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:

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

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:

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:

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. Hi all, I am a 23 year old mom who has ptsd from being sexually assaulted. When I was pregnant with my son I was so happy to have him and excited. Then right after I had him I got post partum depression. One day a horrible thought popped into my head about “what if I ended up touching my child.” I tried to get the awful thought out of my mind but the more it gave me anxiety the more I obsessed about it. I feel like it’s ruining my relationship with my son. When I change him I feel physically sick or even when I bathe him. I just am in a constant state of fear that I’m somehow going to hurt him. Which is the last thing in this world I want to do. I’ve never really talked to anyone about this due to shame. Also since I’ve been living with these thoughts for over a year now I full out have made myself out to be a pedophile in my head. I honestly just want it to stop. I feel physically ill all the time from my thoughts and mental images of things I don’t want to see. I really need someone to talk to. I don’t feel like I can keep going on like this.

  2. Huh.

    I have isolated myself from others for the past five years. I haven’t really been able to maintain interpersonal relationships due to severe depression and anxiety. Essentially, once I graduated from high school and after a medical resignation from a service program, I just dropped most of my relationships and rarely left my room.

    Only now am I discovering that I experience hyper sexuality around others, yet am also deeply repressed and ashamed of any sexual arousal. I am an incest survivor and have been molested by multiple family members.

    I am finally trying to live again and I got a job working in an Early Childhood Development program and it is MISERABLE. I am constantly worried about being perceived as a pedophile, and alarmed by my random sexual thoughts/feelings that can arise when I am around the kids. I am afraid to be alone with them. I like that they want physical comfort and closeness but I fear unintentionally grooming them or violating their boundaries. I also fear harming them in general. I was sitting at the rug after story time and zoned out while looking at one of the kids zippers and other teachers saw and I am convinced that they think I am a pedophile. The worst part is that of course I don’t want to be perceived as a pedophile but then that desire makes me feel guilty and like I am trying to hide something when I want to tell them “hey, you saw that and I am experiencing sexual thoughts about children but it makes me extremely uncomfortable and if I ever did hurt a child, I would want you to murder me.” Because I’d probably kill myself if I did actually sexually abuse a child.

    I can be sexually aroused by LITERALLY anyone, even an 80 yr old man that is creepy and repulsive to me. It feels like a curse.

  3. Damn this comment section makes me feel like a normal human being. It seems most of us are in the same age range (I’m 19). This whole thing started when I was 18 and it’s the worst thing I’ve ever had to deal with mentally. It makes it especially difficult because I live with my parents and younger brother. Some days I cant even talk to my younger brother, I just lock myself in my room wishing that voice in my head would stop berating me and analyzing every thought I’ve ever made. But anyways I just wanted to say that all of us are going to be alright and at the end of the day they’re just thoughts. If you want to hit me up my instagram is frangle.artcorner
    Stay strong!!

  4. I’m 15 years old.I started worrying when I looked at a little kids butt after I looked I avoided her at all cost.Now I imagine little kids in bathing suits to test myself to see if I am one I worry what I won’t have control when I see one or I worry what if she is just so cute I can’t resist I don’t know what to do

  5. Omg I struggled in scilence for so long, it was agonising. thank you all zo much for sharing your stories and for writing this article. After reading this the thoughts lost their power and I can finally let all the tension and anxiety go… I’m so happy that I can finally enjoy my happiness without feeling disgusted with myself because of self doubt.. because I’m having a little baby boy in Febuari and I couldn’t be more excited for it….

Leave a Reply

Your email address will not be published. Required fields are marked *

Post comment