OCD & Sexual Intrusive Thoughts: Connections & Treatment Options

Sexual Intrusive Thoughts and OCD

When someone struggles with OCD, whatever they fear is typically the leading or most-concerning obsession. Suppose someone with OCD has intrusive thoughts about acting out sexually or fears their relationship with their partner is flawed. In that case, they tend to overestimate the probability of that thing coming true.

OCD themes and obsessions can wax and wane. For instance, someone in a romantic relationship could be afraid to make a perceived mistake with their partner. When that same person has a child, they may also develop harm OCD (scared to drown the baby accidentally) or sexual OCD (fear of acting out sexually with the child). Typically, whatever that person cares about the most is the most complicated OCD theme for them at the time.²

Sexual Obsessions Are Not Sexual Fantasies

The line between sexual obsessions and sexual fantasies is stark: fantasies are something a person desires, enjoys, and may want to act out, while obsessions are unwanted, guilt-inducing, and challenging to control their thoughts.¹

Unless it interferes with your daily life, there’s no reason to work towards mastery over your fantasies. However, obsessions tend to rule your life if not addressed properly.

Sexual compulsions of OCD are likewise not someone living out their sexual fantasy. Compulsions for sexual intrusive thoughts are the opposite of someone’s dream. They are used to avoid or undo those obsessive thoughts at any cost. Compulsions are attempts to fight against unwanted thoughts, not to act them out.

Types of Sexual OCD

Sexual obsessions and compulsions can be different for every individual. These responsive habits can also shift over time to other sexual preoccupations or OCD categories, such as concerns over contamination or scrupulosity OCD.² These types of OCD have all been categorized but do not appear in any formal DSM diagnosis.

Types of sexual OCD include:

• Sexual Obsessions: These could be unwanted thoughts of violence during sex, unwanted sexual impulses towards another person, or images or ideas of another person’s genitals.
• Sexual Orientation OCD / HOCD: Sexual orientation OCD (SO-OCD) and homosexual OCD (HOCD) refer to obsessively questioning one’s sexuality. They’re concerned their sexuality might not match what they’ve always believed it to be and seek to figure out for sure what their sexual orientation is.
• Transgender OCD: Though not as well documented as other sub-types of sexual OCD, transgender OCD (TOCD) refers to themes around doubting your gender. A cisgender person may obsess over if they’re transgender, or a transgender person may wonder if they’re cisgender.
• Relationship OCD: Concerns about your love, affection for, and attraction to your partner, and theirs towards you, are all at stake in relationship OCD(ROCD). Everyone asks these questions of their partners at some point, but most people can answer those concerns confidently and move on. Unfortunately, people with OCD are plagued by never feeling sure they can confirm their beliefs and can become fixated on their feelings for their partner.
• Pedophilia OCD: Those who struggle with pedophilic OCD (POCD) are not pedophiles. Pedophiles take pleasure in being sexually gratified by thoughts or acts with children. In contrast, people suffering from POCD are appalled by those thoughts and will go out of their way to avoid them at all costs.

Sexual OCD Symptoms

Sexual OCD symptoms can look an untold number of different ways. Because your sexual obsessions and compulsions will be specific to you, it would be impossible to give an exhaustive list of examples. However, a list of representative examples can help show typical symptoms of obsessive thoughts and compulsive behaviors.

Sexual OCD Obsessions

Common sexual obsessions might include:

• What if I rape my date?
• What if I cheat on my partner?
• Have I recently done something sexually inappropriate?
• If I look at that person, I might want to have sex with them.
• What if I don’t love my partner enough? What if they don’t love me enough?
• What if I’m gay, and I thought I was straight all this time?
• If I pass a woman on the street, I might touch her inappropriately.
• What if I’m straight and thought I was gay all this time?
• If I find that woman attractive, does that mean I’m a lesbian?
• I might molest a baby if someone asks me to change the baby’s diaper.
• What if I’m a different gender and don’t know it yet?
• Questioning if you are aroused sexually by something.
• Asking yourself whether your past actions or thoughts mean you have sexually harmed another person.
• Questioning whether you might one day do any of the following: harm someone, become attracted to children, leave your partner due to lack of love, or change sexual orientation.

Compulsions of Sexual OCD

Sexual compulsions are often characterized by avoidance of unsettling obsessive thoughts. The rationale is that if you can avoid the obsession, you cannot act on it. Common sexual compulsions can include avoiding, excessive checking, and mental compulsion related to sexual stimuli.

Avoidance Behavior related to sexual OCD can include:

• Avoiding being around children (even your own) alone for fear of doing something inappropriate to them.
• Avoiding books, movies, or anything bringing up unwanted sexual thoughts and images.
• Avoiding looking at people you fear may trigger unwanted sexual thoughts and images.
• Avoiding sex with your partner.

