Pedophile OCD (POCD): Symptoms, Causes & Treatment

What Is Pedophile OCD (POCD)?

Pedophile obsessive-compulsive disorder (POCD) is a subtype of OCD that involves having unwanted, distressing, and intrusive thoughts about the possibility of being attracted to children and being or becoming a pedophile. These thoughts provoke intense anxiety. To cope with the anxiety, individuals with POCD perform compulsive behaviors that avoid all thoughts of and interactions with children.

POCD Vs. Real Pedophilia

People with POCD are not pedophiles. POCD involves experiencing disgust and shame for having sexually intrusive thoughts and performing compulsive behaviors to avoid situations with children. The compulsions are an attempt to ensure that they are not a threat to children. In contrast, actual pedophiles often experience gratification when having sexual thoughts about children, and they deliberately plan their course of action and then carry it out.

POCD Symptoms

POCD symptoms consist of obsessive sexual thoughts about children that provoke anxiety, leading them to perform compulsive rituals intended to reduce anxiety. Obsessive thoughts can include “undoing” thoughts, such as imagining scenarios opposite to pedophilic obsessions. Compulsive rituals can consist of mental compulsive rituals, such as repeating “I am a good person,” or behavioral rituals, such as visually checking to make sure the child is unharmed.

Here are some examples of common POCD obsessive thoughts:

• What if I sexually harm a child?
• What happens if I sexually abuse a child and am caught?
• What if that nice feeling I had when I saw that child meant I wanted to molest him?
• Having these thoughts must mean I am a bad person.
• I’m afraid of being alone with a child because I’m not sure if I will act on my obsessions.
• What if God punishes me for having these thoughts?
• What kind of person would have these kinds of thoughts? I must be awful.
• When I changed my child’s diaper earlier, I took longer than usual. What if that means I was trying to molest them?
• What if I have sexually harmed a child and just can’t remember?
• I like spending time with (child), so that must mean that I am a secret pedophile.
• When I hugged (child) earlier, it felt good, so that must mean that I am a pedophile.
• I can’t be alone with (child), or else I might harm them.

Here are some examples of common POCD compulsions:

• Avoiding taking their child to a playground for fear of harming other children
• Avoiding social and family events to protect children from themselves
• Limiting sexual activity with anyone, including a partner
• Make sure never to be alone with a child
• Avoiding or diverting eye contact when watching shows with children in them
• Praying for forgiveness for having the obsessions
• Confessing the obsessions to clergy
• Mentally reviewing a triggering event to replay each aspect of their behavior
• Avoiding changing the diapers of their child or others
• Avoiding bathing or clothing their child or others
• Mentally undoing thoughts about children that seem “bad” or “not normal”
• Utilizing distractions if forced to be around children
• Obsessively seeking reassurance from self or others that they have not or could not harm children
• Mentally replaying or obsessing over aspects of their own childhood

Pedophilia OCD Triggers

Any reminder of children can trigger someone with POCD. These reminders can be children’s physical presence, imagery or videos, or even conversations regarding children. Environments in which children are typically present, such as a playground or school, can trigger POCD, even if there is no mention of children.

Common triggers of POCD symptoms include:

• Being in the presence of children, even one’s own
• Visiting a public location with many children
• Feeling pleasure when noticing how cute or physically appealing a child is
• Experiencing internal pleasurable feelings watching children play
• Changing babies’ diapers or toddlers’ clothes
• Teaching elementary school-aged children

Harmful Impact of POCD

POCD impacts a person’s daily responsibilities, work, and relationships. Someone with POCD may have intrusive thoughts that distract them from day-to-day tasks or spend a significant amount of time performing compulsions. Time spent in obsessions and compulsions may begin to affect work performance, especially if the person with POCD is around children in their work environment.

POCD can also interfere with romantic and sexual relationships because it often triggers avoidance and creates difficulty for the person to remain in any situations involving children. POCD can be difficult for someone who has their own children, as they may avoid or limit time spent alone with them. POCD may also affect a person’s sex life, as they may become afraid of experiencing feelings of sexual arousal.

Stigma Surrounding POCD

People with OCD are frequently seen as overly controlling or “crazy” rather than receiving recognition for the severe distress the disorder causes. Within OCD, POCD is one of the most stigmatized subtypes because of the content of the intrusive thoughts and compulsions.

Because of the stigma, many individuals with POCD push off going for an OCD diagnosis. They often feel too ashamed to disclose their obsessive fears. They may fear being reported to law enforcement or child social services. Instead of seeking professional help, those with POCD may confess their thoughts to clergy, not realizing that there is a clinical reason for the thoughts and that they are not choosing to sin.

How to Push Past the Shame & Reach Out for Support

If you are struggling with POCD, reaching out for help can be terrifying. It is important to remind yourself that POCD is a real mental health experience that requires professional help to overcome. If shame is preventing you from reaching out, try seeking out other people’s stories of POCD or OCD to understand you are not alone.

It can be a challenge to find the right therapist for POCD since it involves specialized skills. Be sure to find someone who specializes in ERP therapy for the treatment of OCD and who specializes specifically in POCD. Begin by checking an online therapist directory or asking your doctor for a referral.

How Is POCD Diagnosed?

There is no specific diagnosis for POCD. Instead, a mental health professional will assess you for OCD. If you meet the criteria for OCD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), they will then diagnose you with OCD. The term POCD is an informal subtype of OCD used to describe a set of obsessions and compulsions that revolve around the fear of being a pedophile.

