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. Hello all, there is hope out there. I hope everyone finds the strength to keep going and defeat this illness. You can improve your life, but you just need to be brave and tackle it head on, here is my story:

    I have had element of Pure OCD my entire life, but the spike in 2012 with the birth of my niece derailed me more than all the others. Jimmy Saville was on the news everywhere, you couldnt turn on the TV without it being mentioned, it sickened me, Ive always wondered how could anyone hurt anyone, let alone a child. One day at my niece’s house the TV was on and I looked at my niece and thought of Jimmy Saville, it terrified me, then the thought made me think was I like him just because I thought of him and I was lost. Consumed by terror and OCD, although I didnt know what it was, I lost my ego, my happiness and my life for awhile as I was so disgusted with myself, trying to find an answer. It happens very quickly and as soon as you grab on to the though it owns you and it tries everything, you can not out logic OCD with reason.

    My life was saved when I found Rose’s article in the guardian on Pure O (type that in and you will find it) massive relief came over me. I wasnt a monster, here was someone who has the same problem as me and a women too. From that point I had a condition. I went to therapy, finding a specialist in pure o. With her I did exposure therapy and it worked a great deal, I could start to rebuild my life and find my ego again that had been obliterated by self loathing. I also found the 4 step process found in the book Brainlock. That was a usual technique to deal with OCD thoughts. I tried other therapy and constantly worked on it.

    This year a friend opened up to me about his Pure O, and it let me to reveal myself fully to someone in my real world, not a councellor. This illness hides in the shadows and by hiding it you are keeping it alive, I understand it is the hardest thing to do, to tell people as it is your darkest fear but it demising the power as you realise ofcourse you are not what your fear. I believe people with pure o, actually care too much, as they love people and they dont want any harm to come to them, so fear mutates around that.

    I have recently told my partner about the last 10 year and the secrecy I have lived in. It has not been easy for her as it is very painful for her to find out I was suffering like this alone, and also just the disturbing nature of it, but Im hoping we can be stronger for it. I certainly feel better for being more open.

    I dont think article is written very well, as I dont think it explains really what it is, we have these thoughts as it’s the last thing we ever what to do, it’s a phobia that we churn around in our head to see if some how we are guilty, it’s a court case and your mind is the judge, jury, defence and prosecution. If you play it’s game you have lost. Take steps to tackle it head on, open up to someone. dont be alone, life can be wonderful.

  2. I am a 22 year old man and I have very recently felt like this. I have not been diagnosed yet but will have a psychiatric evaluation very soon. I am definitely hitting the despairing OCD level at this point. The intrusive thoughts/images/urges are so constant that I have truly convinced myself that I am a pedophile. I have no one to turn to in fear of everyone thinking that I am a monster. This has ruined all sexual aspects of my life. I cannot do anything sexual (i.e. masturbation or sex) without having these horrible intrusive thoughts. I do not know what to do at this point and I am starting to feel entirely hopeless.

  3. Hi
    I have been suffering with thoughts and feelings that I am attracted to young girls since I was 18 I’m now 46.
    A year or so ago I found a therapist who introduced me to ERP.
    I did behavioural experiments where I walked my teenage son to school so I was exposed to school girls.
    It was hard at first but it did get better. I have now been able to drop the safety behaviour of constantly checking if I was attracted to them and now just say it’s just a thought and a feeling.
    I’m just writing to show you that it can improve, I still get anxious and have the same thoughts and feelings but I’m feeling less shame these days. Fingers crossed 2022 will be the year I finally get my life back.

    All the best

    Neil

  4. Hi all,
    I wasn’t going to comment but after reading some comments, i wanted to attempt to share some encouragement. I have definitely struggled with this as well as other obsessions related to OCD, but it’s so on and off for me. PLEASE GET HELP IF YOU CAN!! I know NAMI ( in the US ) even has support groups if therapy is not an option (which is totally valid). Please support yourself. Something i have learned through research that has greatly helped me is that OCD takes your most important values and turns them against you. So ie. in this context-if you are afraid of being a pedo, you are not, and respecting and keeping children safe are really important to you. It twists what’s most important to you, and that’s an aspect of why it’s sooooo distressing to you! It also feels soooo real for this reason. Just because it feels so real, doesn’t mean it is though. Just remember that, your brain is powerful, but it doesn’t know everything. YOU GOT THIS!
    I really truly hope this helps! Stay strong and hold on-it will get better-manifest that!:)

  5. When I was 18 I’m now 35 some 13 year old ask me out ova the net I said “Sure whateva” as a joke but the thing my mind can’t get the story straight was 13 ,14 or 12 , was I 18-17 or 16 , did we talk at all, did we talk about inappropriate stuff , did she tell me to do stuff , did I?

    The next day I deleted her but it still worries me , if we ever did shit we weren’t supposed to

    All I know is we never met, talked on the phone or knew what each other looked like

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