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

POCD plagues this woman

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.

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.

anxiety disorders.

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.
POCD anxiety

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.

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

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.
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

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.

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

  1. 15 year old female here. I’ve had on-and-off pOCD for the past 8 months. My 11 year old step-sister was climbing all over her older sister, and a little part of my brain thought, “Doesn’t [older sister] get uncomfortable with that? [Little sister]’s kinda handsy.” Or something similar. The moment I thought that, on came the barrage of thoughts I’m now worryingly familiar with- “She’s only 11, why are you sexualising her??” And, “Of course [older sister] isn’t uncomfortable, what a creepy thing to think. Why did you think that, are you a pedophile?”

    I was already having intrusive thoughts before this – sexual ones about my dog, and my dad. I then started having mild intrusive thoughts about children – worrying to me, but not as harmful as they eventually got- but then one day.. I broke down. I looked at my little brother, had an extremely disturbing thought, and immediately couldn’t focus for the next week. I spent that whole day in my room, doing research and crying. Anytime a thought cropped up, I’d dig my nails into my flesh, I’d smack my own head extremely hard. I saw an article about something similar to pOCD and breathed a sigh of relief, then saw one about actual pOCD and immediately I could.. exist, again, without freaking out at every thought.

    I tried to follow the advice the website gave me – tried to learn to be alright being unsure in whether the thoughts were real, and it helped a little bit. But not enough for me to not try for therapy. I told my mom and my dad, and my dad found me a lady Christian therapist. It helped – I got a diagnosis, and a compulsion I often go back to is reminding myself how I burst into tears the moment I told her about the thoughts. She did end up comparing my OCD to the devil, and while I understand the reasoning, I’m agnostic. So I quit. Eventually, it was on and off again. Some days I wouldn’t even have a thought- or if I did, my brain wouldn’t latch onto it- and some days, I’d have to take medicine to sleep because it’d get so bad.

    I started doing groinal checks, which never helps. During the bad phases, I knew one thing. If my diagnosis was wrong, if I really was a pedophile, I would kill myself. No doubts about it. I still believe that I’ll do it to this day.

    Lately, it’s gotten worse. The past three days have been hell for me. Graphic thought after graphic thought, constantly. I’m inches away from crying at any moment. I’m praying that once my school is back open, once I’m not isolated with my family at all times, things will get better – but I don’t know.

    I’ve ever met ANYBODY my age who struggles with this. Hopefully, I can make someone else feel not quite as alone. Feel free to respond, no matter your age. It helps me.

