All types of OCD include obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, feelings, urges and doubts, while compulsions are repetitive physical or mental actions performed in an attempt to relieve distress and anxiety.
- This post discusses pedophilia and a form of OCD that causes people to be uncertain of whether or not they’re a pedophile.
- Because this uncertainty is a key cause of distress for people with OCD, we need to understand the fear around pedophilia first. This post begins with a discussion of pedophilia itself—a difficult topic for many.
- Pedophilia, known as pedophilic disorder, is a sexual attraction to children.
- Some people, though, have a form of obsessive-compulsive disorder referred to as pedophilia OCD, or POCD. Like other OCD subtypes, POCD involves obsessions (intrusive, unwanted thoughts) and compulsions (repetitive behaviors aimed at getting rid of the distress caused by obsessions). Symptoms of POCD follow a very specific theme: unwanted sexual thoughts about children.
- This post also discusses ERP therapy for POCD, which is specifically designed to help people face their obsessions and resist compulsions.
- For more information about OCD, learn more on the NOCD blog.
There’s a small number of things nobody wants to talk about: dangerous territories entered only by therapists, newscasters, and stand-up comedians. You can probably come up with most of them—imagine yourself around the dinner table with family or friends, and think of the last conversations you’d like to have.
One of these topics, pedophilia, summons an incredible outrage whenever it’s brought up. Public reactions to recent news stories remind us of how serious we are about protecting children. And our outrage makes a lot of sense: nobody is more vulnerable than kids, and sexual advances on them are inherently violent. It’s so disturbing to hear about these things because we wish deeply that they would never happen at all.
What is pedophilia and who has it?
Pedophilia is a sexual attraction to children. It was defined in the late nineteenth century but has been researched only in the past few decades. It’s known as pedophilic disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the big book that most mental health clinicians in the United States use to diagnose their clients. A pedophile has intense urges toward, and fantasies about, children; these must persist for some period of time (six months according to DSM-5) and may or may not be acted upon. Not all pedophiles are child molesters, and vice versa — the former fantasize about children, and the latter sexually abuse them.
Different authorities disagree about the specifics, but pedophiles are generally thought to be over the age of 16 and at least five years older than the subject of their thoughts. The child they fantasize about is prepubescent—age 13 or younger, according to DSM-5 and a number of other resources. Psychiatric literature differentiates between people attracted to different age brackets, but they tend to be lumped together in public perception.
These details aside, pedophilia is one of the most feared psychiatric disorders. A 2015 study found that pedophiles are subject to anger and social rejection even if they haven’t acted on their thoughts (a significant portion of respondents to one survey said pedophiles “should better be dead”). Many surveys rank child sexual abuse as worse than murder. And, as researchers have often suggested, these public beliefs probably discourage many pedophiles from getting help.
Pedophilia vs. Pedophilia OCD
Sexual thoughts and urges about prepubescent children are, by definition, enjoyable to pedophiles. They may feel ashamed about their thoughts, scared about what will happen because of them, resolutely opposed to acting on them, and so on; but children are still the primary (and sometimes the only) objects of their fantasizing.
Many non-pedophiles experience similar intrusive thoughts and urges, spontaneously and in opposition to their real desires. Someone with no history of pedophilic thoughts or urges might be hanging out with a child and suddenly think, What if I touched that kid right now? Although the thought seems very strange and disturbing, most people shake it off: That isn’t me. I didn’t like that. Oh well. It’s by no means enjoyable, but the thought causes them no real disturbance. Like a random thought about driving off the road or shouting during a meeting, it fades quickly.
We all experience intrusive, unwanted thoughts about a wide range of topics
But another group responds very differently to these thoughts, which feel like a challenge to everything they believe they really are. They have a form of obsessive-compulsive disorder (OCD) referred to as pedophilia OCD, or POCD. Subtypes like POCD aren’t distinct conditions—they’re convenient ways of referring to a specific, common set of OCD symptoms. Like any subtype, POCD involves obsessions (intrusive, unwanted thoughts) and compulsions (repetitive behaviors aimed at getting rid of the distress caused by obsessions). But with POCD, symptoms follow a very specific theme: unwanted sexual thoughts about children.
