Pedophile obsessive-compulsive disorder (POCD) is characterized by having intrusive sexual thoughts about children, followed by compulsions involving avoidance of situations where one may interact with and harm children. The compulsions briefly alleviate the fear and guilt the sexual thoughts provoke, but the anxiety does return in the long-term. The primary treatment for POCD is exposure response therapy.
What Is Pedophilia OCD (POCD)?
POCD is a subtype of OCD that consists of unwanted sexual thoughts about children that provokes fear, anxiety, guilt, and shame. The thoughts cause obsessive doubt in the OCD sufferer that they may be a pedophile and fear that there is an intention to act on the thoughts.This results in compulsive behaviors to avoid interactions with children.
POCD overlaps with harm OCD, relationship OCD, and OCD & sexual intrusive thoughts, but there are no available statistics on how many people with POCD suffer from these other subtypes. POCD can interfere with romantic and sexual relationships because they often trigger the compulsion and creates difficulty for the person to remain in the situation.
Is POCD Pedophilia?
People with POCD are not pedophiles. Individuals with POCD experience disgust and shame for having these obsessions and perform compulsive behaviors to avoid situations with children. The compulsions are an attempt to avoid being triggered and to ensure that they are not a threat to children. In comparison, pedophiles often experience gratification when having sexual thoughts about children, and they deliberately plan their course of action and then carry it out.
Symptoms of POCD
POCD consists 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 rituals, such as “I am a good person,” or behavioral rituals, such as visually checking to make sure the child is unharmed.
People with POCD often have other obsessive fears, such as harming individuals who are sick, disabled, and elderly. They may also worry about hurting animals, who are perceived as helpless and dependent beings. Additionally, they may display religious or moral perfectionism obsessions that cause them to feel condemned by God or that they lack a moral conscience and should be banished by the community.
Common obsessive thoughts in POCD include:
- 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 means I want 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?
Common compulsions in POCD include:
- Avoid taking their child to a playground, for fear of harming other children
- Avoid social and family events to protect children from themselves
- Limiting sexual activity with anyone, including a partner
- Making sure of not being alone with a child or babysitting children
- Avoiding or diverting eye contact when watching shows with a child or children in them
- Praying for forgiveness for having the obsessions
- Confessing their obsessions to clergy
- Mentally reviewing the triggering event to replay each aspect of the person’s behavior
What Triggers POCD Symptoms?
Any environmental reminder of children can trigger individuals with POCD. These reminders can be children’s physical presence, imagery or videos, or even conversation regarding children. Environments where 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
Possible Causes of 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.5 Finally, a stressful or traumatic event may cause the onset of POCD.6
How Is POCD Diagnosed?
Receiving a POCD diagnosis can be complicated because individuals with POCD may feel shame to disclose their obsessive fears. They may fear being reported to law enforcement or child social services. Instead of seeking professional help, individuals 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.
The Y-BOCS and the DOCS are the two measures that are used to assess for and diagnose POCD symptoms.
Questions to ask your doctor about POCD include:
- Where can I find specialized POCD treatment?
- How do you treat POCD?
- What does a typical treatment plan look like?
- How do you know whether these thoughts are true?
- Do you know how to conduct exposure and response therapy?
POCD Treatment Options
POCD treatment options are the same as all other types of OCD treatment, which is mainly a combination of behavioral therapy and medication. It may be a challenge to find the right therapist for POCD since it involves specialized skills. Begin by checking an online therapist directory or asking your doctor for a referral.
Treatment options for POCD include:
- Exposure Therapy (ERP): ERP 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.
- Cognitive behavioral therapy (CBT): CBT for OCD allows people to challenge their irrational beliefs and reframe cognitive distortions. It will enable people to examine and challenge their assumptions about why things happen, then change behavior according to what seems rational.
- Medications for OCD: The most commonly prescribed medications for OCD include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). If these medications are not sufficiently effective, atypical antipsychotics may also be prescribed to enhance the effects of SSRIs or SNRIs.6
- 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 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 that enable a person to accept obsessive doubt and still live a life according to values and goals. Treatment can help reduce self-stigmatization so you do not base your worth or identity on obsessive thoughts.
Helpful coping strategies for POCD include:
- Recognize the obsessions: Recognize and label the cognitive distortions in your head and reframe the thoughts to a more realistic view of what is happening.
- 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.
- Develop mindfulness skills: Mindfulness helps 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.
POCD responds to effective treatment just as all types of OCD. Changing behavior through ERP will result in a change in thoughts and feelings. It is not easy, but it works! If these symptoms have disrupted your life and those around you, seek professional treatment. At some point in time in the recovery process, you may have the ability to find some humor in seeing how irrational the thoughts are.