptoms also include avoidance, such as not watching television shows in which there is an LGBTQ character or avoiding spending time with same sex friends. Conversely, the individual may watch pornography with homosexual characters to determine if it arouses them, and then compare their reactions with heterosexual pornography. Another common compulsion to combat the obsessions is to increase sexual intercourse with a partner in order to reassure the individual that s/he still enjoys sexual activity with someone of the opposite sex. People with sexual orientation obsessions are driven by the fear of losing access to people of the opposite sex and acquiring an attraction to people of the same sex.
It is reported that sexual-orientation obsessions have lifetime rates of about ten percent among treatment-seeking people with OCD. In addition, it appears that more males experience sexual orientation obsessions than females. The lack of a specific diagnostic tool to identify people with this subtype of OCD can cause people to be undiagnosed or misdiagnosed by clinicians that are not experienced in treating people with OCD. Such a therapist may mistakenly believe that the individual is undergoing a sexual identity crisis due to “being in the closet,” and this sort of discussion only increases the fear in the individual. Being unable to obtain a proper diagnosis or proper treatment may lead to feelings of hopelessness, despair, and even suicidal ideation. This makes sexual orientation obsessions a particularly worrisome type of OCD. Thus it is vitally important that people with sexual obsessions in OCD be treated by an experienced and effective OCD therapist.
In an effort to make the thoughts stop, the individual performs compulsions, which may present as checking for indications of physical arousal when around attractive members of the same sex. Symptoms also include avoidance, such as not watching television shows in which there is an LGBTQ character or avoiding spending time with same sex friends. Conversely, the individual may watch pornography with homosexual characters to determine if it arouses them, and then compare their reactions with heterosexual pornography. Another common compulsion to combat the obsessions is to increase sexual intercourse with a partner in order to reassure the individual that s/he still enjoys sexual activity with someone of the opposite sex. People with sexual orientation obsessions are driven by the fear of losing access to people of the opposite sex and acquiring an attraction to people of the same sex.
It is reported that sexual-orientation obsessions have lifetime rates of about ten percent among treatment-seeking people with OCD. In addition, it appears that more males experience sexual orientation obsessions than females. The lack of a specific diagnostic tool to identify people with this subtype of OCD can cause people to be undiagnosed or misdiagnosed by clinicians that are not experienced in treating people with OCD. Such a therapist may mistakenly believe that the individual is undergoing a sexual identity crisis due to “being in the closet,” and this sort of discussion only increases the fear in the individual. Being unable to obtain a proper diagnosis or proper treatment may lead to feelings of hopelessness, despair, and even suicidal ideation. This makes sexual orientation obsessions a particularly worrisome type of OCD. Thus it is vitally important that people with sexual obsessions in OCD be treated by an experienced and effective OCD therapist.
Watch Dr. Monnica Williams explain more about sexual obsessions
Research Articles
Williams, M. Homosexuality Anxiety: A Misunderstood Form of OCD. In Leading-Edge Health Education Issues, L. V. Sebeki, ed., Nova Science Publishers, 2008.
Williams, M. T., Crozier, M., Powers, M. B.: Treatment of Sexual Orientation Obsessions in Obsessive-Compulsive Disorder using Exposure and Ritual Prevention, Clinical Case Studies, 10: 53-66, February 2011.
Williams, M. T., Farris, S.G.: Sexual Orientation Obsessions in Obsessive-Compulsive Disorder: Prevalence and Correlates, Psychiatry Research, 187: 156-159, 2011.
Pedophilic OCD
Obsessions Caused by P-OCD
Obsessive-compulsive disorder (OCD) is a severe and disabling condition that includes intrusive obsessions and repetitive compulsions. OCD can take on many forms, including fears of harming others. Pedophilia-themed obsessions may produce an even greater level of discomfort, anxiety, and shame for sufferers due to the distasteful and offensive nature of the obsessions. When the OCD is severe and persistent, clients are often unable to manage the disorder without specialized psychological help.
Clients with P-OCD (or POCD) typically fear that they are sexually attracted to children, including their own, if they have any. Some may also fear that they will commit sexual crimes against children, either consciously or unconsciously. Essentially, clients with P-OCD suffer from recurring mental thoughts and images of children in sexualized contexts, which often raises doubts about whether they will engage in acts of sexual violation toward them. Sometimes fixating on the thoughts can even lead to a groinal response, causing more distress.
Unlike pedophilic disorder (those we might call “pedophiles”), the thoughts in P-OCD are unwanted and cause severe shame, disgust, and anxiety in sufferers. Whereas clients who have pedophilic disorder enjoy and are aroused by sexualized thoughts and images of children, clients with P-OCD fear that they may actually enjoy or find pleasure in these images. As a result, clients with P-OCD can spend several hours throughout the day worrying about the possibility of being or becoming pedophilic. People with P-OCD tend to have great difficulty carrying out professional, academic, and social/interpersonal routines because of the amount of time and mental resources they devote to their pedophilia-themed worries.
