POCD: It Doesn’t Have To Be a Life Sentence
What Is POCD?
POCD is a type of OCD that can be anything from annoying to devastating for those who have it. Read on to learn about this condition and the recommended treatment for POCD.
Pedophilic obsessive-compulsive disorder (POCD) is an informal name for OCD when the primary symptom is pedophilic obsessions. It is a sub-type of obsessive-compulsive disorder (OCD).
POCD is sometimes considered a version of “pure O” OCD or purely obsessive OCD. OCD usually involves obsessions and compulsions. The “pure O” label is used for the rare patients who do not appear to have any compulsions. (Please note: Research shows that someone with obsessions but without visible compulsions is likely to have unobservable or mental compulsions. So, the “pure O” concept is probably a myth.)
POCD often involves compulsions. These can be inward, outward, or both.
What Are Pedophilic Obsessions?
An obsession is a thought, image, or impulse that is usually repeated, unwanted, and/or inappropriate. Obsessions cause significant anxiety when they occur.
Pedophilic obsessions are repeated thoughts, images or impulses related to concerns about being a pedophile. Here are examples of obsessive thoughts, images, and impulses that an adult might encounter if they were worried about being a pedophile:
A pedophilic obsessive image might be imagining that you are engaging in a sexual action with a twelve-year-old child.
A pedophilic obsessive impulse might be experiencing an urge to perform an inappropriate or sexual action with a twelve-year-old child.
How Common Is POCD?
One of the largest and most comprehensive research efforts ever made to measure the prevalence of conditions like OCD was a study called the National Comorbidity Survey Replication. It assessed thousands of people. The study found that over a quarter of Americans have obsessions or compulsions at some point in their lives. They also found that 2.3% of Americans have OCD during their lifetime and, at any given time, about 1.2% of Americans live with OCD. This means that, right now, around four million Americans have OCD!
The study referenced above did not specifically measure how common POCD was because POCD is not an official psychiatric diagnosis. However, the study gives us some helpful clues about how frequently POCD occurs in the American population.
There are several categories of obsessions. These include, but are not limited to, perfectionism, sex and sexuality, religion, contamination, losing control, and harming others. POCD involves a sub-type of sex and sexuality obsessions.
Although research doesn’t give us exact figures, it is reasonable to surmise that less than 10% of people presenting for OCD treatment have POCD.
What’s It Like to Have POCD?
People with POCD often describe their obsessions as demoralizing. They suffer from a lot of shame and doubt, and may feel isolated.
Those who have POCD usually do not confide in loved ones. This is because when they do, they are often met with kind reassurance, such as, “Oh, you’ve got nothing to worry about. I’m sure you’re not one of those people. Please don’t stress about that.”
Sometimes this feels helpful, but only for a short while. Other times, responses like this feel so disconnected from one’s anxiety and concern that they feel impossible to believe. This leaves the POCD sufferer feeling misunderstood and ashamed.
Uncertainty Avoidance
The engine that drives POCD is a deficit in tolerating uncertainty. This experience drives a sequence of events that creates significant anxiety.
Here’s a typical example of how it works for a person living with POCD:
- You see a cute kid on a TV show.
- You think to yourself: Am I sexually attracted to that kid?
- Then — despite the fact that all your previous romantic and sexual relationships have been with age-appropriate partners — you feel terror accompanied by the suspicion, I think maybe I am attracted to that kid!
Unhelpful POCD Coping Efforts
Distraction
Either out of calm strategizing or outright panic, someone with POCD may decide to focus their attention on something totally unrelated to the obsessive thought, image or impulse. They do this in the hopes of being productive with their time — or of just escaping the obsession. This often works in the short term, but not in the long term.
Successful Attainment of Reassurance
Seeking reassurance — which is also a compulsion — is perhaps the most popular strategy to calm the anxiety of those with pedophilic obsessions. POCD sufferers who find themselves obsessing are very tempted to find “proof” that they are not a pedophile. The ways people do this vary widely.
Here are some examples
- Explicitly asking for a loved one’s opinion (“I’m probably not a pedophile, right?”).
