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. I never had these types of thoughts until I became concerned about purity because of a relationship. Then when I was babysitting my little brother, he was on my lap and my hand noticed that his his diaper was soggy. And the thought popped in my mind, was I just touching him inappropriately? So l squished his diaper a few more times to see if I was feeling anything inappropriate inside and now I think I did something bad for doing that. And then another time l was helping my little sister go potty and she went to put her undies on and she paused so I looked to see what she was doing and I saw her naked, and now I’m scared that I looked at her that way on purpose. I would never want to do anything inappropriate with a child and right now I don’t see a way out of my thoughts and actions …. Please help me.

  2. Another thing I think it’s important to get out there: not all pedophiles are monsters. It would be so much easier if I could just think: “I would never want to hurt a child, so I can’t be a pedophile” but most pedophiles don’t offend, and only about half of child abusers are actually pedophiles. A lot of pedophiles don’t want to be attracted to children.

    An episode of This American Life called “Tarred and Feathered” explains this really well. The hosts interview a young man who’s a pedophile, and helped me understand what pedophilia is and how people experience it. It made me a little calmer for some reason—I’d highly suggest you guys check it out.

    Anyways, the point of me saying this is twofold: even if you think you have a legitimate attraction you children, it does NOT make you a monster. Our actions define us, not our desires. Other people are in the same boat as you, and there are organized support groups that can help you. You are also in a position to help someone else—and there are so many more aspects to your personhood than this disorder.

    Second, for those of us with POCD, I think it’s important that we are informed about actual pedophilia and don’t spread stereotypes or misinformation. We know how awful it is to worry about being pedophiles—we have no reason to think existing AS a pedophile is any less awful. Let’s not stigmatize this disorder—and those who have it but don’t hurt others—any further.

    Ok, off my soap box now. Thanks so much for this article. It’s really helped me.

  3. Hey guys thank you so much for sharing this has been so helpful for me (at least for the day . . . Tomorrow watch me be on here again, still unconvinced).

    I am also young (late teens) and I thiiiiiiink I suffer from POCD. I’ve had this worry on and off for a while now—it got REALLY bad around the start of 2020 (what an omen); so bad I talked to my therapist about it. Looking back, she was extraordinarily understanding. I didn’t know what POCD was then, so I thought (and still fear) that I might be an actual pedophile. Then I found out about POCD and calmed down for a while.

    One interesting thing to note is that this worry seems to get really bad for me when I explore or question my sexual orientation . The first time I remember having these strong disturbing thoughts and compulsions to silence them is right after developing a rather strong crush on an older girl I worked with. I thought it was just a sexuality crisis. The second time was right after my soon-to-be boyfriend asked me out. I had thought I might be ace, and/or gay, but as soon as he asked me out I knew I was into him, and had been for a while. It made me really happy—and then suddenly I thought: “what else have I been hiding from myself?”

    After my initial freak-out and learning about POCD, I calmed down and mostly put it out of my mind, with one caveat: I decided to never have children. It felt (and still feels) too risky. I figured: I can spend my life in denial about “being” a pedophile and lead a happy semi normal life, but if I have children it might all come crashing down. Maybe I’ll discover that I really am attracted to children, and what would I DO?! I tried to cast this as some feminist choice (to this day I know I DO want to focus on a career and I’m unsure if I’d want a family), but really it just made me sad.

    Now my boyfriend and I have broken up—and LITERALLY THE DAY AFTER OUR BREAKUP I started worrying I was a pedophile again. I don’t know if this is because I’m suddenly sexually available again, or because I’ve come out to myself as bisexual. I have a normal, healthy crush on a woman my own age, but I’ve started being afraid to spend time with her, like ANY attraction I feel is somehow polluted. And now I’m old enough that a relationship I start might be long-term . . . And I could ending up having to explain why I don’t want children. It feels more important to KNOW.

    It also might be because I’ve realized sexual attraction can take many forms. My attraction to this woman (and sometimes women in general) FEELS different than my attraction to my ex (and perhaps men in general), but they are both definitely ATTRACTION. So is whatever I feel for children—I feeling I can’t even name, because every atom of my being immediately suppresses it—attraction as well? Furthermore, if I didn’t live in a queer-friendly culture, I may never have recognized my feelings for other women. We DEFINITELY don’t live in a pedo-friendly culture (which is a GOOD THING), but does that mean I just don’t recognize my “feelings” for children????

    Has anyone else noticed a similar pattern? Like you’re ok when you’re with a partner, but not when ur single? Or (for those who are queer) this worry flares up when you think about your sexuality?