Difference Between Pedophilic Disorder and P-OCD
Pedophilic Disorder
P-OCD
Sexual attraction to children
Fear of sexual attraction toward children
Prefers the company of children and desires to be intimately close with them
Avoids or minimizes contact with children or reminders due to feared thoughts
Performs grooming behaviors toward children for sexual contact
Experiences sexual gratification from sexual contact with children
Experiences extreme distress and possible suicidality with feared thoughts or reminders
Compulsions Caused by P-OCD
Clients who suffer from P-OCD tend to engage in many types of repetitive rituals, whether overt or covert. Mental compulsions or rituals are very common. These often include excessive mental review of one’s interactions with children (Moulding et al., 2014). The mental review process may involve mentally replaying past scenarios or situations in which children were present, in order to check for any sexually inappropriate thoughts or actions during one’s interactions with or around children. Clients with P-OCD who engage in mental review may ask themselves questions such as, “When I was talking to that little boy, did I think about or look at his genitals?” or “When I was changing my daughter’s diaper, did I look or touch her vagina longer than necessary?” Mental review of interactions with children can haunt clients with P-OCD as they attempt, albeit unsuccessfully, to ascertain whether or not they have violated the children sexually.
Rumination is very common in P-OCD. Rumination appears to be linked to the use of mental review in an attempt to achieve some form of resolution of the uncertainty, or some semblance of confirmation that no sexually inappropriate or perverse actions occurred when interactions with children.
Other mental compulsions may involve repeating certain words, phrases, or visual images multiple times, in an effort to soothe or distract oneself from triggering situations and events. For example, in one client, if an intrusive sexual image of her daughter came to mind, she would attempt to replace that with a ‘safe image’ of her daughter sitting in a chair smiling. She would also sometimes try to replace any intrusive sexual image of her daughter with a comforting image of her husband’s face.
Clients with P-OCD may specifically check their body for signs of sexual arousal or attraction to children. In this checking process, any physical sensation or movement experienced in the genital region in the presence of children and/or during pedophilia-themed obsessions may be misinterpreted as a sign of sexual arousal or attraction.
Reassurance-seeking can take many forms, including constantly reassuring the self, persistently seeking reassurance from others, confessing to others, or compulsively searching the internet and/or scrutinizing relevant reading materials for explanations for one’s obsessions
Avoidance is also a common response to the agony of these unwanted thoughts. In order to prevent the thoughts or the feared manifestation of pedophilic tendencies, clients with P-OCD may avoid children at all costs. This can be a major problem when clients have jobs that require working with children or if they have children of their own.
Understanding and Overcoming the Stigma of Pedophile Obsessive-Compulsive Disorder (POCD)
What is POCD?
Pedophile OCD, also known as POCD, is a form of OCD in which individuals experience recurrent and unwanted thoughts, images, or urges of a sexual nature involving children. Despite not actually having any sexual attraction to children, individuals with POCD experience overwhelming anxiety, guilt, and shame associated with these thoughts.
People with POCD may engage in mental or physical compulsions, such as checking, avoidance, or seeking reassurance from others, in an attempt to reduce their anxiety and prevent harm. These compulsions can become time-consuming and interfere with daily activities, leading to distress and even impairment.
It is important to understand that having unwanted thoughts or impulses related to pedophilia does not make someone a pedophile, nor does it indicate any intention or desire to harm children. Furthermore, it is important to understand that people with POCD are not pedophiles, nor do they have any desire to harm children. Rather, they are tormented by unwanted and distressing thoughts caused by OCD that make them worried and confused.
The stigma of pedophilia has caused many people with POCD to suffer in silence, afraid to seek help or talk to anyone about their experiences. However, those with POCD need to seek support and treatment, as effective therapies are available to help manage their symptoms and improve their quality of life.
The term “pedophile OCD” is not a distinct mental health diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Rather some mental health professionals and online OCD communities use the term to describe a specific subtype of obsessive-compulsive disorder (OCD) that involves unwanted, intrusive sexual thoughts and impulses related to children.
Effective Treatment for POCD
One effective treatment is Exposure and Response/Ritual Prevention (ERP). ERP is the gold-standard treatment used to treat subtypes of obsessive-compulsive disorder (OCD). ERP involves exposing individuals to situations or stimuli that trigger their obsessions without allowing them to engage in their compulsive behaviors. This exposure helps individuals to develop coping strategies and reduce their anxiety around their obsessions.
In the context of POCD, ERP would involve exposing individuals to situations or stimuli that trigger their obsessive thoughts about children (for example, pictures of children on a playground) without allowing them to engage in their compulsive behaviors (such as avoiding children or seeking reassurance). This exposure would help individuals learn to tolerate their anxiety and reduce compulsive behaviors related to their obsessions.
