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.
49 Comments
started having these thoughts mid april, turned 15 pretty recently. it was a torturous first few weeks but it does get better im telling ya, i still have a persistent fear of children but the intense phobia is dies down more and more each day. for the first few weeks i couldnt even stomach the thought of a child under the age of 12 both girls and boys, but the fear for now is only there when im physically close to a child. the thoughts dont really surface all that much anymore and dismissing them gets easier, my biggest goal right now is to eliminate my fear of children or at least curb it enough so i can function in public lol. the stress is still present from the constant thought that i will have to see a child when i go out, still finding ways to weaken its potency and so far havent found an effective solution but i will get there.
ive only suffered for about three weeks which isnt a lot but ive learnt a lot in the highest and lowest points of this entire trainwreck. one stupid thing ive done is try my own “exposure therapy” which i discourage anybody who reads this from doing, it made things worse for me at least. it only became a disguise for my compulsions and well staring at kids till the fear goes away is a compulsion and not really that good for the long term like please get a therapist. a professional can help set up a plan and they know the difference between real help and giving into compulsions, im getting one soon. some other of my compulsions ive recognized and im working on is recalling my primary school years with ages repeating in my head, comparing my very innocent and oh so pure self to actual child predators(this is reassurance like dont do that lol), researching symptoms of pedophilic disorder among others. resisting them especially the first one is pretty difficult but im working on it, remember that setbacks arent the end of the world. a part of me feels guilty that i scrolled back to look at some meme with an image of a little girl, but i remind myself that im very very far from square one even if the cortisol levels say otherwise. my newest worry right now is that “will i ever be able to stop fearing children and trust myself again?”, i stopped trying to rationalize it and like with all my other thoughts all i answered ‘perhaps’. it hurts to be so uncertain but its for the best, anxiety is temporary anyways. i once also got into the spiral of “wait what if im in denial of being a pedo?” and the way i got out was visualizing it as an entity separate from me. the condition is complex and varies from person to person so this is simply suggestions, im no expert im just a kid throwing random shit at my newfound mental illness and seeing which one burns, doesnt do anything, or backfires.
im at my worst right now but i also tell myself that the future is bright and the return of peace of mind is closer than what my doubts tell me. the pain and stress is agonizing but it isnt forever. healing from pocd is beyond difficult but i cant wait for the day my efforts are paid off and i return to the normalcy that i yearn for. i hate that its a slow process but healing slowly is better than not healing at all, itd be nice if the universe granted me mental stability the next time i awake but life really had to be hard on me. it sucks that ive been cursed with this ailment at the young age of 15 for pretty much no reason at all, life gave me lemons so i took a bite out of them and spat it in its eyes because im not fucking weak and so is everyone that suffers the same condition. my hobby in drawing has been less joyful for a while but im starting to feel the excited motivation that i so dearly miss which is a great sign for me. i also managed to dismiss visual intrusive thoughts completely and all thats left is those verbal thoughts, i cant express how much im proud of myself. some days feel hopeless but please remember that these awful feelings are temporary, may everyone in this comment section find peace. the battle is hard but itll be worth it for sure, your will is above all and is more powerful than your ocd. be kind to yourself, let yourself be angry at your suffering but remember to not lament for too long. it doesnt matter if youve been experiencing this for only a month like me or for years even, your experience is valid regardless and it is never too late to get help.
I started having these thoughts completely out of nowhere. It terrifies me every time and makes me sick to my stomach. I would never want to do anything like that. The thought just randomly popped in to my head one day and immediately brought me to tears. I have had a lot of sexual trauma and suffer with depression, anxiety, BPD. Some days I’ll feel fine and some days it haunts me. It feels like hell and sometimes it makes me want to throw up. I don’t want to be a monster. It’s my biggest fear to become a monster. Like I said I would never do anything like that. And I am attracted to people around my age. I don’t know what to do and it’s driving me crazy. I don’t know how to tell anyone not even my therapist because I’m so scared that people will think I’m a creep. I don’t want my parents to think that their daughter is a creep. The thought KILLS me. I need help.
Would someone who had this have hilucinations? Like my friend is freaking out crying hilucinations that everyone around her is calling her a pedophile and it’s making her think she did something to someone’s child and can’t remember it. But she hasn’t.
I’m 14 and I’ve had POCD for 6 months. It feels like hell. Going to school is so hard since there are many children around. I feel so sorry for people that expirened it for years and I hope it will end soon for all of us. Keep in mind that you are not a Pedophile.