What Is Pedophilia OCD (POCD)? Symptoms, Causes, And Treatment

The US National Comorbidity Survey Replication¹ determined that more than a quarter of Americans have obsessions and compulsions at one point in their lives. Additionally, 1.2% have a form of obsessive-compulsive disorder (OCD) at any given time.

Among the most common forms of OCD is pedophilia obsessive-compulsive disorder (POCD), with less than 10% of people with OCD reporting symptoms of the disorder.

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What is pedophilia OCD (POCD)?

Pedophilia OCD or pedophilia-themed obsessive-compulsive disorder² (POCD) is a term used to describe a subtype of obsessive-compulsive disorder (OCD) in which an individual suffers from obsessions characterized by recurring, unwanted, and intrusive thoughts, urges, and images that evoke intense sexual fantasy involving children (typically 13 years and older). These thoughts or urges often trigger intense anxiety and fear. 

In most cases, an adult with POCD is known to the child³ and can even be a family member. However, the individual feels the desire to perform compulsion or practice safety behavior to: 

  • Alleviate the fear and anxiety

  • Prevent their condition from causing harm to others

  • Convince themselves that they aren't pedophiles 

For instance, a mother may feel an intensely intrusive sexual attraction towards her toddler (obsession) but takes preventive measures (compulsion), such as avoiding playing with the child, because of the ill nature of the thoughts. 

Pedophilia OCD is not pedophilia

Pedophilia⁴ is a recurring sexual attraction towards pre-pubertal children. It's a form of paraphilia because the individual's sexual thoughts depend on objects, activities, and situations regarded as abnormal or atypical, often causing harm to others. A person with a pedophilic disorder is known as a pedophile.

However, not all pedophiles are child monsters, and that's where the difference between pedophilia OCD and actual pedophilia comes in. In the latter, the individual's obsessive sexual thoughts, desires, urges, and fantasies toward children are ego-syntonic.

They align with their values and self-concept. Therefore, the intrusive sexual thoughts about children are pleasurable to them. 

It's the opposite with an individual with POCD because their obsessions are ego-dystonic. That means the feeling of being attracted to a child sexually goes against their values and self-concept.

Unlike a pedophiliac, a POCD sufferer is usually concerned about the feelings and doesn't find them pleasurable, so they do anything to alleviate the obsession because of how terrorizing they are.

Causes and risk factors of pedophilia OCD

While scientists haven't yet identified the causes of obsessive-compulsive disorder, research⁵ shows that genetic, biological, and environmental factors may increase the chances of one developing OCD. These factors affect specific areas of the brain, triggering OCD. The Yale School of Medicine conducted a study⁶ to measure the brain activity of people with and without OCD.

The results showed that the brain of an individual with OCD is more hyperactive than their counterparts without the disorder. 

Additionally, environmental factors may contribute to the development of OCD. However, the person with the disorder must have been biologically predisposed to the condition for an environmental factor to trigger its onset. These environmental factors include trauma, other mental issues, pregnancy, etc.

Symptoms of pedophilia OCD

By nature, any form of obsessive-compulsive disorder is a doubting disorder. That's contrary to the popular understanding of the term "obsessed." Many people interpret being obsessed as having a deep love for doing something one enjoys, as in "I'm obsessed with watching movies."

In psychology, it's quite the opposite because obsession is something that causes distress. A person doesn't enjoy sexual thoughts, urges, or images about children. Pedophile knows they are attracted to children, but their anxiety pushes them to perform compulsions to reassure themselves that the obsessions aren't true. 

Some of the common symptoms of POCD include (but are not limited to) the following:

  • Having sexual images of children that pop into the mind frequently

  • Involuntarily thinking about sexual fantasies about children 

  • The fear that having close contact with or being around a child will turn one into a pedophile

  • Being fearful that a sexual thought or mental image of a child might make one a pedophile

The anxiety associated with pedophilia OCD stems from a person's uncertainty about their pedophilic feeling or status. People suffering from the symptoms of POCD often experience internal conflicts, asking themselves questions like:

  • What if I'm actually a pedophile?

  • What if I enter into a romantic relationship with a child?

  • What if I go out of my mind and commit a sexual act on a child?

  • What if I cannot overcome this obsession, and it ruins my life?

  • What if I turn into a pedophile?

  • What if I'm aroused or attracted to children?

How does it feel to have POCD?

People with POCD often describe their obsession as demoralizing. They feel ashamed and doubtful and can sometimes feel isolated. They often find it difficult to open up about their intrusive and intense sexual thoughts to loved ones because they don't get a reassuring answer to alleviate their anxiety completely.

They get the same "you don't have to worry about that because you're not like the other child monsters" answer after confiding their feelings to a loved one.  

While that might be helpful, it only offers a short-lived solution. Sometimes, the response or answer may feel disconnected from their anxiety or troubled mind to the extent that they find it difficult to believe. It demoralizes them, leaving them feeling helpless, ashamed, and misunderstood. 

Common compulsions for pedophilia OCD

Compulsions are mental and physical acts that an individual with POCD performs as a response to an obsession. It's not their intention to do these compulsions, but they do them in an attempt to prevent an unwanted or terrifying outcome. 

Handwashing is a well-known OCD compulsion, and it projects itself physically. However, people with POCD perform mental compulsion, making it challenging for others to notice their struggle with the disorder. Combine that with the stigma and shame that people with pedophilia OCD feel — it becomes a drawback for such an individual to seek proper treatment. 

Below are some of the common POCD compulsions:

  • Avoiding interactions with children

  • Avoiding all media (TV shows, films, social media, photographs, magazines, etc.) that feature children 

  • Questioning oneself to prove or solve obsessions; for instance, "Do I find pleasure in these thoughts?"

