Pedophilic OCD (pOCD) - An Overview
Pedophilia OCD (pOCD) is a subtype of OCD commonly seen in clinical settings by clinicians with experience treating OCD. However, it can often be misunderstood and mishandled in broader clinical settings or society at large. Pedophilic OCD is usually accompanied by a significant amount of secrecy, shame, and embarrassment. pOCD is defined as an intense and excessive fear of being a pedophile, being attracted to kids, being viewed as a pedophile, having thoughts similar to those that a pedophile might have, or doing something that could be construed as harming kids. These thoughts are unwanted, intrusive, and very distressing.
Mental health clinicians utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), to assist in the diagnosis of mental disorders. In the fifth edition of that manual, it defines pedophilia as “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children”(APA, 2013).
When comparing pedophilia to pOCD, we can see that they are on opposite sides of the spectrum. The most noticeable and significant distinction between the two is the element of excitement, ie (arousal) or distress produced by these thoughts. Individuals who would meet diagnostic criteria for pedophilia get enjoyment and arousal from and fantasize about sexual activity with children. Conversely, individuals experiencing pOCD report intense distress and discomfort from these thoughts. Not only are these thoughts distressing and unwanted, but they are often accompanied by shame, embarrassment, guilt, depression, isolation, and loneliness.
Similar to other themes of OCD, pOCD is fueled by doubt and uncertainty. “Did I look at that kid in their groin area?” “Did I feel a sexual response when looking at that child?” “Am I attracted to children because I smiled at that kid?” are common doubts and uncertainties experienced with pOCD. The search for certainty ("I need to know 100%!") is fodder for the OCD cycle and fuels its sustainability and intensity.
OCD is a master at shrinking people's world and limiting their lives. Avoidance and reassurance-seeking are two other compulsions that we aim to reduce when treating pOCD. People experiencing pOCD symptoms often find themselves avoiding places, people and things that could trigger these obsessions. This includes things like missing their child’s basketball game, avoiding the mall, or avoiding spending time with friends who have kids. These behaviors go against their values and make it so that they are disconnected from systems of support.
As with other taboo subtypes of OCD, a number of treatment modalities are utilized in the treatment of pOCD. These primarily include cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and exposure and response prevention (ERP). With all of these modalities, self-compassion is an extremely vital component of treating pOCD. Helping individuals with pOCD practice grasping that their thoughts are not indicative of their character and that they deserve to do the things that are important to them is essential in treatment. I often ask clients, “Does the fact that you had these thoughts or the fact that you are concerned/distressed about them say more about who you are as an individual?”
In recent years, there has been some increased awareness and insight about this subtype of OCD, which brings optimism and hope. While the mechanisms and the OCD cycle look the same regardless of the theme or content of the obsessions, it is important to be cognizant of how pOCD symptoms uniquely impact clients. Finding a clinician that is trained and skilled in utilizing these treatment modalities can set you up for success.