Checking OCD can become related to sexual OCD when:²

• You check to see if you’ve had a “groinal” response (i.e., if you felt genital sensation).
• You watch certain types of porn to check if you have any sexual response to it.
• Checking your partner’s phone to see if they’ve been talking to other people (i.e., checking to make sure they are in love with you)
• Starting arguments with your partner to check on their faithfulness—will they leave you or not?
• Actively reassurance-seeking or asking trusted people around you to confirm your fears are untrue

Mental compulsions related to sexually intrusive thoughts can include:

• You think of positive thoughts to counteract your upsetting thoughts.
• You were replaying memories through your mind to reassure yourself that you didn’t do something wrong.
• You were ruminating on your thoughts and playing out possible scenarios of sexual obsession in your head.

Intensified Untreated Sexual Intrusive Thoughts

As with all subtypes of OCD, intrusive thoughts will intensify over time if you do not confront them. It’s like the “white bear” thought experiment—the more you try not to think about a white bear, the more it will dominate your mind. All the effort you put into compulsions to undo or lessen the obsessions will end up keeping obsessions top of mind. The opposite of what you want—to neutralize the obsession—occurs.

There can also be interpersonal conflicts. Your partner may get tired of reassuring you of their love for you or if you are checking their phone. Your friends may get frustrated by you dictating the movies you watch together based on the possibility of triggering content.

The obsessions and compulsions can also take up several hours each day, rendering you unable to live your life in a meaningful way.

Treatment for Sexual OCD

Treatment for OCD is out there, but you may need to advocate for treatment geared explicitly towards unwanted sexual thoughts. Because your counselor may not know what symptoms you are experiencing, being sure to share the thoughts you are having are vital for recovery.

• Exposure and response prevention: The most widely used treatment for OCD is exposure and response prevention (ERP), a type of CBT for OCD.³ In exposure therapy, you gradually expose yourself to your fears, either in your imagination or real life, in a meticulous manner so that you can decrease the amount of anxiety associated with your obsessions.
• Mindfulness: Counselors will often incorporate Acceptance and Commitment Therapy (ACT) and mindfulness into your OCD treatment.
• Medication: OCD Medication is often paramount in treating symptoms, especially if they worsen or if ERP has not helped.

How to Stop Sexual Intrusive Thoughts

The problem with intrusive sexual thoughts and images is that they feel unmanageable.⁴ OCD is a chronic illness, but there are some things that you can do to begin increasing your awareness and implementing new responses. Because OCD is highly individualized, and friends or family cannot overtly see mental compulsions, professional treatment is the best option for treating your OCD. However, there are some self-help strategies you can try as well.

Here are five tips to better manage your OCD-related sexually intrusive thoughts:

1. Recognize Your Thoughts

Because sexual thoughts often trigger anxiety, recognizing the thought or image is the first step to breaking the obsessive-compulsive cycle. Your thoughts likely arose from something ordinary—a child walking past, a well-dressed man, or a gift from your partner. Acknowledge that you had the thought, and remind yourself that the thought is only that. Thoughts and images are not actions, nor do they imply past or future actions.⁵

2. Don’t Judge the Thoughts as They Arise

Thoughts are just thoughts. They’re not all pleasant, but they do come and go. The more weight you put on your sexually intrusive thoughts, the more difficult it is to let them go. Holding onto the fear of it becoming a reality signals to your brain and body that you arein danger. However, in truth, the thought is just a thought.

3. Utilize Self-Compassion

Remember that everyone gets intrusive thoughts sometimes. It’s harder for you to shake them off than other people, but that is normal. Kristen Neff says self-compassion involves common humanity—the knowledge that all humans are imperfect at times and all experience unpleasant things, including unwanted sexual thoughts.⁶

4. Remember the Thoughts Aren’t You

Thought-action fusion is the idea that thoughts are the same as acting on them, so merely having the unwanted intrusion is morally equivalent to acting on it. It is crucial to remember that having an undesirable idea does not mean that you will act on it. Nor does it mean the thoughts are the same as it happening in real life.³

5. Notice Your Triggers

Finding a practitioner in Exposure and Response Prevention (ERP) therapy to address your triggers is the most effective treatment to develop coping mechanisms. However, there are cautions to trying ERP without the guidance of a licensed counselor trained in ERP. ERP helps to undo the response you experience after being triggered by allowing you to learn that you can handle your trigger without acting on compulsions.⁷

Final Thoughts

OCD is a complex condition to live with, and sexual themes in OCD can be even harder to seek treatment. There may be stigma, shame, or guilt attached to your sexual themes, but if you find a therapist trained in treating OCD, they will not be surprised, shocked, or disgusted. Instead, they will be understanding, validating, and ready to help you feel empowered to overcome your OCD.