Sexual Fears in OCD

Expert OCD psychologist, Dr. Monnica Williams explains sexual worries, fears, and anxieties in obsessive-compulsive disorder in this informative video presentation.

Sexual Obsessions in OCD Cen Be Debilitating

Obsessive-compulsive disorder (OCD) is a severe anxiety disorder involving distressing obsessions and repetitive compulsions. Obsessions are intrusive, unwanted thoughts, images, or impulses that increase anxiety, whereas compulsions are repetitive behaviors or mental acts used to decrease anxiety.

Although there has been much written about how to treat obsessive-compulsive disorder (OCD) using cognitive-behavioral therapy (CBT), there has been little focus on how to help those suffering from sexual obsessions. Treating sexual obsessions in OCD is different from the treatment of other forms of OCD due to greater feelings of shame surrounding symptoms, widespread misdiagnosis from professionals, and the covert nature of compulsive behaviors.

This online video presentation provides reviews unwanted, intrusive thoughts of a sexual nature. Included are examples of pedophile OCD (sometimes called P-OCD) and sexual orientation OCD (called SO-OCD or H-OCD), impregnating obsessions, and violent obsessions.

Sexual Symptoms Often Misdiagnosed

Sexual symptoms in OCD are frequently misidentified. A 2013 study assessed clinicians’ ability to correctly identify common symptom presentations of OCD. Participants were members of the American Psychological Association (APA), randomly selected to participate (50 per state). One of five OCD symptom vignettes was assigned to each participant, who was asked to give a diagnostic impression. Eighty-two percent were doctoral-level psychologists, 81% were licensed, and over half reported a CBT orientation (Glazier et al., 2013).

Sadly, 77% misidentified the vignette on obsessions about sexual orientation, and classified the problem as sexual identity confusion. In contrast, only 15.8% misidentified contamination obsessions as being indicative of OCD, and 28.8% misidentified religious obsessions as part of the disorder. Tragically, 43% misidentified sexual obsessions about children, with over a third classifying the problem as pedophilia. In a mental health setting, this could amount to innocent, treatment-seeking patients being reported to child protective services for trying to get help. If licensed psychologists can't identify common forms of OCD, there is little hope for people with sexual obsessions to ever obtain a proper diagnosis. It’s not uncommon for our clients to tell us horror stories of misdiagnoses from prior medical professionals who should have known better. These clients are the lucky few who figured out that their therapists were wrong and kept looking for answers.

Sexual OCD Can Be Harder to Treat

Unwanted sexual thoughts have traditionally been considered difficult to treat because of their taboo and stigmatizing nature. Those suffering with such thoughts often experience intense shame and guilt, and so they are less likely to talk to others about their OCD due to fears of social rejection. These fears are not completely unfounded, as unwanted sexual thoughts are shown to be less acceptable to others and more stigmatizing than other OCD themes, such as contamination or checking.

These sexual symptoms seem to complicate the treatment process, as such patients spend on average, 3.4 years longer (over 30% longer) in treatment than people with other types of OCD. But because sexual obsessions in OCD are frequently misdiagnosed, many never make it into treatment at all. Thus, the number of those with sexual obsessions in OCD is probably much higher than current estimates. Shame and embarrassment prevent many sufferers from telling anyone about their frightening sexual worries, even patients who may be in treatment for other forms of OCD. Most people with OCD have worries in more than one area, and failure to address all symptom areas can lead to treatment failure or relapse.

Good Treatment is Critical

It is critically important for those suffering to the get the right kind of treatment from a provider who understands OCD very well. The key to recovery is Exposure and Ritual Prevention. A short-term intensive treatment. It's not easy, but worth it.

This is all really just a taste of this important topic. For clinicians who really want to learn how to do this, we recommend the Williams & Wetterneck (2019) treatment manual, accompanied by supervision with an experienced OCD therapists.

Scientific References

Glazier et al. High rates of OCD symptom misidentification by mental health professionals. Annals of Clinical Psychiatry 2013;25(3):201-209.

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.

Williams, M. T. & Wetterneck, C. T. (2019). Sexual Obsessions in Obsessive-Compulsive Disorder: A Step-by-Step, Definitive Guide to Understanding, Diagnosis, and Treatment. Oxford University Press. ISBN: 9780190624798. doi: 10.1093/med-psych/9780190624798.001.0001

Related Links

Sexual Intrusive Thoughts at the Peace of Mind Foundation.