Typically, POCD compulsions revolve around past, present and future themes:
- Mentally reviewing present and past experiences for “evidence” of pedophile behavior
- Looking for events in your past that may have lead you to have pedophilic thoughts today
- Ruminating if you will become a pedophile in the future and brainstorming preventative measures
- Checking if you have a physical sensation or groinal response after seeing a child
- Testing yourself to see if you are still attracted to adults
- Avoiding places where children might hang out
- Watching documentaries on pedophiles to collect “evidence” by self-comparison
- Being hypervigilant around children and reviewing other’s behavior around children, contrasting it with your own.
Paradoxically, while compulsions provide temporary relief, they may also create false positives, which in turn emphasize the need for certainty and extended suffering.
The crux of POCD is that people aren’t sure if they really would act on their thoughts. They never feel certain that can trust themselves, and are prone to compulsively mitigating the risk they perceive. Their obsessions open up extremely disturbing, seemingly urgent questions at the core of their reality; compulsions tie things back together for a little while. For example:
- Obsession: What if I really did sexually abuse a child? —> Compulsion: Turning down babysitting jobs and avoiding children in public
- Could I really be a pedophile? —> Look up articles about famous pedophiles every day and compare oneself with them
- Suddenly picturing a sexual act with a child —> Make oneself list ten reasons they’d never be attracted to a child, rewrite it five times every night before bed
Research suggests that POCD, while common among people with OCD, is unnoticed and misdiagnosed in most patients. This suggests that the shame surrounding these thoughts is so strong that people don’t even want to tell their therapists. That’s why we need brave people to set a precedent and share their difficult stories.
We recently spoke with one of these brave people—we’ll call her Kate—who lives in London with her partner and their two-year-old daughter. Like any parent, she’s been working ever since her daughter’s birth to figure things out.
The birth of her child brought Kate great joy. But only a few weeks later, deeply disturbing thoughts started popping into her head. These thoughts morphed over time, and brought her to a breaking point.
A young mom with pedophilia OCD: Kate’s story
Before I had my daughter, I never paid attention to children. I didn’t care for people’s baby showers or kids’ birthdays. I never paid attention to their vulnerability—they were just these little humans their parents wouldn’t stop going on about.
That was until I had my own. For the first six months of my daughter’s life I had thoughts of killing her, it consumed my every waking moment. She had died a million times in my head. But one day that all changed.
I know this sounds clichéd, but I honestly remember it like it was yesterday. I was reading my usual Hollywood gossip pages when there was a story about Mark Salling, the bloke from Glee, being arrested for child pornography. And from that moment on it was like a switch was flicked in my head and my usual killing thoughts (which I had started to get used to) became more sinister. I started to have panic attacks. What if I molest my daughter? What if I’m a pedophile and don’t know it?
I remember frantically ringing my father and telling him all of my worries while crying on the living room floor. I honestly thought I could turn into a pedophile overnight and harm my daughter. From then on, I was terrified to change her, bathe her—any time a body part of hers was exposed, I would have a panic attack.
It didn’t end there. OCD wouldn’t let me get away with it that easily. I was scared to walk past schools in case I looked like a pedophile, especially when it was break time and kids were playing on the playground. Did I look at them in a creepy way? Do I look like a pedophile?
I was broken.
This kind of OCD takes you into utter darkness, so much so that I contemplated ending my life because I couldn’t cope with another thought. Even while writing this I’m very conscious of the language I use: I don’t want someone to think that I am a pedophile.
You see, that’s how fucked up OCD is: it convinces you that you are what it says you are, even with zero evidence. However, I have come to realise that OCD wants you to keep your thoughts secret. It doesn’t want you to bring them into the light where they might have to face some rationality.
So, if you’re suffering, what do you need to know?
Well, you need to see these pedophilic thoughts like any other intrusive thought, because that’s all they are. The big difference between someone with OCD and a pedophile is how they react to the thought that they might be one.
“How do I know that I am not a pedophile?”
I would ask you what happens when you have these thoughts…
- Do you panic?
- Avoid places where there are children?
- Do you think you’re a bad person?
- Do you have compulsions that you use in order to rid yourself of the thoughts?
Thanks to Kate for her bravery in sharing this story with people around the world. There’s so much fear about the kinds of thoughts she experiences that very few people ever tell someone (even a therapist) about them. But if your own story is anything like hers, or you know someone who’s struggling with pedophilic thoughts, help is available. (This is true for both pedophilia OCD and actual pedophilia).
