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. God I’ve been suffering with this ever since the beginning of March and it’s been one of the worst things to ever happen to me. I’m currently 18 and ever since beginning of March I’ve been having pOCD symptoms and it’s practically uprooted my life to the point where the only way I’m able to have a “good day” is where I stay at home, and don’t leave, and don’t watch any movies or do anything that could have kids in it for the fear of the thoughts coming back. It’s been so stressful and I don’t know what the hell to do because researching about pedophilia can sometimes be reassuring but other times it can make me more stressed because my brain goes: well what if you are and what if that does relate to you? Even though I know deep down that it doesn’t. I can’t even begin to describe how debilitating this has been and recently I’ve thought that if I really am a pedo then I’m just going to kill myself because there’s no way in hell im going to hurt a kid. I’ve talked to my dad about it actually in depth and I’ve explained the thought processes to him and he’s tried to help me out but that was back in April and I’m afraid that if I keep talking to him about it then he will think I’m a pedo and that’s making me really stressed as well. Reading all these comments have helped though just to know that there are other people out there going through this and that it’s not just me. I’m also afraid of getting a therapist as I don’t know where to start

  2. I’m 15 (M) and over the last month or two I’ve been so extremely paranoid and anxious about being a pedophile and of course the more I think about “what if I am a pedo” the more intrusive thoughts I get. It’s just a positive feedback loop of “I’m a f*cking monster” that gets worse the more I think about it.

    I’m so glad that I found this article now rather than later because over the past few days I’ve been nervous about walking down the road I live onsince since one time when I did I saw a mother with her two kids, maybe… I dunno, 9 and 6. They were looking at me and I was looking back at them, as people do, and in hindsight it was a normal eye-to-eye glance exchange, but at the time I was almost shaking because the mother seemed so judgemental and I was afraid that I was staring at her kids weird.

    It’s gotten to the point where I’m afraid of being into girls my age because they’re not fully developed women above 18 because I’ve been so afraid of being a pedophile.

    This definitely puts me at ease a little bit, as I felt like I was burning up from anxiety just a few minutes before I heard the term online and immediately jumped here. I just hope it’ll be better once schools open again and I’m back around people. Thank you a ton, and I’m cheering for the rest of those here with the same problem.

  3. I’m 23. I’ve been going to therapy for other mental health problems for over a year now (I started going just before the pandemic). First cognitive-behavioral until I reached a standstill and now psychotherapy with light antidepressants.

    I think I always struggled with some form of OCD or invasive thoughts, though until recently it was either about me dying/being harmed or killing/harming others. It was rare enough that I could try to ignore and forget about. I was able to manage that but this pOCD stuff makes me so distressed and anxious every time it happens.

    I’ve been experiencing this for the past few months. Again, it’s not constant for me. I’ve noticed that it usually happens when I’m in a noticeably worse mental state. I believe that the situation caused by the pandemic has somewhat pushed me into this.

    I’m working up the courage to tell my therapist about it. There are a few things I still haven’t told them about and this is probably be the worst one.

    I really wish it will just go away eventually if I take care of my mental health. I feel like I’ve been robbed of a normal life before I could really start living it.

    Thank you for giving me hope. The idea of having to live with it and manage it for the rest of my life still makes me feel miserable and terrified but I feel a little better knowing that it’s treatable.

  4. I’ve been dealing with this for a while now. I’m 17 and this illness is literally the worst thing I’ve ever had. I’ve had health anxiety, other intrusive thoughts, and ocd. My ocd switches from harming people I love to like my pets or uncontrollably harming myself. It’s recently been about the pocd thing which is definitely the scariest.

  5. I can’t believe all these comments of people my age (17) dealing with the same things. Like it did make me cry but I also don’t feel so alone. Aaaagh I just can’t express how much I relate to everyone’s comments here, and this thread has really given me hope sort of. If anyone wants to chat that’s around my age or whatever my Instagram is: emmer1202. Maybe we can talk about how much it sucks and we can get better together :,)

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