There are several ERP programs and providers that specialize in the treatment of POCD. Some providers offer ERP programs online, while others offer in-person sessions. Most therapists are not well-trained in treating OCD, therefore it’s essential to find a qualified and experienced therapist trained in ERP and with experience working with individuals with POCD.
Medications such as selective serotonin reuptake inhibitors (SSRIs) can also help reduce the intensity and frequency of intrusive thoughts. However, it is important to work closely with a healthcare professional to determine the best course of treatment, as each person’s experience with POCD is unique.
POCD is not the same as Pedophilia
It is important to recognize and understand the difference between POCD and pedophilia. While both involve thoughts of sexual attraction to children, POCD is a form of OCD and does not reflect a desire to harm children. People with POCD do not sexually abuse children. They should not be stigmatized or ostracized for seeking help and should be provided with the resources and support they need to manage their symptoms and live fulfilling lives. People with POCD do not want to have these thoughts and should not be shamed for them.
POCD is a challenging and distressing condition that affects many individuals, but effective help is available to manage and overcome these symptoms. Those with POCD need to seek support and treatment, and for society to recognize the difference between POCD and pedophilia and provide compassion and understanding to those affected by this condition.
What to do if you think you have P-OCD
Despite the high rates of sexual obsessions among clients with OCD, many mental health professionals are still poorly informed in terms of recognizing, assessing, and/or tailoring specifics of treatment to clients’ intrusive sexual thoughts. Thus, P-OCD, may be misunderstood and improperly attended to by mental health professionals. It is not uncommon for uninformed hospital staff or social workers to report such sufferers to child protective services even though research shows that people with POCD are not a danger to children. As such, it is vital that anyone with POCD seek treatment from a qualified OCD expert. As a result, it is vital that anyone with P-OCD seek treatment from a qualified OCD expert.
Sexual Thoughts in OCD
Unwanted Concerns in Obsessive-Compulsive Disorder (OCD)
Many people with obsessive-compulsive disorder (OCD) have sexual obsessions, or unwanted sexual thoughts. This may include sexual orientation fears, which is sometimes referred to as sexual orientation OCD (SO-OCD) or homosexual (HOCD). These are not the same as fantasies or being homophobic.
Sexual thoughts in OCD may include:
- The obsessive fear of being or becoming LGBTQ
- Intrusive, unwanted mental images of upsetting sexual behaviors
- The fear that one may become a pedophile
- The fear of becoming sexually aggressive
The Worst Kind of OCD
Although people with OCD may obsess over any number of concerns, one of the most upsetting types of OCD involves worries about causing sexual harm to a child, sometimes called pedophile OCD or POCD.
Although this type of OCD typically receives little attention from the media, the Power to Change aired the story of a man whose POCD was so severe he contemplated suicide before he was treated by OCD expert, Dr. Monnica Williams.
Hear his story online and learn about OCD treatments from psychologist Dr. L. Kevin Chapman.
New Book from Oxford University Press
Sexual Obsessions in OCD: A Step-by-Step, Definitive Guide to Understanding, Diagnosis, and Treatment
by Monnica T. Williams, Ph.D., ABPP & Chad T. Wetterneck, Ph.D.
Learn more about this important book or order it today from Amazon.com.
References
Bruce, S. L., Ching, T., & Williams, M. T. (2018). Pedophilia-themed obsessive compulsive disorder: Assessment, differential diagnosis, and treatment with exposure and response prevention. Archives of Sexual Behavior, 47(2), 389-402. doi: 10.1007/s10508-017-1031-4
Glazier, K., Calixte, R., Rothschild, R., & Pinto, A. (2013). High rates of OCD symptom misidentification by mental health professionals. Annals of Clinical Psychiatry, 25, 201-209.
Gordon, W.M. (2002). Sexual obsessions and OCD. Sexual and Relationship Therapy, 17(4), 343-354.
Moulding, R., Aardema, F., & O’Connor, K. P. (2014). Repugnant obsessions: A review of the phenomenology, theoretical models, and treatment of sexual and aggressive obsessional themes in OCD. Journal of Obsessive-Compulsive and Related Disorders, 3, 161-168.
O’Neil, S.E., Cather, C., Fishel, A.F., & Martin Kafka, M. (2005). “Not Knowing If I Was a Pedophile . . .” – Diagnostic Questions and Treatment Strategies in a Case of OCD. Harvard Review of Psychiatry, 13, 186-196.
Williams, M. T., Crozier, M., & Powers, M. B. (2011). Treatment of Sexual Orientation Obsessions in Obsessive-Compulsive Disorder using Exposure and Ritual Prevention. Clinical Case Studies, 10, 53-66.
Williams, M. T., Farris, S. G., Turkheimer, E., Pinto, A., Ozanick, K., Franklin, M. E., Simpson, H. B., Liebowitz, M., & Foa, E. B. (2011). Myth of the Pure Obsessional Type in Obsessive-Compulsive Disorder. Depression & Anxiety, 28, 6, 495-500.
The Impact of OCD
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Lasting Relief
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