P-OCD, Taboo & Sexual Obsessions
Sufferers of OCD commonly experience obsessions in the form of taboo sexual obsessions, often characterised by intrusive thoughts of unwanted sexual themes such as paedophilia or incest, prompting distress and attempts to compulsively neutralise, analyse, debate, or suppress the thoughts. Read more about this for of OCD and its treatment below.
P-OCD & Sexual Obsessions in OCD
The subtype of OCD centred around fears of paedophilia is often referred to as Paedophilic Obsessive-Compulsive Disorder (POCD). It's important to note that individuals with POCD are not pedophiles; rather, they experience intrusive and distressing thoughts or obsessions related to the fear of being or becoming a paedophile. Other forms of obsessions related to sexual arousal include obsessions around fearing being aroused by taboo sexual themes, such as incest, or having unconscious sexual feelings towards a friend, or someone they know from another context where sexual arousal might be considered to be "inappropriate", e.g., seeing someone in a vulnerable position. These thoughts are ego-dystonic, meaning they go against the individual's true values and cause significant distress.
Characteristics of P-OCD and other Sexual Obsessions:
Taboo Sexual Obsessions:
Intrusive Thoughts: Individuals with these forms of OCD experience unwanted and distressing thoughts about the possibility of being sexually attracted to children, relatives, or other taboo contexts. They may also fear that they will "become" aroused by these thoughts, or become a paedophile if they do not fight with the thoughts, or that they would be "bad" for ignoring the thoughts, or that they're ready "bad" for even having the thoughts in the first place. Sometimes individuals may even obsessively fear and ruminate that they will condition themselves to become a "pseudo-pedophile" (i.e., fearing that they might become aroused by the sight of children due to a conditioned response from the OCD, rather than a genuine arousal) if they do not control the thoughts, e.g., if they ignore intrusive thoughts about children while engaging in intercourse with their spouse.
Intrusive Sensations: Sufferers of this obsession also experience intrusive sensations, prompting further intrusive thoughts and obsessing over whether or not these sensations are indicative of arousal. Sometimes these sensations are just ordinary bodily sensations or symptoms of anxiety that have been misattributed as being sexual arousal, or other times patients believe that they experience intrusive sexual urges, but when asked how they experience these urges, they actually have nothing to report, only a thought that they have an urge, rather than an actual urge. Other times there may be genital stimulation or arousal, but this is not due to being sexually aroused by the taboo content, but instead, a product of compulsive attention to their genitals or engaging in mental imagery which manufactures a false sense of arousal.
Intense Anxiety and Guilt: Individuals with this form of OCD typically experience high levels of anxiety, guilt, and shame due to the nature of their obsessions, mistaking the content of their intrusive thoughts as true, or that its "bad" to even have intrusive thoughts about this at all, rather than seeing the intrusive thoughts as a product of their OCD, and that most people even without OCD experience intrusive thoughts from time to time.
Impaired Functioning: The distress caused by these obsessions can significantly interfere with daily functioning and relationships, as a result of pervasive avoidance, relating to themselves as a guilty bad person, or living with chronically dysregulated anxiety with excessive time and attention dedicated to their OCD.
Insight: Many individuals with these forms of OCD are aware that their fears are irrational and inconsistent with their true desires and values, however some see their thoughts as true due to mistaking their anxiety as proof of the credibility of their thoughts, as well as their compulsive rumination manufacturing feelings of guilt, and then reasoning to themselves (cognitive distortion called emotional reasoning) that this guilt must mean its true.
P-OCD & Sexual OCD Compulsions
Reassurance-Seeking: Seeking reassurance from others, such as friends, family, or mental health professionals, to alleviate the anxiety associated with the obsessions. They may also seek reassurance that from others to confirm that they did not sexually harm them, or make them uncomfortable in some way.
Avoidance: Avoiding situations involving children to prevent the perceived risk of harm. Avoidance can also be more subtle, such as avoiding looking in certain directions or avoiding films or media related to children. They may also try to avoid their thoughts, and try to block them out or suppress them, or engage in distraction to push these thoughts away, but in doing so keeping the thoughts hanging around in the back of their minds all day long.
Mental Compulsions & Rituals: Engaging in mental rituals or thought suppression to neutralise the distressing thoughts. They usually engage in internal debates with their mind, trying to prove their innocence to the OCD, but this compulsive engagement with the intrusive thoughts only creates further anxiety, doubt, uncertainty and guilt, making the thoughts appear more credible and true. They may also compulsively make statements to themselves such as "it's just OCD" or "no!" or "I would never do that!" but again, these compulsions only create more anxiety and give power to the thoughts. They may also imagine images of an attractive adult in their mind to "test" and prove their arousal to someone appropriate, or the inverse: trying to torturously picture what it would be like to engage in the taboo sexual act, to test their reaction. They may also analyse their thoughts, and try to explain them away, or engage in hyper-intellectualisation about their symptoms in attempt to undermine them, but in doing so, the obsessive rumination becomes increasingly entrenched.
Staring compulsions: Individuals may stare at children compulsively, trying to "test" whether they are aroused by them or not, or perhaps stare at adults to "prove" to themselves this is who they are really attracted to, where both of these compulsions inevitably lead to cognitive dissonance "maybe I'm just staring because its what I really want to do" and yield ambiguous results.
Somatic checking: compulsive hyperawareness to their genitals for signs of arousal, to "test" whether or not they are aroused by children. This hyperawareness on the genitals only creates more anxiety, as trying to "test" out the fear only makes it appear to be credible. Further, paying attention to their genital region makes them notice ordinary bodily sensations they would otherwise have not become aware of, which creates a perceived sense of threat "its coming true!", or the very act on paying attention to their genitals can create subtle sensations of arousal, or they may engage in mental imagery to "test" if they are aroused, but the very nature of imagining what genital stimulation would feel like (even under circumstances they would find to be abhorrent) will only lead to ambiguous results and a false sense of credibility to the thoughts that they are secretly aroused.
P-OCD & Sexual Obsessions Treatment
Exposure and Response Prevention (ERP): ERP, a specialised form of cognitive-behavioural therapy, involves exposing individuals to the feared thoughts (exposure) and preventing the engagement in compulsive rituals (response prevention). This helps break the cycle of anxiety and avoidance.
Building Metacognitive Awareness & Cognitive Restructuring: Cognitive restructuring involves challenging and changing maladaptive thought patterns associated with sexual obsessions. This includes addressing cognitive distortions and developing more adaptive beliefs. Reducing compulsive rumination, and learning to not fight with their thoughts, allows the individual to break free from the OCD over time, no longer fearing the thoughts or feeling the need to fight with their mind.
Mindfulness-Based Approaches: Mindfulness exercises (when implemented in an OCD treatment congruent manner) can help individuals observe and accept intrusive thoughts without judgment, reducing the emotional reactivity and distress associated with sexual obsessions.
Page Author: Caspar Wenn,
The OCS Clinic Director & Principal Psychologist