  • Refraining from sexual intimacy with themselves or others because of fear that an image or thought of a child will pop up in the mind

  • Staring at children to confirm that they do not arouse them

  • Purposely inducing sexual thoughts or images of children to weigh how they react to them

  • Checking their bodily feelings mentally to prove or solve an obsession; for instance, checking the groin area to gauge their level of arousal

  • Interacting, holding, or high-fiving a child deliberately to convince themselves that they aren't aroused

  • Seeking mental reassurance or confiding in someone about their obsession

  • Washing the hands after touching a child or something a child has touched to avoid "contamination"

  • Extensively searching the internet for information that reinforces their reassurance of not being a pedophile

  • Assessing past events or instances mentally to ensure that they did not act inappropriately

  • Mentally capturing the instances or daily activities and using them as markers that reassure them that they acted appropriately

  • Avoiding unwanted thoughts by replacing them with "good" thoughts

  • Punishing themselves for allowing the thoughts in their mind; that may involve not eating enough or calling themselves mean names

  • Sanitizing the groin area because they feel a bodily sensation or arousal after having a thought

Diagnosis

Pedophilia OCD is not an actual diagnosis but a nickname. The diagnosis is usually OCD, regardless of the contents of thoughts, images, or urges. The only reason OCD subtypes are described with nicknames is to give people the idea of the obsession that the OCD sufferer is experiencing.

For a doctor to diagnose pedophiliac OCD, an individual must meet the following criteria:⁷

  • Recurrent and intense sexual thoughts, images, urges, and fantasies with children (usually 13 years and younger) for a period longer than six months

  • The sexual urges and thoughts trigger the need to perform compulsions or significantly impact the pedophilic individual's social, occupational, and other aspects of life.

  • The individual must be at least 16 years and five years older than the child they feel sexually attracted. That doesn't apply to an individual in their late adolescence who has an ongoing relationship with a 13-year-old.

Furthermore, a POCD diagnosis must indicate whether an individual is exclusively attracted to children or not, the gender they are attracted to, and whether the sexual thoughts involve a child who's a family member. 

POCD coping practices

In a state of anxiety and shame, a person with POCD can indulge in several activities or practices to help them cope with their obsession. Nonetheless, not all coping efforts are effective.

Distraction

Whether from calm strategizing or out of panic, someone with POCD can channel their efforts into an activity or something unrelated to the obsessive thought, impulse, urge, or image. They do that to use their time more productively or to escape their thoughts. That might work, but only in the short term. 

Attaining reassurance successfully

Seeking reassurance — a compulsion in itself — is the most popular means of suppressing anxiety among people with pedophilic obsessions. These individuals are often driven to find "proof" or reassurance that they are not pedophiles. The following are ways people with POCD have successfully attained reassurance:

  • Engaging in sexual intercourse with another adult to check whether they are attracted to them

  • Explicitly soliciting another person's opinion; for instance, "I might be a pedophile, right?"

  • Deliberately looking at images and content with children to gauge one's reaction toward them

  • Masturbating while imagining adults to check one's arousal level

Unsuccessful efforts to get reassurance

The strategies listed above may or may not offer reassurance. For example, the excessive online research on pedophilia may not generate the desired answers, while imagining an adult may not evoke the feeling of attraction. When that happens, a person with POCD feels more distressed and anxious.

The individual then ends up seeking more reassurance behaviors. One might think, "If I wasn't attracted to that woman, I might get attracted to another." That results in further despair, leaving an individual with POCD feeling more shame than ever.

Repeating that frequently may even result in depression. 

Treatment 

In reality, the content of obsession doesn't dictate the treatment approach for OCD because whatever the type of obsession, they are all OCDs. A popular and effective treatment for OCD is exposure and response prevention (ERP).

Exposure and response prevention

ERP is a behavioral therapy administered as part of the cognitive behavioral therapy (CBT) umbrella. 

ERP aims to expose the pedophilic person to their feared stimuli while alleviating the need for compulsion. For instance, a doctor might advise a pedophilic father to change their child's diaper and tolerate the anxiety or discomfort of unwanted thoughts without taking a self-inventory to confirm whether they are aroused. 

ERP treatment has proven successful as it facilitates the following:

  • A habitual practice — The person with OCD experiences decreased anxiety and discomfort after repeated exposure to a feared stimulus.

  • Inhibitory learning — A person learns there's no exaggerated risk or danger as their brain is trying to alert them. Inhibition learning involves acquiring new safety information to inhibit the recurrence of obsessional fear and anxiety. 

In OCD, compulsions are the primary problem because they alert the brain that one should focus on their obsession – a false alarm emanating from the overactive fear center in the brain. That stimulates the brain to develop more obsessions. 

That's why traditional therapeutic approaches, such as talk therapy, are ineffective at their best and harmful at their worst. Attempting to solve an obsession with talk therapy is one big compulsion. An individual spends money to talk to a therapist whose over-attendance to their obsession only fuels OCD.

Mindfulness skills training

Another effective treatment for OCD is mindfulness skills training. In this treatment, a person with OCD learns to accept and live with their unwanted impulses, thoughts, fantasies and urges without responding to them compulsively. 

Initially, POCD sufferers feel compelled to rid their minds of children's sexual thoughts and imaginations because they cause them trouble. Mindfulness skill training recognizes that we are not always in control of our thoughts or feelings. Any attempt to resist or suppress those thoughts and urges only makes them worse.  

The lowdown

OCD is a health problem affecting many people; fortunately, the disorder is treatable, and many individuals go on to lead quality and meaningful lives. They get into satisfying relationships, get married, and even have children. ERP is an effective OCD treatment modality proven to reduce OCD symptoms. 

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