The OCD Cycle
We live in a society where we do not like to be uncomfortable and where we have difficulty tolerating distress. Anxiety is an emotion that has a lot of negative connotations and leads us to quickly try to find solutions by going into problem-solving mode. For some people, the danger signal gets attached to everyday neutral things like other people, social situations, doorknobs, dogs, physical sensations, or emotions. The actions we take when anxiety is present are called safety behaviors, or within OCD, they are called compulsions. These actions are meant to decrease our distress, which they do, but only temporarily. Some common safety behaviors include avoidance of anxious triggers, reassurance seeking, researching, substance use, washing, counting, etc. Since these behaviors actually work (but only in the short-term), people continue to use them. Unfortunately, continuing to rely on these behaviors causes individuals to get trapped in the anxiety cycle and prevents them from learning that the fear was unfounded or tolerable. Ironically, these safety behaviors and compulsions maintain the fear in the long run and simultaneously prevent growth and learning, which can severely limit an individual’s life. The thought, situation, emotion, or body sensation that creates the anxiety might be different within each presentation of OCD, but the cycle that maintains anxiety is the same.
Please see our previous blog entry – Understanding the Cycle of Anxiety – for further information.
What is Pedophilia OCD?
Pedophilia OCD (POCD) is a subtype of OCD defined by obsessions and compulsions related to a preoccupation with fears or intrusive thoughts revolving around themes of pedophilia, fears of being around or acting on sexual thoughts involving children, or fears of losing control or being unable to remember one’s actions around children. Pedophilia and POCD are very different. A person with POCD is deeply disturbed, fearful, and concerned about the content of their intrusive thoughts, which leads then to engage in behaviors, or compulsions, to relieve distress and uncertainty related to these thoughts.
Differences Between Pedophilia and Pedophilia OCD (POCD)
A person with pedophilia experiences thoughts, urges, arousal, and attraction that are congruent with what they want and aligns with their desires. POCD meets the criteria for an OCD diagnosis, with the presence of both obsessions and compulsions. In the context of POCD, anxiety related to children and intense fear of being identified as a pedophile creates significant impairment and distress in the person’s life. It is crucial to distinguish the difference between pedophilia and POCD as the content of intrusive thoughts in POCD can create deep shame and lead to withdrawal or alienation from society, often causing the individual to suffer in silence.
Common Obsessions with Pedophilia OCD
Past oriented obsessions:
- Did I ever do anything inappropriately sexual in my life?
- Did I do anything recently that was sexually inappropriate?
- Have I ever been attracted to an adolescent or child?
- Did I touch that kid on the playground when I was 15?
- Did I ever molest anyone?
- What if I did something in my past and I just don’t remember?
- Could that action from my past be construed as sexual?
- How do I know that I haven’t touched someone inappropriately?
- Am I attracted to this child in front of me?
- Was I just checking out this child?
- What if I fall in love with a child or young adolescent?
- Did I just touch this child?
- Did someone just notice me doing something strange?
- What if I impulsively grope them?
- A thought of a child popped in while kissing my significant other, does that mean I’m a pedophile?
- I just felt physically aroused or a groinal response while I was near a kid, does that mean I’m attracted to them?
- Am I sexually aroused by this child on TV or in this movie?
Future oriented obsessions:
- How do I know that I will never engage in pedophilic behavior?
- What if I am attracted to children one day?
- What if I never stop obsessing about this and it ruins my life one day?
- What if I turn into a pedophile in the future?
- What will my family or friends think of me if I act on my thoughts one day?
- What if I get arrested and go to jail?
- How can I be around my own kids?
- Will I be creepy or do something inappropriate when I have a baby?
These examples are just a few of many varieties of doubts that may arise in individuals with POCD. These thoughts can create a high level of anxiety for the individual and make them feel a need to engage in compulsions and/or rituals in an attempt to mitigate their doubts. These intrusive thoughts can also impair their ability to concentrate at school or work, creates conflict and concerns in personal relationships, and lowers the ability to connect with their loved ones. These symptoms (if left unaddressed) can create additional obstacles and barriers to overcoming and recovering from OCD.