POCD Treatment Options

POCD treatment options are the same as all other types of OCD treatment, which is mainly a combination of exposure and response prevention therapy (ERP) and medication.¹ Some ERP practitioners will also incorporate mindfulness practices, and for some, group therapy may also be helpful.

Exposure and Response Prevention (ERP)

ERP for OCD helps people face their fear without compulsively attempting to reduce or avoid anxiety. It is considered the gold standard OCD treatment as it recalibrates the brain and helps people learn to accept uncertainty caused by obsessive fears. Exposures for POCD will focus on situations that are safe and reasonable for the individual as well as any children involved.

Exposures for treating POCD could include:

• Looking at pictures of children while emphasizing the nonsexual nature of the POCD intrusive thoughts
• Watching nonsexualized videos of children
• Going to a park where children are playing
• Attending a movie with children in the same theater
• Being in the same room with a child

Free Hierarchy of Fears Worksheet

The hierarchy of fears provides a structured plan to gradually face and overcome one’s fears in manageable steps, reducing anxiety over time.

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Other Treatment Options for POCD

Although ERP is the front-line treatment for OCD, there are other effective therapy options that can be used on their own or in combination with ERP. Every individual is unique, and it is important to find what works for you.

Other potential therapy options for POCD could include:

• Medication: The most commonly prescribed medications for OCD include SSRIs and SNRIs. If these medications are not sufficiently effective, atypical antipsychotics may also be prescribed to enhance the effects of SSRIs or SNRIs.²
• Group therapy: Group therapy can help reduce shame and stigma by meeting and talking with people with the same symptoms.
• Acceptance and commitment therapy (ACT): ACT for OCD helps people accept their current reality and commit to changing dysfunctional thought and behavior patterns.
• Self-Compassion (SC): SC is an approach that teaches people to be mindful of their negative or judgmental self-talk and instead talk to themselves as they would a good friend who is struggling.

How to Cope With POCD

It is incredibly challenging to live with POCD, but there are healthy coping mechanisms for OCD that can help a person accept obsessive doubt and still live a life according to their values and goals. Treatment can help reduce self-stigmatization so you do not base your worth or identity on obsessive thoughts.

Here are eight tips for coping with POCD include:

1. Practice self-compassion: Due to the intense shame experienced by those with POCD, self-compassion is generally a good coping skill to practice. Self-compassion might look like exploring movement, eating healthy meals, or spending time in nature. Whatever self-compassion looks like in your life, make it a part of your daily routine to combat POCD thoughts.
2. Remind yourself of your core values: One of the reasons why POCD is so painful is because it attacks a person’s fundamental morals. Reminding yourself of core values like love, protecting others, and protecting children can help you begin to develop insight into why attaching meaning to these intrusive thoughts keeps happening.
3. Find a provider who can guide you through exposure therapy: Exposure therapy for POCD eventually will encourage the person to spend time around their own children or other children. A mental health professional might help you develop an exposure hierarchy which helps you practice approaching feared situations around children.
4. Practice opposite actions: Opposite action is a dialectical behavioral therapy (DBT) skill that emphasizes the importance of doing the opposite action that a person’s compulsions suggest. This reinforces to the brain that the feared behaviors are not as scary as the POCD tells them.
5. Develop mindfulness skills: Mindfulness and meditation for OCD help a person with POCD by staying focused in the present moment over which you have control. It enables you to shift your focus from thinking about the past or future to being more objective and less emotional about the obsessions.
6. Avoid reassurance-seeking from yourself or loved ones: Although seeking reassurance from others that you are “good” or could not harm a child reduces stress in the short-term, in the long-term, it reinforces the content of intrusive thoughts. Not allowing yourself to seek reassurance from others or self-reassure is one strategy to expose yourself to intrusive thoughts. Make sure to do this under the guidance of a professional trained in exposure therapy.
7. Plan ahead for triggers: If you know that you have to be around children for an extended period of time, you may want to plan to either use it as an exposure opportunity or how you will utilize coping skills to make the experience easier. Planning ahead will help you feel confident in approaching feared situations, even if you are uncomfortable.
8. Talk about your experiences with trusted others: One of the core experiences of POCD is intense shame because of the content of intrusive thoughts. Build a supportive network of friends, family, professionals, and others who experience POCD. Learn to speak about your experiences so that you do not get lost in the shame of intrusive thoughts.
9. Challenge unhelpful thoughts: Although intrusive thoughts feel so real, they can be challenged, and challenging them can help to reduce what they have over us. Cognitive restructuring is a CBT technique that can help you reframe thoughts such as “What if I hurt that child?” to “I have never hurt a child so far, and actually feel very sad at the thought of hurting a kid, which means I will likely not hurt this child.”

Free Cognitive Restructuring for OCD Worksheet

Cognitive restructuring can help challenge and change the intrusive thoughts that lead to compulsive behaviors.

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What Causes POCD?

Possible causes of POCD include a chemical imbalance, genetics, or a traumatic event. Studies show that neurotransmitters such as serotonin, dopamine, and glutamate are elevated in people with POCD.³ Additionally, around 65% of people with OCD have a genetic history of the condition in their family.⁴ A stressful or traumatic event may also cause the onset of POCD.²