Understanding Pedophilia OCD (POCD): When Intrusive Thoughts Take Over

Trigger Warning: This content discusses intrusive thoughts, which may be triggering for some readers with OCD.

People with normal, healthy minds can experience fleeting, uncomfortable thoughts. But what if those thoughts centre around harming children? For individuals struggling with Pedophilia OCD (POCD)—not to be confused with paedophilia—this isn’t just a fleeting moment; it’s a relentless nightmare.

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)

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.

Dr Elaine Ryan

POCD is a specific type of Obsessive-Compulsive Disorder (OCD) characterized by intrusive thoughts and anxieties about being a paedophile. Despite having no desire to harm children, people with POCD experience intense distress and shame due to these unwanted thoughts.

Here’s what separates POCD from paedophilia:

• Intrusive vs. Desired Thoughts: Thoughts in POCD are unwanted and cause immense anxiety, unlike the pleasurable urges experienced by paedophiles.
• Shame vs. Arousal: Individuals with POCD are horrified by their thoughts, whereas paedophiles may feel arousal or seek gratification.
• Compulsions vs. Acting on Thoughts: POCD sufferers engage in compulsions to neutralize anxiety, whereas paedophiles may act on their urges.
• Fundamental Distinction: Importantly, people with POCD are disturbed by their thoughts and would never act on them, emphasizing their deep-seated fear rather than any real intent.

The Cycle of POCD

POCD follows a well-defined pattern:

1. Intrusive Thoughts: Unwanted thoughts about being attracted to children appear.
2. Anxiety: The thoughts trigger intense fear and disgust.
3. Compulsions: Repetitive behaviours or mental acts aim to reduce anxiety, such as seeking reassurance or checking for urges.
4. Temporary Relief: Compulsions provide short-term relief.
5. Repeat Cycle: The cycle restarts when intrusive thoughts return.

Common POCD Compulsions

• Reassurance Seeking: Repeatedly asking for confirmation they aren’t a paedophile.
• Mental Checking: Analyzing thoughts and feelings for signs of paedophilia.
• Avoiding Triggers: Avoiding situations or stimuli that might trigger intrusive thoughts, like playgrounds or children’s movies.
• Specific Impact Examples: These compulsions can lead to avoidance of family gatherings where children are present, or constant apologies to friends for having intrusive thoughts, impacting social relationships and daily functioning.

Expert Insights

Dr. Elaine Ryan, a psychologist specializing in OCD, explains: “It’s vital to understand that POCD is marked by extreme anxiety over thoughts that are entirely unwanted. The distinction from actual pedophilic disorder is crucial, as POCD sufferers are tormented by fears of being what they most despise.”

Breaking Free from POCD: Effective Treatment Options

If you suspect you or someone you know has POCD, seeking professional help is essential. Cognitive-behavioral therapy (CBT) is highly effective in treating OCD and its subtypes, including POCD. Through CBT, individuals learn to:

• Identify and Challenge Intrusive Thoughts: Recognize that thoughts are not facts and develop healthy coping mechanisms.
• Reduce Anxiety: Learn techniques to manage anxiety without resorting to compulsions.
• Prevent Relapse: Develop skills to maintain progress and prevent future episodes.

Remember, You Are Not Alone

POCD is a mental health condition, not a reflection of who you are. With proper treatment and support, you can manage your OCD and live a fulfilling life. Here are some resources for further information and support:

• International OCD Foundation: International OCD Foundation
• National Alliance on Mental Illness (NAMI): Visit NAMI
• Anxiety and Depression Association of America (ADAA): Learn More at ADAA

By raising awareness and understanding of POCD, we can help those struggling to find the help they deserve. Don’t hesitate to seek help if you recognize these symptoms in yourself or someone you know.

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.

Treatment

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.

Sources
Colter Snethen, Debbie M. Warman,
Effects of psychoeducation on attitudes towards individuals with pedophilic sexual intrusive thoughts,
Journal of Obsessive-Compulsive and Related Disorders,
Volume 19,
2018,
Pages 92-98,
ISSN 2211-3649,
https://doi.org/10.1016/j.jocrd.2018.10.001.

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