- Laying a reassurance “trap” when talking to a loved one (“I wasn’t being weird at our 6 year old cousin’s birthday party last weekend — was I?”).
- Looking at children or images of children to gauge one’s reaction / attraction toward them.
- Looking at adults or images of adults to gauge one’s reaction / attraction toward them.
- Masturbating while imagining children / adults to gauge one’s level of arousal. (See also our separate page on sexual arousal and POCD.)
- Seeking / having sex with adults to gauge one’s attraction toward them.
- Researching pedophilia on the internet.
Unsuccessful Effort to Attain Reassurance
The strategies listed above may or may not result in achieving reassurance. Looking at an attractive adult of one’s preferred gender may not produce a feeling of attraction. Internet research on pedophilia may not yield comforting information. When this happens, the person with POCD often feels even more distress.
Typically, this leads to more reassurance seeking behaviors. The POCD sufferer might think, Well, I didn’t feel attracted to that woman, but I’ll find another one. This often spirals and leaves them feeling even more despair and shame than ever. Depression often results if this pattern is frequently repeated.
Avoidance Behaviors
in addition to the compulsive ways that people with POCD try to seek reassurance, they may also take steps to ensure that they do not sexually abuse or inappropriately touch children. These are called “avoidance behaviors” and could include measures like the following:
- Ensuring one is never alone in a room with a child, including family members.
- Finding excuses to not attend parties for children, even if they’re marking important milestones.
- Intentionally arriving late — after children are likely to be sleeping — to family gatherings.
- Avoiding normal physical contact with children who are relatives or children of friends (e.g. lap sitting, hand holding, hugging, etc.).
- Crossing the street or maximizing physical distance on the sidewalk to avoid an approaching child.
- Taking a seat unnecessarily far away from a child on a bus or train.
An Addiction — to Reassurance
Medication Options
Prescribers primarily use two classes of medication to treat OCD. Selective serotonin reuptake inhibitors (SSRIs) are medications that increase the amount of a naturally occurring chemical in the brain called serotonin. SSRIs include medications such as Luvox, Lexapro, Prozac and Zoloft. SSRIs are the first type of medications prescribed for OCD, and they are prescribed at high doses. Unfortunately around half of people treated for OCD with SSRIs do not respond well enough to meet their goals.
If SSRIs aren’t effective, prescribers will sometimes use other medications sometimes used to manage OCD. These include Anafranil (a tricyclic antidepressant) and medications called novel antipsychotics such as Abilify.
So Which Treatment Works Best?
Which is more effective, ERP or medication treatment? This question needs more research, but studies have suggested that ERP without medication is slightly more effective than medication without ERP (e.g., this study and this study). Many people have a greater comfort level with one of these two options over the other; if you strongly prefer one, seek it out! Treatment can change lives — life after OCD can be a whole new ballgame.
Despairing POCD
POCD Treatment
The most effective treatment for POCD is exposure and response prevention therapy (ERP). ERP is a form of cognitive-behavioral therapy typically delivered once a week for several months. During this therapy, patients learn about OCD, how OCD works in general, and how it works for them in particular. Patients learn to identify their obsessions and compulsions and gain critical strategies to handle these symptoms when they happen. Eventually, patients receive training in exposure exercises. Exposures are ways to practice improving tolerance for the unpleasant emotional states that precede a compulsion.
By improving your tolerance for these feelings, you hone your ability to refrain from compulsions. This is true for either observable (behavioral) compulsions or for invisible (mental) compulsions. In so doing, you weaken the OCD gradually over the course of therapy.
What’s the Prognosis for POCD?
As mentioned, ERP is the treatment of choice for POCD. Studies typically show ERP for OCD to produce meaningful improvement in two-thirds of patients who receive it. One in three recovers completely.
The two most commonly used medications to treat OCD are selective serotonin reuptake inhibitors (SSRIs) and clomipramine (Anafranil). Research suggests that although these medications can help people with OCD, neither add benefit beyond ERP alone. At this time, there is no reason to believe that POCD would respond differently to the various forms of OCD treatment.
Advice for Those with POCD
- Many of the people who do not benefit from ERP do not complete the homework exercises that are assigned by their therapist as part of their POCD treatment. Others drop out of treatment. If you don’t follow the therapist’s recommendations — or if you stop going to therapy — there is little reason to believe you will improve. So, this part is under your control!
