POCD: It Doesn’t Have To Be a Life Sentence

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.

Last updated: November 1, 2020

What is 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 thought might be, What if I’m attracted to that twelve-year-old child?

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.

These obsessions can be about children who are familiar or not; family members, friends, strangers, or even one’s own children may be the foci of POCD obsessions.

As described above, these obsessions occur repeatedly and are unwanted. Typically, they have a terrifying effect on the person with POCD because they suspect that having these thoughts, images, or impulses means they are a pedophile.

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!

What comes next is often one of four things, none of which are ultimately helpful.

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

The reduction of anxiety that POCD sufferers feel when they gain reassurance is powerful. As with most addictions, getting your “fix” only makes you more likely to seek it out again later. (This happens due to a phenomenon called negative reinforcement.) With POCD, this release combines with the abject horror one faces at the idea of being a pedophile and creates a supercharged obsession-compulsion cycle.

For example, if someone has an obsession about being attracted to a child and then achieves reassurance by remembering they recently had enjoyable sex with their adult partner, they feel better. This relief is seductive and causes them to want more; but the only way to get more is to find another obsession. So, then they may think: What if I really am attracted to children, and my relationship with my partner is just a manifestation of my denial?! Thoughts like this are often followed by another effort at attaining reassurance, and the cycle continues.

People often find there are no easy off-ramps from this POCD highway.

“Despairing POCD”

Some people with POCD have been so victimized by the condition that the obsessive thoughts no longer feel like new and startling possibilities — they just feel like the truth. I call this “despairing POCD.”

People with this kind of POCD avoid being around children, not because they’re afraid that they might be a pedophile, but because they’re confident they are one. The last thing they want is to endanger children.

Treatment for “despairing OCD” with exposure and response prevention (described below) can be effective. Despite the hopelessness this condition entails, various forms of cognitive-behavioral therapy can be potent tools to help people with this dispiriting condition.

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

If you suffer from POCD it might seem daunting that only two thirds of people typically respond well to ERP therapy. It is helpful to keep the following points in mind:

• 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.

Frequently asked Questions about POCD

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!