POCD Basics
Pedophilia-themed obsessive compulsive disorder (POCD) is a form of obsessive-compulsive disorder (OCD). POCD involves upsetting and unwanted thoughts (obsessions) about children. The thoughts are often about fears of being attracted to children or sexually abusing them. These thoughts are deeply upsetting to the person experiencing them and are not a reflection of their desires or values.
For example, if you suffer from POCD, you might see a child in a movie and have the thought Was I just attracted to that child? Thoughts like these can trigger intense anxiety, leading to spiraling. Other thoughts may then follow, such as, Does having this thought mean I’m a pedophile? or What if I get arrested?
To try to get rid of the anxiety and distress, you might ask a friend or family member for reassurance (“Having this thought wouldn’t make someone a pedophile, right?”). It’s also common to check your body for any signs of arousal. In POCD, checking your body or asking for reassurance are considered compulsions.
SEE ALSO: The Role of Reassurance in Anxiety and OCD
The above description of POCD reflects the cycle of OCD. This cycle starts with an intrusive thought (or obsession) that is followed by anxiety or emotional distress. A behavior (compulsion) like asking for reassurance or checking one’s body provides relief from this anxiety or distress. Unfortunately, that sort of asking or checking actually strengthens the OCD cycle. Over time the process becomes increasingly disruptive to everyday life.
How Is POCD Treated?
Research shows that the most effective treatment for OCD (including POCD) is cognitive behavioral therapy (CBT). (Specifically, one particular type of CBT called exposure and response prevention – more on that below.) CBT focuses on how your thoughts, actions, and emotions influence your mental health. In CBT, you and your therapist may focus on changing your thoughts and actions to reduce the anxiety created by pedophilic obsessions. In CBT, you learn about how OCD works and learn to identify your symptoms.
When you understand how obsessions and compulsions feed into the cycle of OCD and better understand your own symptoms, you will be better equipped to beat it!
Understanding obsessive / intrusive thoughts in POCD
Part of what makes POCD so distressing is the meaning you assign to the intrusive thoughts. For example, you might believe that having a disturbing thought must mean something about who you are. Many people with POCD believe that If I had that thought, I must be a terrible person. These kinds of interpretations make the intrusive thoughts feel more threatening and increase your anxiety. These obsessive, or intrusive, thoughts are actually a common symptom of OCD and not a reflection of who you are (or what you want). CBT aims to help you understand these thoughts as symptoms of OCD rather than signs of danger or immorality.
Exposure and response prevention (ERP) therapy
The gold standard for treating OCD and breaking its cycle is through exposure and response prevention (ERP) therapy, a form of CBT. ERP for OCD aims to help you improve your ability to bear the uncertainty and discomfort triggered by obsessive thoughts — and do so without engaging in behaviors that would typically bring you short-term relief (compulsions). This involves building tolerance for the doubt that arises after an obsession and before a compulsion.
Exposure
To develop this tolerance, ERP teaches you how to gradually confront the thoughts, images, or situations that trigger anxiety. At the same time you’ll improve your ability to resist the urge to engage in compulsions. This is accomplished with the guidance of a trained and experienced therapist.
ERP for POCD can involve behavioral as well as mental exposure exercises. For example, you and your therapist might design an exposure exercise in which you watch a children’s television show or walk past a playground (behavioral exposures). Or you might imagine scenarios such as sitting next to a toddler or seeing a child in a swimsuit (mental exposures). These exercises are designed to evoke the intrusive thoughts or fears in a controlled setting, and give you an opportunity to practice responding to these triggers differently.
The key is not only to face these triggers, but also to practice tolerating the discomfort and uncertainty that may arise—thoughts like, What if some part of me liked that? or What if this means something terrible about me? Instead of trying to “figure it out” or neutralize the thought, you sit with the uncertainty and allow the feelings to pass on their own.
Response Prevention
Another key aspect is to refrain from doing the compulsions you would normally use to feel better. Examples of such compulsions might include mentally reviewing your reactions, checking your body for signs of arousal, or seeking reassurance. This effort to resist compulsions is called response prevention. Over time, response prevention helps your brain learn that obsessive thoughts do not need to be feared or acted on, and that discomfort can be managed without compulsions.
Though it can feel challenging and uncomfortable at first, ERP teaches your brain that these triggers are not actually dangerous, and that anxiety can fade on its own without needing to “fix” it or find an answer. Over time, this helps reduce the power of obsessions and improves your ability to tolerate the type of uncertainty that’s central to POCD.
Examining Negative Beliefs
CBT Treatment for POCD can also include examining unhelpful beliefs, such as the notion that having a disturbing thought means you’re a bad person. Your therapist might also focus on other beliefs that may make your obsessive thoughts feel especially threatening. For example, beliefs related to low self-esteem like “I am worthless” can make intrusive thoughts feel even more overwhelming. CBT helps to identify and challenge these kinds of beliefs, making you less vulnerable to the emotional distress that fuels the OCD cycle.
Medication
In addition to therapy, many people with OCD — including POCD — find that medication can be a helpful part of treatment. Doctors often prescribe medications called SSRIs (selective serotonin reuptake inhibitors), such as fluvoxamine (Luvox), sertraline (Zoloft), or fluoxetine (Prozac). These medications are commonly used for OCD and are generally considered safe and well-tolerated. It’s important to note that while medication can be effective, OCD symptoms often return if the medication is stopped.
Still, many people choose to take medication because it’s convenient, is often affordable with insurance, and can make therapy more effective by reducing the intensity of anxiety.
Summary
POCD involves intrusive, unwanted thoughts about children that cause intense anxiety but do not reflect the person’s desires. These thoughts often lead to compulsions like reassurance-seeking or checking. The most effective treatment is cognitive-behavioral therapy (CBT), specifically exposure and response prevention (ERP), which helps people face triggers without performing compulsions. CBT may also target negative beliefs that make these thoughts feel especially distressing, reducing their emotional impact over time.
Although living with POCD can be incredibly difficult, it’s important to know that you are not alone. With the right treatment, things can get better. With evidence-based care many people with POCD find long-term relief and reclaim their lives.