- If you don’t improve from ERP, you can try medication treatment.
- Whether or not you take medication, you can always try ERP again in the future. It is possible that, even if you do not benefit from the therapy initially, you may benefit from it later on.
POCD is a treatable disorder, just as OCD is. If you suffer from POCD and are looking for help, please contact us using the blue “schedule an appointment” button below. We are happy to work with you or help you find someone local who can help.
Now It’s Your Turn
Let us know about your experience in the comments below. If you have questions this page did not address, please mention them and we will try to address them as the page gets updated over time.
Please contact us
if we can help you in your efforts to find therapy for POCD here in New York. Our CBT therapists are doctoral-level psychologists. We also have student therapists who offer reduced-fee services. Our offices are in midtown Manhattan, but we offer teletherapy services to people elsewhere in New York State, New Jersey, and Florida. If you’re looking for therapy for POCD in another part of the country or world, please contact us — we are happy to help!
POCD Frequently Asked Questions
Because POCD is a subtype of OCD, POCD is likely caused by the same as the same factors that cause other types of OCD. These include a combination of environmental, genetic, and neurochemical factors.
A burning desire to know the answer to this question is characteristic of those who suffer with POCD. Please consider consulting with a therapist who specializes in treating obsessive compulsive disorders.
POCD can get better or worse on its own; it can also shift into another form of OCD. Exposure and response prevention therapy and some medications have been shown to be effective for OCD; there is little reason to believe POCD is any different.
51 Comments
I always have this, I just didn’t realise it. Even before getting sexually harassed by my older brother at 17, I remember a vague fear about children all the time. After watching a movie where the kidnapper held a kid hostage, I felt a sense of fear and would be afraid of doing the same thing to other children. For the longest time, I thought I was just a sex addict or didn’t grow up normally, and the thoughts grew even worse after what my brother did and I suffered silently through the pandemic. Sometimes the pain was so intense that I just gave in to my arousal again and again. That made me think that I actually liked what my brother did, or that I would love it if it wasn’t my brother who assaulted me. To the point, I wished it was a random man who touched me, pushed me onto a bed or knocked me out. I can’t read news of people raping children because I would imagine myself as the rapist in the news. But there were days when I only read news about rapists to try to wake myself up and just stop thinking of harmful things or I would end up in jail.
One day I found out about POCD and it changed everything I know. And I have spiraled deeper since then. I read that exposure therapy helps get rid of this but that just scares me even more, how will I ever tell another human about the thoughts I have? How will I ever be exposed to the things I am scared of, how is that a good idea? What if I end up as a pedophile after being exposed to triggering situations constantly? What if I end up hurting a kid in those situations? I know how much that hurts because it hurt me when my brother did it. What if I tell everything to my therapist and they say I am just a pedophile and I am faking everything? What if I AM faking everything? Why can’t I just move on like how my brother is? He’s living a great life. Why can’t I just live a great life? Why can’t I just forget everything he did?
I am so tired, I want my friends back, I want them back in my life but my brain wouldn’t let me. I feel so lonely. I’ve tried to push away my boyfriend too because I don’t want children. I am sabotaging my life and I am so tired of everything. I wish they just put me in jail to avoid everyone. If any parent could hear my thoughts they wouldn’t hesitate to call the police on me. I am not normal and I will never get better. I wonder about the fact that my brother could possibly have POCD too and his pain is now gone because he let it out on me. He lost friends at my age too. What if when I reach his age, I would end up doing it to someone? And what if I didn’t get away with it? People won’t care about any mental illness once you commit a crime. I will be judged by everyone. What if I give a bad rep to POCD for people who are really suffering from it? What if I just enjoy doing this to myself? What if I was meant to be alone? What if my brother’s actions are not ‘that bad’ and I am just using it as an excuse to fantasise? How much longer can I put the blame on him? What if all of this isn’t his fault at all and I am just delusional? What if his actions are what stopped me from hurting a child and made me aware of my sick mind? Maybe he broke me before I broke anyone? I deserved it but I am so tired.