Paedophilic Obsessive-Compulsive Disorder (POCD) is a particularly distressing and shame-provoking type of Obsessive-Compulsive Disorder (OCD) characterized by intrusive, unwanted, and distressing thoughts about potentially being a paedophile. Today I want to talk about the myths and stigma that surround this condition, as despite the distress these thoughts cause, many people to come forward for help, due to the fact that POCD is misunderstood, leading to significant social stigma and additional psychological burden for those affected.
Understanding and addressing the myths and stigma surrounding POCD is crucial. In this article, I want to discuss the facts about POCD based on my experience as a psychologist for 20 years, debunk common myths, and provide practical strategies for managing this condition.
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Differentiating Between POCD and Paedophilia
One of the most significant misconceptions is equating POCD with paedophilia. Paedophilia is a psychiatric disorder characterized by a primary or exclusive sexual attraction to prepubescent children. In contrast, POCD sufferers are disgusted and terrified by their thoughts and try to avoid having them at all costs. and do not have any desire to act on, rather they go to great lengths in case they should come true. If you want to read further on this subject, please read my article here.
Understanding this distinction is critical, not only for those affected by POCD but also for clinicians and the public. While individuals with paedophilia may require specialized treatment to prevent acting on their urges, those with POCD need support and treatment to manage their OCD symptoms and alleviate their distress.
It is very important for clinicians to understand this difference. Properly qualified mental health professionals with a broad depth of experience of treating OCD will know this difference, but there are many people offering treatment who lack the skills or knowledge to truly help, worse, if they are alarmed in any way by the content of what is an OCD obsessions, you will make the person who came for help, feel worse and possibly deepen their sense of shame.
Common Myths and Misconceptions
Myth 1: POCD Thoughts Reflect True Desires
A prevalent myth is that the intrusive thoughts experienced in POCD reflect an individual’s true desires. This is false. The nature of OCD is such that it targets an individual’s deepest fears and insecurities, leading to distressing thoughts that are contrary to their values and desires. The term for this is ego-dystonic thought and you can read more about it here. I think being able to label your thoughts as something at this early stage can bring some relief and distance from the thoughts. Intrusive thoughts are not voluntary, and they do not signify one’s character or likelihood of engaging in the feared behaviours.
Myth 2: People with POCD Are Dangerous
Another damaging myth is that individuals with POCD are a danger to children. The reality is quite the opposite. People with POCD are deeply disturbed by their thoughts and even end of avoiding children, until they eventually seek treatment and understand that they are suffering from OCD and have not turned into a terrible person that they do not recognise.
Myth 3: POCD Is Untreatable
Like all forms of OCD, there is a myth that the condition is untreatable.
Many people believe that POCD is a lifelong condition with no effective treatments. While POCD can be challenging, it is treatable, and one of the reasons that it can be challenging is that people are reluctant to come forward out of fear of being judged or worse. Cognitive-behavioural therapy (CBT), particularly Exposure and Response Prevention (ERP), has been shown to be highly effective. Medications like selective serotonin reuptake inhibitors (SSRIs) can also be beneficial.
The belief that POCD is untreatable can leave individuals feeling hopeless and reluctant to seek professional assistance. However, with appropriate treatment, individuals with POCD can experience significant reductions in their symptoms and improvements in their quality of life. Therapy can help them understand their thoughts, reduce their fear and anxiety, and live a life that aligns with their values.
Myth 4: Seeking Help Will Lead to Legal Trouble
Individuals with POCD often fear that seeking help will lead to legal repercussions or social stigmatization. However, mental health professionals are trained to understand the distinction between intrusive thoughts and actual behaviours. Confidentiality and ethical standards ensure that individuals can seek help without fear of legal consequences.
The fear of being reported to authorities can be a powerful deterrent from seeking help, but it is important for individuals with POCD to know that therapy is a confidential process. Therapists are bound by confidentiality laws and are there to help, not to judge or report clients unless there is an imminent risk of harm to oneself or others.
The Stigma Surrounding POCD
The Impact of Stigma
Stigma surrounding POCD can lead to significant emotional and psychological distress, as I stated above it can prevent individuals from seeking help, exacerbate feelings of shame and guilt, and worsen the severity of symptoms. Breaking down this stigma is essential for effective treatment and support. Stigma can also create barriers to accessing necessary resources, such as specialized therapists and support groups.
The societal misunderstanding and judgments about POCD can perpetuate feelings of isolation and hopelessness. Individuals may fear disclosing their condition even to close friends or family members, which can further entrench the stigma and make it more difficult to seek support. It is imperative that society becomes more educated about POCD to foster empathy and understanding for those affected.
Educating the Public
Public education about the nature of POCD and OCD is crucial. Understanding that these intrusive thoughts are a symptom of a mental health disorder rather than a reflection of character can help reduce stigma and encourage those affected to seek help. Education can dispel fears and misconceptions that prevent people from accessing care.
Education initiatives could involve awareness campaigns, informational resources, and collaboration with mental health organizations. By increasing public awareness, we can create a more informed society that can better support individuals with POCD. Education is a powerful tool in changing perceptions and creating a more accepting and knowledgeable community.
In writing that, I appreciate how difficult public education can be due to the sensitive nature of the topic and the emotions involved, but I also think of a client I had many years ago and the sheer torture ( and I do not say that lightly) of the thoughts she had in her head, and only by chance did we get her to talk about it in session. If the public knew even a little of this type of OCD, many people, like my client may come forward for treatment.
Practical Strategies for Managing POCD
Cognitive-Behavioural Therapy (CBT)
CBT is the gold standard for treating OCD, including POCD. ERP, a subset of CBT, involves gradually exposing individuals to their fears while preventing the compulsive behaviours that typically follow. This process helps reduce the power of intrusive thoughts over time. By learning to tolerate the anxiety without engaging in compulsions, individuals can weaken the cycle of OCD.
Therapists working with POCD patients are skilled in creating tailored exposure exercises that address the unique fears of each individual. These exposures are done in a controlled and safe environment, allowing the person to confront their fears without engaging in avoidance or reassurance-seeking behaviours. Over time, this leads to a significant reduction in anxiety and an improvement in functioning.
Medication
SSRIs are commonly prescribed for OCD and can be effective in reducing the intensity of intrusive thoughts. Working with a psychiatrist to find the right medication and dosage is crucial. Medication can serve as an adjunct to therapy, providing relief from symptoms that may be too intense to manage with psychotherapy alone.
It’s important to note that medication works differently for each person, and finding the right treatment may take time. Being patient and maintaining open communication with a healthcare provider is key to determining the most effective medication strategy for managing POCD.
Seeking Professional Help
If you have decided that you would benefit from professional help, it is best to look for someone well-qualified and with extensive experience. There are many types of therapists and many types of therapy, but only certain types will help with POCD. You can read a bit more on therapy here, but to summarise the article, you need someone who provides CBT and ERP. Not only do you want them to provide those models, you want them to be experienced and highly skilled in the model, generally to ensure that, you are looking for a highly skilled and qualified practitioner. If in doubt, I always advise people to ask their local doctor for recommendations, as most of them hold a list of reputable mental health professionals in their locality.
