What to Read
Imagine one day that you are walking past an elementary school playground. You glance over at the children and, out of the blue, a thought enters your head: “Did I just look at those kids in a creepy way?” Your brain immediately begins to doubt and analyze whether your glance was creepy and you are flooded with terror: “Why would I be staring at kids?” “Do other people do this?” “Was I physically attracted to one of them?” “Is there something wrong with me?” “Did I do something inappropriate?” “Did I get aroused by the children?” “Am I a pedophile?” “Am I going to become a pedophile?” “What does this mean that I am even thinking these thoughts?
Experiencing taboo thoughts like these is one of the most common, yet lesser known, manifestations of OCD. Many people with intrusive and taboo thoughts, such as being preoccupied about being a pedophile, have minimal or no observable compulsions. Instead, the compulsive behavior is internal. Only the person suffering can see it. This is also sometimes referred to as “Purely Obsessional OCD” or “Pure-O” because we used to consider anything experienced on the inside of a person as an obsession and anything external as a compulsion. However, now we recognize that what separates an obsession from a compulsion is that obsessions trigger anxiety and are uncontrollable. Compulsions are controllable and are aimed at trying to reduce anxiety. So, even for someone whose obsessions only manifest as intrusive thoughts, a great deal of effort is still spent repeatedly checking, neutralizing, ruminating about, attempting to pray away, and avoiding certain thoughts — these mental actions are the compulsions.
An individual suffering with pedophile OCD (pOCD) will experience intrusive thoughts or images (spikes) accompanied by terrorizing anxiety. The OCD has the ability to produce doubt or question memories, real or imagined. Additionally, OCD encourages you to monitor sexual urges as part of the evidence-gathering process. Based on the importance that pOCD places on sexual attraction, your brain constantly draws attention to sexual arousal — for example, the presence of an erection or vaginal lubrication in the wrong setting becomes evidence for OCD’s case against you. This increased monitoring allows for a case of mistaken identity in which any microscopic movement is determined to be arousal towards children. Taken together, unwanted thoughts, images, and urges can persuade an individual with pOCD that they are a sexual deviant. Spikes tend to revolve around past, current or future behavior.
Common past-oriented spikes:
- “Did I ever do anything inappropriately sexual when I was younger?”
- “Did I do anything recently that was sexually inappropriate?”
- “Have I ever been attracted to an adolescent or child?”
- “Did I ever molest anyone?”
- “Could ambiguous action X be construed as sexual?”
- “Have I accidentally clicked on child porn?”
- “Does a person from my past know something that suggests I’m a pedophile?”
Common present-oriented spikes:
- “Am I attracted to this 10-year-old in front of me?”
- “Was I just checking out this 13-year-old girl?
- “Did someone just notice me doing something strange?”
- “I should stand on the other side of the subway, away from this 6-year-old boy so that I don’t impulsively grope him.”
- “Am I sexually aroused by this little girl on TV?”
Common future-oriented spikes:
- “How do I know I will never engage in pedophilic behavior?”
- “What if, one day, I really am attracted to children?”
- “What is the right way to hold/hug/change a child?”
- “What if I get arrested and go to jail?”
- “Will I be creepy or do something inappropriate when I have a baby?”
Reassurance seeking is common within this theme. Individuals with pOCD will ask friends and loved ones questions aimed at figuring out this threatening unknown. Endless hours are spent mentally ruminating in an attempt to alleviate anxiety. Checking the physical environment to ensure that insidious behavior has not occurred is also common. Incessant answer seeking also occurs on the Internet through Google searches and online forums. Common searches include looking up infamous pedophiles and comparing to oneself or sifting through legal jargon to prepare for feared consequences. The hope is to find a nugget of information from anyone — anywhere — that will extinguish the horrific threat. The Internet can be an extremely debilitating weapon that leads individuals with pOCD down the proverbial rabbit hole.
There is a considerable amount of testing that takes place within this theme. Individuals with pOCD feel compelled to compare their thoughts, feelings, behaviors, and sexual arousal when they are around adults and children. The hope is that this will serve as a pedophilia litmus test. As mentioned earlier, this inevitably yields a multitude of false positives that leads to further ritualizing. While all of these rituals serve to temporarily relieve anxiety, they ultimately prevent someone with pOCD from progressing in treatment.
Avoidance plays an important role in the perpetuation of pOCD. Individuals suffering with pOCD will do everything in their power to ensure that these fears do not come to fruition. As is the case with all forms of OCD, escape and avoidance maintain and exacerbate the anxiety. In response to an impulsivity fear, one may stand as far away as possible from a minor or escape the situation altogether. Avoiding children at parks, museums, or nearby schools helps to ensure that these thoughts, images, and feelings will not surface. In line with avoidance, some individuals may choose not to have children of their own in order to limit the danger that they feel they pose to children.
Treatment for pOCD entails engaging in exposure therapy while simultaneously addressing the shame resulting from stigma discussed above. Facing the fear head on while limiting ritualistic behavior is the most effective way to manage OCD. This includes intentionally placing oneself in situations that will progressively provoke more challenging unwanted intrusive thoughts and accompanying anxiety. An emphasis is placed on situations that are inducing a desire to escape or avoid. Sample exposure items include going to public parks, looking at pictures of children, watching movies such as The Lovely Bones, or reading news stories about pedophiles.
The goal of these challenging exposure exercises is to let unwanted thoughts be present while allowing anxiety to dissipate organically. Taking this “risk” feels impossible but, after engaging in exposures consistently and repeatedly, the rational brain (the real you) can dominate the conversation. When anxiety is allowed to naturally dissipate, threatening situations are no longer perceived as such and one does not feel relentlessly compelled to resolve questions related to potential for pedophilia. This theme can become irrelevant through exposures and response prevention.
Adapted from Jordan Levy, Ph.D..
What to Watch
Please watch the videos below relating pedophile OCD.
[VIDEO]
What to Do
Create your ERP hierarchy following the example and instructions below.
- [Pedophile OCD Hierarchy example]
- [ERP Instructions]
What to Measure