July 11, 2024

Pedophilia OCD (pOCD): If People Only Knew the Thoughts that Pop Into my Head

In previous blog posts, we have discussed various taboo subtypes and themes of OCD. Today we are going to explore another taboo subtype of OCD that is amongst the most difficult to discuss. Pedophilia OCD (pOCD) is an intense and excessive fear around being a pedophile, being attracted to kids, being viewed as a pedophile, having thoughts that a pedophile would have, or doing something that could be construed as harming kids. These thoughts are unwanted, intrusive and very distressing.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which clinicians utilize to assist in the diagnosis of mental disorders, defines pedophilia as “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children”(APA, 2013).

Using that definition, pedophilia and pOCD are on opposite ends of the spectrum. The most noticeable and significant distinction between the two being the element of excitement or distress produced by these thoughts. Whereas individuals who would meet diagnostic criteria for pedophilia get enjoyment from and fantasize about sexual activity with children, individuals experiencing pOCD experience intense distress and discomfort. Not only are these thoughts distressing and unwanted, they are often accompanied shame, embarrassment, guilt, depression, isolation, and loneliness.

People, places, images, memories, activities, feelings, and sensations are just a sampling of the things that can trigger these obsessions. Similar to other themes of OCD, pOCD is fueled by doubt and uncertainty. “Did I look at that kid in their groin area?” “Did I feel a sexual response when looking at that child?” “Am I attracted to children because I smiled at that kid?” are common doubts and uncertainties experienced with pOCD. The search for certainty ("I need to know 100%!") is fodder for the OCD cycle and fuels its sustainability and intensity.

Compulsions come in many forms. Often they are thought of as simply physical compulsions, such as washing your hands or avoiding touching things. Another form of compulsions are mental. Mental compulsions are compulsions that take place internally. These are tricky to notice and to resist. Because they go unseen and take place in the brain, they often get conflated with obsessions and go untreated. Mental compulsions are a catalyst to propel the OCD cycle and left untreated will make the worries, fears, and anxiety worse. A significant portion of treating pOCD is working on mental compulsions as the search for certainty, analysis, figuring things out, and ruminating.

OCD is a master at shrinking people's world and limiting their lives. Avoidance and reassurance-seeking are two other compulsions that we aim to reduce when treating pOCD. People experiencing pOCD symptoms often find themselves avoiding places, people and things that could trigger these obsessions. This includes things like missing their child’s basketball game, avoiding the mall, or avoiding spending time with friends who have kids. These behaviors go against their values and make it so that they are disconnected from systems of support.

As with other taboo subtypes of OCD, a number of treatment modalities are utilized in the treatment of pOCD. These primarily include cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT) and exposure and response prevention (ERP). With all of these modalities, self-compassion is an extremely vital component of treating pOCD. People with pOCD need to understand that their thoughts do not mean anything about their character and that they deserve to do the things that are important to them.

We are excited and optimistic about the increased awareness and better understanding of the various subtypes of OCD, including pOCD. While the mechanisms and the OCD cycle look the same regardless of the theme or content of the obsessions, it is important to cognizant of how pOCD symptoms uniquely impact clients. Finding a clinician that is trained and skilled in utilizing these treatment modalities can set you up for success.