  4. I was sexually abused when I was 3 yrs old till about 5 yrs old. Other boys were involved and all were under 10 yrs old. We were forced to watch child porn on the abusers TV screen and he forced us to act out what we were watching..when I was 9 yrs old, I went swimming at the ymca and after swimming I took a shower and a little boy around 6 or 7 yrs old came in to take a shower and he was completely nude and I remember I could not stop looking at his butt. Since then I have been obsessed with little boys buttocks. I believe I have pocd after reading this article, but I feared I was a pedo since I was 10 yrs old. I am 41 yrs old now and still am obsessed with little boy butts. I am attracted to adult females but I am not sexually active because I fear I am a pedo. I still feel I am a pedo but now I believe it is just pocd..if you like to chat contact me on telegram @shrtnchls

  5. I feel so much sympathy for the suffers who have courageously shared their terrifying experiences. I am 52 and have suffered OCD since I was 18 which has worsened over the years. I have always questioned myself as I have often made strong relationships with others and cared more deeply for them than I suspect is normal.

    This included an 86 year old lady who had escaped communist Russia during the revolution. She left me all her photographs when she died and I spent years decoding photographs and foreign text to unveil an amazing life story. Comfortingly there are a few people who claim this special lady had a profound effect on their life. So for me this feels normal and safe now.

    However when I was fifteen I worked at an after school program. I was not happy at my own school and silently sat through other family members squabbling with each other. At this program I feel a huge affection for the children and one girl in particular who I felt some sort of adoration for. I was young , immature and searching for some kind of affection and this 8 year old made me feel loved. I never at any stage ever had any sexual thoughts of any kind towards her or any other child. However, reflection after watching a show on T.V. saying it was impossible for a young male to ‘love’ a child. That if someone did then they were most likely a paedophile. This caused me huge upset and shame. Although I never had a single sexual thought I felt ashamed for caring so very strongly for a child.

    Later I became a teacher and have taught for 26 years. I developed POCD from recalling my 15 year old past and building fears upon it. On the positive side the huge work load and love for teaching started to push the OCD away. I thought well I certainly don’t want to be around the kids all the time. I had strong concerns for their welfare and education but, a bit like a parent would say, I liked my break time from them. I certainly had changed from when I was fifteen.

    Sadly though my POCD came back in the form of a pre-thought. Like most OCD people I would think about what I might worry about in advance and then they would eventuate into genuine fears. 25/26 years and I have never ever done anything inappropriate towards any child and in my brain I knew I didn’t want too. But the fears would over run my brain. It has always felt like a battle between my intellect and my emotions. I usually knew I did not want to commit any hideous act of abuse but often the fear outweighed the logic. I think that is a common OCD problem. The brain/logic is overridden by the fear.

    My reasons for previously sharing the story of my ‘love’ for an 88 year old and an 8 year old is an attempt to try and illustrate how incredibly caring I can feel for others regardless of age. The only problem is I do think, and I am sure I am right, it is not ‘normal’ for a teenage male to adore an 8 year old child and I am unable to explain that. Yet I feel no obligation to explain my ‘love for Nina my 88 year old friend. With Nina I still feel a huge ‘love’ towards her twenty years after her passing.

    I know that OCD sufferers are not meant to seek reassurance but the fact that I still can not quite understand after decades of trying to understand why did I love kids so much and in particular one. I remember this child had told me that her father was abusive and a horror and that they were Jehovah Witnesses. Maybe she sought comfort from me without me realising it. I just don’t know. I do know when uni students would go on teaching ‘pracs’ they all seemed to adore the attention of the students. Perhaps I had got that out of my system earlier on.

    I wish to stress I never had any sexual thoughts of this child or any other. But months later seeing a show on the unpleasant topic of Sexual Child abuse I began to panic. I still never had inappropriate thoughts until a couple of years later when I reflected back and questioned who I as a person was. These were not visual intrusive thoughts but rather intrusive thoughts questioning my being. As years passed my OCD changed into visual intrusive thoughts that I loathed. These would usually focus on a particular child in my class. One year I had OCD thoughts on a student the year before when I also taught her never had any OCD thoughts.

    I feel today that perhaps I was odd or unusual but not a deviant. However as I never can resolve this question in my mind and the subsequent POCD over years has left me feeling dreadful most of the time. I can worry about things like what if I inappropriately touch my partner of 20 years when we sit in the front of the car! Even sillier things that make me cringe at the same time as worrying. Fear over logic and common sense again.

    I know in my heart I am a very caring person, and I know I was 15 and pretty sad in life but I don’t know if that makes my strong affection for a child (at that time) inappropriate or worse. This only lasted for maybe half-a-year. When I went to university things changed. I was attracted to many of my female friends who were the same age as me. From then on I was just a ‘normal’ teen, attracted to the attractive girls and enjoying life. I was no longer seeking attention or affection from other places. Although my love for Nina never went away.

    I want people to be honest with me. I know I have POCD but I have nothing but ongoing anxiety about wanting an answer to my fifteen year old self and why I wanted to be in the company of kids and a strong affection for one in particular. I think thank goodness I never hurt or intended to or wanted to hurt any child but am ashamed I felt so much huge affection for an 8 year old child. Why? Why? Why? In today’s world there are so many past stories coming out of atrocious sexual child abuse. I can’t watch these news stories. They distress me immensely and always have throughout my entire life.

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