POCD treatment and therapy: Self-monitoring
Kate wants to remind everyone that exposure and response prevention (ERP) therapy, conducted by a licensed OCD therapist, is the best way to recover from OCD—including pedophilia OCD. This unique therapy is specifically designed to help people face their obsessions and resist compulsions.
ERP therapists focus on externalizing OCD. That means imagining it as a separate entity to your mind. This makes it easier to target and treat and helps facilitate the healing process. Externalizing also allows a person who may be suffering greatly from their OCD to take a step back, assess their symptoms and deal with the negative feelings in a constructive way. It is a creative way to condense and separate the thoughts from your mind.
In therapy, you’ll notice that a trait of the OCD entity is to keep thoughts vague and to trick you into believing your anxiety is overwhelming and impossible to defeat. It loves to see you isolated with your thoughts, lonely and suffering. It feeds on your perceived guilt and shame and is absolutely elated to see you live in your head and become detached from your real life.
That’s why OCD therapy touches on self-monitoring. Self-monitoring is the act of becoming highly aware of your intrusive thoughts, images and urges and their related compulsions, and collecting these observations either on paper in a self-monitoring form or in the NOCD app. While at the start of therapy, you might think self-monitoring sounds like a futile exercise, you’ll likely ultimately find that it is key to a deeper understanding of your triggers and compulsions. By containing these triggers and compulsions, we are able to develop a hierarchy of fears. You will actually rate each intrusive trigger and the level of anxiety they cause you. The hierarchy also creates a sense of control by giving you a game plan to pursue and sheds light on the most important themes to be treated.
A typical treatment scheme could look like this:
- Learning to externalize OCD.
- Through self-monitoring, gather the intrusive thoughts/triggers and recognize the compulsions associated with them.
- Rate the anxiety level of each thought according to the subjective unit of distress scale (SUDS) 1-10.
- Together with your therapist, choose a lower level POCD thought/trigger to work on for your first ERP exercise and work yourself up to the “scarier” ones in later sessions.
- Accept that you will feel anxiety, but that it will wash over you like a wave crashing to the shore, sinking into the sand. All emotions are temporary.
- Resist the urge to do a compulsion and focus on the ERP at hand.
- Practice ERP regularly between sessions and, under your therapist’s direction, actively seek anxiety-provoking situations to challenge yourself.
- When a thought or trigger comes up, you decide to accept uncertainty and know that it is not your job to figure it out nor will OCD ever be satisfied with your attempts at certainty.
POCD treatment and therapy: Exposures
A typical ERP exercise program for POCD might look like this:
- Priming the words and removing some of the “scary” factor. Practicing saying the words pedophile, child molester, rapist, sexual, etc. out loud. Then, sing them to your favorite tune. Record yourself. Listen to the recording as many times a day as you can.
- Mild ERP: Go to the store at peak times when families shop. Choose to buy foods from shelves close to where the mom has her cart with her baby. Go down the baby items aisle and stare at diaper packages until the anxiety feels reduced. If not, repeat.
- Moderate ERP: Watch YouTube videos of kids’ fashion shows or older children modeling grown-up-style clothing.
- Tough ERP: Write an imaginary worst-case scenario story as if the intrusive thoughts were actually true. Throw in as much detail as possible and avoid integrating backpedaling compulsions such as guilt.
If at any point the ERP exercise feels suddenly overwhelming to you, please discuss this with your therapist. You are able to take a step back and revisit a former step before moving on to the next level. Taking a step back is part of the learning process, and never a failure. You are a fighter, and even fighters need to reassess the situation and regroup sometimes. The possibilities of ERP are endless, creative, flexible and effective.
Where to find treatment for POCD
ERP is most effective when practiced with a therapist who has received specialized training in OCD treatment. They know what to anticipate when you describe your thoughts and behaviors, and how to build your personalized treatment program. Their expertise is in teaching you how to manage your OCD so you don’t feel stuck on disturbing thoughts like Kate’s. This is the same important training all of our NOCD Therapists receive.
The goal of NOCD is to reduce your OCD symptoms within just a few weeks of live one-on-one video therapy. You’ll be also welcomed into our Pedophilia OCD community, with 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.
If you are struggling with POCD, there is hope! The first step is finding the right help by seeking out a provider trained in treating OCD with Exposure and Response Prevention (ERP) Therapy. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training. Schedule a free call today with one of our clinical team members to learn more about how a licensed OCD therapist can help you get better. This consultation is free and doesn’t take very long—and it could be one of the most important calls you ever make.