The Most Repugnant of Repugnant Thoughts: Pedophile OCD (or, POCD)

I’ve recently met several new clients who presented with the same heartbreaking, terrifying illness: POCD. While most Americans have heard the term “OCD” and are familiar with at least some of the disorder’s symptoms, few people have ever heard of POCD, or Pedophile OCD. As the name implies, Pedophile OCD involves intrusive thoughts of such a repulsive nature that clients often wait years before seeking treatment. They feel mortified about the possibility that their intrusive thoughts about children might become a reality, might cause bad events to transpire, or might suggest something sinister about their character. Even worse, some clients are misdiagnosed by mental health professionals who take an oath of “do no harm” but are, tragically, uninformed of the diagnostic criteria for POCD.

In an effort to dispel the myths about POCD, let’s take a look at what distinguishes it from actual pedophilia.

POCD SYMPTOMS

• Intrusive, unwanted thoughts or images of a sexual nature about children (these may be children known to the person suffering from POCD or random children)
• Fears that you may have accidentally or unintentionally sexually abused a child (“did I change her diaper wrong?” “did I inadvertently rub up against that boy as he walked by?”)
• Worries that having the intrusive thoughts may cause you to act on them and sexually abuse a child
• Checking to make sure that your behavior was safe or moral (mental review of past events)
• Compulsive internet research to determine if you fit the criteria for a pedophile
• Avoiding being around children so as to not act on the intrusive thoughts (sadly, this often means that parents will even avoid their own children)
• Avoiding normal contact with children such as hugs, kisses, holding hands, and cuddling or giving baths/changing diapers
• Avoiding watching movies, TV shows, or reading material that involves anything related to pedophilia
• Telling/confessing; asking others for reassurance that you are not a pedophile
• Fears that you may have inadvertently left DNA near where a child was and will be prosecuted for pedophilia
• Fears that you may have sexually abused a child in the past but forgotten it, repressed it, or are in denial
• Obsessive evaluation of your sexual orientation and frequent self-reassurance that you have a preference for adults
• Unwanted physical arousal when around children or thinking of children; body-scanning to make sure you are not aroused when around children which may inadvertently result in arousal
• Other symptoms not listed here — OCD symptoms are highly-individualized and can vary person to person

DISTINGUISHING POCD FROM PEDOPHILIA

• POCD features symptoms consistent with other OCD and anxiety disorders: worry, doubt, guilt, ruminations, intrusive images, unwanted/distressing thoughts, avoidant behaviors, obsessions, anxiety spiraling, checking behaviors, and fear. Persons struggling with POCD do not in any way enjoy experiencing these intrusive thoughts and images. Quite the contrary.
• Persons with OCD, including POCD, are more likely to attempt to neutralize, avoid, or suppress unwanted thoughts. Pedophiles may also try to rid themselves of their thoughts but are more likely to engage with them.
• Persons with POCD tend to have more frequent thoughts about children and be overwhelmed by the frequency of the intrusions. Pedophiles are more likely to have sporadic episodes that are triggered by specific events, alcohol/substance use, or when developing fantasies.
• Physical arousal at the thought, image, or presence of a child is not a reliable indicator of pedophilia. Persons suffering from POCD tend to become hyper-aware of their body sensations and conduct ‘body-scans’ in which they compulsively check to see if they become aroused. Sometimes, it is the case that this causes arousal. Arousal as a stand alone symptom should not be considered an indicator of pedophilia.
• Persons with POCD tend to feel incredibly distressed and anxious about the nature of their thoughts. They seek treatment for the resultant anxiety, guilt, and fear and often self-refer for help. A pedophile is less likely to experience distress related to their thoughts, is more likely to derive pleasure from the thoughts, and is less likely to seek help. When a pedophile does engage in the mental health system, it is typically due to worries about being caught or for peripheral issues such as depression and they are typically referred by the court system or an agency.
• Persons with POCD tend to avoid children, avoid looking at them, or avoid even subtle engagement. Pedophiles are more likely to seek out activities that involve children or find ways to be alone with children.
• Many persons with POCD have other OCD symptoms and should be evaluated for other OCD subtypes as well as comorbid conditions such as ADHD, BDD, and BFRBs.

Persons with POCD symptoms should reach out for qualified help from a knowledgeable, compassionate, and understanding mental health professional who will not further stigmatize or judge them. All humans have intrusive thoughts of a violent or sexual nature at some point in their lives. What makes a person with POCD suffer so much is that they begin to fixate on these intrusive thoughts, view them from every angle, over-analyze them, and then ascribe meaning to them such as believing that the unwanted thoughts must say something about who they are as a person. Ironically, persons with POCD pose the least harm to children — the reason they feel so distressed by the thoughts and images is because they represent the exact opposite of everything that person holds dear and values.

If you, or someone you know, is struggling with symptoms of POCD, please reach out for help. Treatment for POCD is available and can be quite effective. There is hope.