What is POCD?
POCD stands for Paedophile Obsessive-Compulsive Disorder and is a type of OCD where the individual obsessively fears being or becoming a paedophile. The person copes with these thoughts by carrying out compulsive behaviours aimed at reducing anxiety and preventing a feared outcome from happening.
Unlike paedophilia, which is a sexual interest in prepubescent children, POCD is not a sexual disorder and is instead based on an irrational fear of being or becoming a paedophile. Sufferers of POCD can experience severe disruptions in their life as a result of the anxiety and compulsive behaviours associated with the disorder.
I wrote this article because few people understand what happens when they first have unwanted thoughts about children, and fewer will seek help. This could be due to the shame experienced by the individual or lack of understanding and attitudes towards individuals with these types of intrusive thoughts. (1)
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I have been working as a psychologist for almost two decades, and not once has a client come to me asking for help with POCD. I have, however, worked with many clients who have obsessive unwanted thoughts about children, but this only materialised in session after we had built considerable trust between us.
Most of these clients were unaware that their thoughts could be part of a mental health condition, OCD. Instead, they were deeply ashamed of the thoughts. Still, they experienced relief once they became open to the idea that they were experiencing obsessions and compulsions relating to OCD instead of the terrifying thought that they might be a paedophile.
Possibly due to the type of thoughts, these types of obsessions are not as well known as the more mainstream obsessive thoughts that occur with OCD.
Some of our knowledge comes from media representations, which means we glean wisdom from TV and newspapers. Several years ago, I researched where mental health professionals’ understanding of personality disorders came from. I found that some of their knowledge about the condition came unwittingly from TV shows!
Suppose I asked you about the work done by psychologists, even though you might not have attended one. In that case, you could offer an answer as you will have seen some on TV and can reference that knowledge in your mind.
Suppose a person becomes more concerned with contamination and germs and starts washing more often or differently. In that case, they may think they have OCD as their behaviours are recognisable from things they have seen in the media. They have a knowledge base in their head relating to OCD.
Likewise, if the person needs things organised in a certain way and becomes anxious if someone changes the order, this is also recognisable as OCD.
However, there are many ways that OCD can arise, and only some are popularised in the media. Suppose you start to have unwanted thoughts relating to children. In that case, the chances are the only knowledge you have in your head relating to this is that something is very wrong with you, and you might be a paedophile. You will not think of OCD.
What is the difference between paedophilia and paedophile OCD?
Pedophilia is the condition of being sexually attracted to children. It is a form of paraphilia, a mental disorder characterised by an abnormal interest in sexual activity with children. Paedophiles may have recurrent fantasies about child sexual abuse, act on their desires by molesting or having sex with children, or the thought of it may simply arouse them.
Paedophiles often seek opportunities to exploit children for sexual gratification and may even abduct them. It is essential to differentiate this from Pedophilic OCD, in which the individual feels deep fear, shame and anxiety. Pedophilic OCD is often marked by intrusive, unwanted and distressing thoughts, images and sensations related to children. Usually, it involves false memory obsessions and excessive worry that one has acted on pedophilic impulses.
It is important to note that people with Pedophilia OCD experience distress from their intrusive thoughts, whereas those with Pedophilic Disorder do not. Furthermore, those with Pedophilic Disorder enjoy their sexual thoughts while those with Pedophilia OCD do not.
Someone with POCD may become extremely upset by their inability to stop intrusive thoughts (obsession) – even though they desperately want to make them disappear. This person may want to control their thoughts because they have grown weary of performing specific actions that only yield temporary results. On the other hand, a person with Pedophilia may enjoy sexual thoughts, urges feelings, images, and fantasies.
The symptoms of POCD are often different from those of Pedophilia. For example, people with POCD may experience anxiety, compulsive rituals, and intrusive thoughts. In contrast, people with Pedophilia may experience sexual attraction to children or teenagers, fantasising about sexual acts with children or teenagers, and seek out opportunities to be around children or teenagers.
How do I know I have POCD?
