Case Study; Living with POCD

POCD image on moodsmith book
Dr Elaine Ryan
Written by Dr Elaine Ryan Psychologist and Founder of MoodSmith® Elaine obtained her Dr in Psychology from the University of Surrey and has worked in psychology for 20 years. Dr Ryan specialises in Intrusive Thoughts, OCD and anxiety-related conditions.

In this article, I want to present a case study of POCD to help you understand how it can manifest within Obsessive-compulsive disorder.

Living with POCD

All names and personal details have been changed.

Olivia, a 43-year-old woman, self-referred herself to my clinic for help with OCD. Olivia is married with three children and works part-time.


During the assessment session, I noted the following OCD themes;
not stepping on cracks on the pavement, wiping doorknobs. Olivia offered this information but did not mention any pedophilia-related thoughts.


In my experience working as a psychologist for almost two decades, most people do not announce in their first session that they want help with POCD. Instead, if the therapist can create a trusting environment and pick up on subtle clues, in that case, the client may start to realise the thoughts they find most shameful are a symptom of OCD. They then might be prepared to discuss and get help with their thoughts.


It was not until our 7th or 8th session that Olivia became distressed and informed me she thought she had done something terrible in the past. She could not recall what it was but had a feeling that it was awful.


I asked her to tell me as much as she could remember, and she stated that she watched a television program on child abuse, and she thought, what if I had done that?

The critical point to note here is that the thought stuck. The type of thoughts that stick are the thoughts that alarm you the most.

Olivia was terrified that this type of thought had even entered her head. What did it say about her as a person, as a mother? Was she capable of doing something so awful?


For months, and then eventually years, Olivia had almost forgotten about the initial trigger, watching a television program that documented child abuse, and the thought, what if I had done that? Her dominant thoughts had become going back over past events involving children to ensure that she had not done anything to a child.

Important points to note.

Olivia had a thought after watching a TV program about child abuse; her thought was, what if I had done that?


Olivia had never harmed a child.


The thought stuck and became obsessive, with the following compulsions.


When thoughts stick, they can create thought-action fusion were and eventually end up as a false memory.

The content of future sessions was all to do with asking me how I knew that she had not done something terrible. You can read more on reassurance seeking here.

If this is something you can relate to, I urge you to be aware of the doubt and uncertainty created by all forms of OCD. You get caught up in the spiral of seeking certainty. If you can label it, I am experiencing doubt and uncertainty relating to OCD and try to move on; you are starting to break the cycle.

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