Sexual Obsessions in OCD

Obsessive-compulsive disorder (OCD) is characterized by compulsions (an uncontrollable impulse to perform an act, often repetitively) and obsessions (the inability to stop thinking about a certain topic without anxiety).

Sexual OCD is a manifestation of these obsessions, where the individual becomes fixated on specific sexual behaviors or situations. These thoughts can be troubling, especially when the subject of obsession is taboo. People who experience these thoughts fear the stigma that disclosure might bring, but there are ways to treat and regulate them.

Understanding Sexual Obsession

Although a person may experience a wide range of sexual obsessions, common themes involve those that may be considered forbidden, such as:

• Bestiality
• Incest
• Infidelity
• Sexual abuse or violence
• Sex and religion as a form of blasphemy
• Sexual enslavement
• Pedophelia
• Sexual sadism or masochism
• Sexual thoughts about friends
• Underage sex

It has been estimated that between 6% and 24% of people with OCD will experience some form of sexual obsession. The number may be even higher given that most people are reluctant to share such thoughts.

While people tend to identify sexual obsession as a primarily male characteristic, research suggests that men and women with OCD will experience them at more or less the same rate.

Sexual Obsessions Are Not Sexual Fantasies

Sexual obsessions are not the same thing as sexual fantasies. Whereas sexual fantasies are typically related to pleasure or desire, attainable or not, sexual obsessions are unwanted and distressing thoughts that are typically associated with anxiety, shame, or self-loathing.

People with OCD will often worry that a forbidden or illegal sexual obsession may one day lead them to act upon those desires, whether it be about pedophilia, rape, or sexual violence. In contrast to someone who might be at risk for acting on these impulses, a person with OCD will find the obsession immoral and feel repelled at the thought of acting upon it.

This is not necessarily the case with persons who perpetrate rape or pedophilia who, despite knowing the behavior is wrong, typically act upon such thoughts as a pathological form of self-gratification.

If accompanied by sexual compulsion, a person with OCD may become abnormally preoccupied with pornography and/or masturbation as "outlets" for unwanted thoughts.

Treatment

Mental health professionals trained in OCD will recognize sexual obsession as a symptom of the disorder and, in the absence of any risk factors (such as a conviction for a sexual crime), will help the person understand the nature of the obsession and minimize any fears as to what the thoughts "say" about the person and/or their possible actions.

Within the construct of OCD, sexual obsessions are treated in exactly the same way as any other obsession. The treatment may involve a combination of medications alongside ongoing psychotherapy, typically in the form of cognitive-behavioral therapy (CBT) or exposure and response prevention (ERP) therapy.

With ERP, exercises may involve the recounting of your sexual obsession on audiotape after which you would listen to the tape over and over until the obsession no longer generates anxiety. A variety of other exposure exercises can be developed depending on the nature of sexual obsession.