Some sure signs and symptoms alert you to the possibility of having this subtype of OCD.
These are your unwanted and unwelcome thoughts. I must tell you that you are not choosing to have these thoughts. The following are some examples, but this is not an exhaustive list.
- Am I a paedophile?
- Am I capable of harming children?
- I’m a monster; I’m disgusting.
- I’m a terrible person.
- Is there anything in my past that can explain this?
Disturbing sexualised thoughts and images regarding children
Increasing fear that you might do something immoral against your will
Obsessing over the fear of having to be around teenagers or minors in case they trigger inappropriate thoughts.
Having these types of thoughts and images is extremely disturbing, and because of the thoughts, many people, maybe you, tell no one about it or seek help. You remember that this is just another manifestation of OCD; it says nothing about you as a person.
These are the things you do to help you cope with your thoughts.
- You might keep searching in your mind for something to explain your feelings. For example, you might go over things that happened when you were a kid, such as playing ‘doctors and nurses, but instead of neutralising your thoughts, you could now see it as evidence that something is wrong with you.
- You might stay away from children, as you are concerned you present a threat.
- You might have changed your behaviour around your children, especially regarding bathing and dressing.
- Avoid looking at children
Try to avoid lifting, holding or cuddling children
Avoidance of adult consensual sex due to fear that an inappropriate thought of a minor may pop into your head.
Going over situations that occurred in the past to make sure you did not do anything inappropriate.
What is it like to live with POCD? Case study
All names and personal details have been changed.
Olivia, a 43-year-old woman, self-referred 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 in the pavement, wiping doorknobs. Olivia offered this information but did not mention any paedophilia-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 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 eventually years, Olivia had almost forgotten about the initial trigger, watching a television program documenting 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 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.
- Asking her partner to bathe and dress her children.
- Not attending events with children present.
- Mentally reviewed all instances when she was alone with children to ensure she had done nothing wrong.
- Wanting to confess to something she had not done (when I asked what she wanted to reveal, she did not know.)
When thoughts stick, they can create thought-action fusion and eventually become a false memory.
The content of future sessions was all about asking me how I knew 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 about OCD and trying to move on; you are starting to break the cycle.
How is POCD diagnosed?
There is no official diagnosis of POCD. Instead, it falls under the umbrella of OCD and its associated intrusive thoughts. But sometimes, labels such as POCD help us to know what we are discussing.
You want the same style of treatment that you would get for OCD. The recommended treatment is CBT–Cognitive Behavioural Therapy, but I also recommend mindfulness and Acceptance and Commitment Therapy.
How the different therapies will help you.
CBT will help by helping you to form more realistic appraisals of your thought processes. It shall also help you change behaviours that are not helping you. For example, suppose you have adjusted your behaviour towards your children or avoid children. In that case, CBT shall help to change this back for you.
Mindfulness Acceptance and Commitment Therapy will help you accept your thoughts for what they are; they are just thoughts.
Colter Snethen, Debbie M. Warman,
Effects of psychoeducation on attitudes towards individuals with pedophilic sexual intrusive thoughts,
Journal of Obsessive-Compulsive and Related Disorders,
Snethen, C., & Warman, D. M. (2018). Effects of psychoeducation on attitudes towards individuals with pedophilic sexual intrusive thoughts. Journal of Obsessive-Compulsive and Related Disorders, 19, 92–98. https://doi.org/10.1016/j.jocrd.2018.10.001
Bruce, S. L., Ching, T. H. W., & Williams, M. T. (2018). Pedophilia-Themed Obsessive–Compulsive Disorder: Assessment, Differential Diagnosis, and Treatment with Exposure and Response Prevention. Archives of Sexual Behavior, 47(2), 389–402. https://doi.org/10.1007/s10508-017-1031-4
Glazier, K., Swing, M., & McGinn, L. K. (2015). Half of obsessive-compulsive disorder cases misdiagnosed: Vignette-based survey of primary care physicians. Journal of Clinical Psychiatry, 76(6), e761–e767. https://doi.org/10.4088/JCP.14m09110