  2. Oh man. These comments are exactly how I’ve been feeling. On my heart I know I’m not one but in my mind it’s like it’s trying to convince me I am one? (So just a quick backstory before I start. I was raped multiple times as a kid by someone I trusted, I was also molested by multiple different family members)
    One day I was sitting on the couch with my husband and we were watching Private Practice (spinoff of Grey’s anatomy). There was an episode that was about this guy who had court mandated therapy for a risk evaluation about pedophilia. In his therapy session he said “all I want to do is talk to her hang out with her” the therapist then said “is that what the man who hurt you said” in that moment it was like a switch flipped, an overwhelming sensation came over me and I went through a complete mental break down. Wondering if because I was raped because I was molested does that mean I’m going to become one. I stayed up for a week couldn’t sleep wouldn’t eat drink or do anything. I literally could not function. I stayed in the bath tub and even called my mom waking her up in the middle of the night to come sit with me in the bathroom because if she didn’t I was scared I might hurt myself. It’s been 3 weeks since that happened and for a minute I started to get better, but then another episode about pedophiles came onto tv and it sent me back through the spiral. I’m telling my husband I hate him and he’s a cheater and all sorts of things. Trying to place blame I guess. I feel like there’s another person trying to fight their way out of me. I wanted to have kids more than anything, I wanted to be a mother more than anything. Teach my kids how to treat others, teach them no means no, teach them that even tho the world is scary it’s worth fighting the demons, I wanted all of these things for me and my husband and our future together. Now I am so terrified about ever becoming a pedo that Im scared to have kids and move on with my life. I’m stuck in this loop that I can’t pull myself out of and I’m dragging others down with me. I’m only 21. I feel that I deserve better then what I’m being delt right now. I know that sounds selfish but my mind is conflicting with my heart so much that I have ended up hurting myself. I feel alone. Like no one is ever going to understand and that I just look like a pedophile or I seem crazy because I worry I am one. After everything I’ve said I’ve had to put in I’m not one tho just to reassure. I know I’m not one I shouldn’t have to reassure myself. Why is this happening? Why would I even think I am one ? That must make me one? Why am I so worried about it? That kid touched my leg and I didn’t like it it made me feel weird does that make me one?
    These are constant questions I ask myself and more, then I come to the realization that if I was one I wouldn’t be so worked up over it. If I was one I would’ve known the second I started having sexual feelings towards anyone. If I was one I wouldn’t want to hurt myself. If I was one….
    It just keeps going an endless loop. I don’t want this to stop me from living my life. I don’t want this to ruin relationships. I don’t want this to be a problem anymore. I want my thoughts gone. I want to know I’m not alone. I want to know I’m not one and I never will be one. I don’t want to avoid children I don’t want to feel isolated. Before any of this happened I could be around a child without a second thought. Most of my friends have children and they absolutely love their auntie but this past month I don’t even want to have the kids around me I avoid kids on Facebook and tik tok I avoid being outside when the kids go to school or come home from school. It hurts thinking that I could ever be that way because I am great with kids. I know I’ll make a great mother. I know I’ll hurt myself or anyone else before that child gets hurt you know. And once again typing those thing my mind went straight to what if people think I’m a pedophile? This form of mental disability is suffocating. You don’t know who to tell who to trust or who’s just going to spread things about you if you tell them. I feel broken and lost. I have no sexual desires about children but the fear of it is crushing me and making it very difficult to get out of bed in the morning. I’m becoming an adult now, it’s time to grow up.

  3. So i remember once i had found something called loli when i was 12,and didn’t know literal what it was,i found it odd and i had thought it was like some adult stuff.i had just found out what masterbation was and had tried it out and nothing happened,pretty sure it was just like some random groinal response.forgot about it then a year later i found that again and had a stronger response and i started panicking since i got an intrusive thought saying “hey are you a pedo? hey are those kids” and i was like no? like these are grown adults right? i didn’t even know what it was i google and it had said there *falsely* that they were grown women so i had thought it was ok.ended up masterbating to prove to my intrusive thoughts i was not a pedo,then i saw comments saying that it was loli meaning kids,and instantly started panicking thinking “oh my lord my intrusive thought was right i was pedo this whole time oh my goodness what am i doing” i couldnt do anything well that day of all the panicking.and i can’t get therapy since i’m still a minor and my parents don’t think anything’s wrong with me.

  4. So my situation is different. Long story short I had a normal sexual dream with a friend my age. Right at the end of the dream I look down it’s my dog and immediately throw her off (in the dream) and was like WTF. Waking up and remembering this dream was absolutely terrifying. For some odd reason my mind said that was pedofilish which is far from that. Ever since the P word has been in my head and won’t leave.

    I don’t have thoughts like most POCD people really at all. But this word has been nagging at my mind for two weeks straight Daily. Now to the point

    As soon as a see I kid I go into reassurance mode. My thoughts go something like this. See you are fine. You’re NOT attracted to kids but then the other side is like hey but what if you are.

    This is debilitating. As stated I haven’t had thoughts about children at all. But that P word won’t leave and is a vicious cycle.

    I’m so lost and scared

  5. I’ve been dealing with this for nearly 2 years and It’s caused me to break up a relationship I had because I was so obsessed with it that I couldn’t be in a relationship. I have weeks where I’m fine and then weeks I’m not. Even tho I know I’m not one and my thoughts aren’t real It still makes me feel terrible and ruins my life. Being excited for something or even just hanging out with friends. The thoughts pop up and I instantly get anxiety. I’m 20 years old and I haven’t told anyone for 2 whole years. I’m learning to live with it but I’m so fed up of having this condition I just want it gone. I’m scared that if I tell someone they will think I am one, and I don’t know what to do….

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