Common Compulsions with Pedophilia OCD
Compulsions are defined as any intentional thought or behavior done in an effort to neutralize or reduce the distress caused by an individual’s anxiety. Within POCD, compulsions can include:
- Avoiding walking near schools or playgrounds to avoid interacting with children
- Avoiding discussing one’s thoughts out of fear someone will think they actually want or desire these thoughts
- Neutralizing thoughts by replacing “bad thoughts” with “good thoughts”
- Washing hands or other body parts that may have come into contact with children
- Checking physical arousal or groinal response when around others and children
- Sanitizing groin area after having an intrusive thought
- Checking and comparing others’ reactions when around children
- Seeking reassurance from friends and family members that they are not a pedophile
- Seeking reassurance or repeatedly asking loved ones about their behaviors and what occurred in their interactions with children
- Seeking reassurance on the internet that they are not a pedophile
- Providing themselves with reassurance that they are not attracted to children and did not engage in inappropriate behaviors
- Confessing behaviors when around kids to ensure they are not doing anything inappropriate
- Avoiding intimacy or sex for fears of getting triggered with doubt
- Avoiding being in a romantic relationship out of fear they are not understood and/or to prevent these emotions and responses from being triggered
- Avoiding spending time with family members with children or with their own children
- Videotaping or recording themselves and their responses when around children to ensure they did not touch anyone inappropriately
- Avoiding watching movies with children in them, reading children’s books, or listening to children targeted songs for fear of being triggered
- Self-punishment and self-criticism that they are a “bad person” for having intrusive thoughts of children
- Mentally reviewing past situations to assess their body language: if they touched someone, how close they are to someone, events attended, reactions, and reviewing feelings or physiological reactions in these moments
- Rumination on rightness of feelings or thoughts or memories when around children (Please see our previous blog entry – Rumination — for more information)
Treatment of Pedophilia OCD
The most evidence-based treatment for POCD is Exposure and Response Prevention (ERP). ERP treatment is often augmented with Acceptance and Commitment Therapy (ACT). Through ERP, individuals can engage in exposure to their fears in order to help them to learn to tolerate the uncertainty, discomfort, and doubt that their OCD creates. Exposures can include any stimuli that triggers uncertainty related to children, and it can be beneficial to start with targeting areas and activities that the individual avoids. Examples could include walking by or going to places where children are likely to be present, such as parks, playgrounds, malls, libraries, schools, or even family parties. Individuals can spend time with previously avoided cousins, nieces/nephews, or children in their life by playing with, holding, hugging, or changing diapers. Exposures can even start with observing photos of children in their life prior to spending time in person. Individuals can also engage in exposures such as watching TV or movies with pedophilia content (i.e Lovely Bones, Euphoria). Individuals can benefit from reading uncertainty statements on thoughts, future, and urges. ERP focuses on exposing individuals to these thoughts and having them refrain from engaging in compulsions (Response Prevention). This way individuals are able to teach themselves a new way to respond and will likely experience a reduction in anxiety. If their anxiety does not decrease, they will at least learn that they can handle the anxiety and uncertainty that these thoughts create. Please see our previous blog entry — What is Exposure and Response Prevention (ERP) – for more information about this treatment.
Within ACT, individuals are introduced to the concepts of mindfulness and acceptance, helping them to be present with their thoughts without trying to change them or engage in compulsions. Interventions focusing on increasing acceptance of uncertainty and doubt are necessary to supplement ERP work in the treatment of POCD. Acceptance entails making space for the thoughts and allowing worries to be present without feeling the need to react or respond to them. Struggling against painful and distressing thoughts is likely to create more emotional suffering. Using ACT-based strategies, individuals are better able to differentiate their thoughts and values from their OCD and identify if the behaviors they are engaging in provide them joy and pleasure (which is the goal), or if they are behaving in response to anxiety and uncertainty stemming from their OCD. They are able to learn to be aware of their thoughts and fears while not paying more attention to and/or over-engaging with them. The goal is to learn to live life and participate in activities that are important, even if the thoughts are present. Thus, ACT is employed to increase psychological flexibility and reduce the cognitive rigidity seen in OCD by helping people to defuse from their obsessive/intrusive thoughts and maintain a present-focused awareness. Outside of therapy, individuals with POCD can also benefit from medication.
Need help or support?
If you or a loved one are struggling with OCD or any other mental health concerns, know that you are not alone. If you are a parent or a caregiver and are seeking additional information about these diagnoses and how you can best support your child, our office provides parent training with the SPACE program. Please see our November 2021 Newsletter for more information on SPACE.
For these or any other mental health concerns, please contact The OCD & Anxiety Center at (630) 522-3124 or email@example.com. We have offices in Oak Brook and Orland Park and our clinicians specialize in helping individuals overcome anxiety disorders, Obsessive-Compulsive Disorders, and other co-occurring mental health issues. We also provide telehealth services that are available in Illinois, Indiana, Georgia, and Iowa.
At The OCD & Anxiety Center, we can provide treatment both in the office and at off-site locations (your home, mall, school, etc.). We will work closely with you to create an individualized treatment plan and discuss the appropriate frequency of visits needed to achieve your treatment goals. We look forward to hearing from you and working with you to conquer your anxiety!
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Stephanie Pruefer is a Licensed Clinical Professional Counselor at The OCD & Anxiety Center in Oak Brook, IL and Orland Park, IL. She specializes in treating all forms of OCD and anxiety in children, teens, and adults. She provides Exposure and Response Prevention Therapy and is comfortable working in and outside the office, wherever anxiety happens.