What Are Sexual Obsessions in the Context of OCD?

The Difference Between Fantasy and Obsession

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An obsession, at least within the context of obsessive-compulsive disorder (OCD), is an unwanted thought, image, or idea that won't go away, and which causes distress. One of the subsets of OCD-related obsessions is the sexual obsession.

Although there are a wide range of sexual obsessions, common themes include homosexuality/sexual identity, sexual abuse, sexual thoughts about friends, incest, infidelity, sexual perversions, sex with animals, violent sexual behavior, and blasphemous thoughts combining religion and sex.

What's important to remember is that sexual obsessions can occur with or without compulsions.

What is also important to realize is that sexual obsessions are not sexual fantasies. Whereas sexual fantasies are normally pleasurable, harmless, and guilt-free, sexual obsessions are unwanted, distressing, and rarely (if ever) lead to sexual arousal.

Many people with OCD worry that the nature of their sexual obsessions signify that they might be a pedophile or rapist, or sexually perverted in some manner. For this reason, they are afraid to open up about their obsession with their friends, family, or health care provider.

If you yourself have OCD and are worried about what your obsessions indicate in regard to your identity, it is essential to remember that while a pedophile or rapist would enjoy imagining sexual situations involving children or violent sexual domination, and may even act on such a fantasy, individuals with OCD who are experiencing a sexual obsession do not want to experience these thoughts.

They find these thoughts extremely distressing and guilt-provoking, and do not want to act upon them. For this reason, you should feel safe opening up to your health care provider about the thoughts you're struggling with. Only with your openness and honesty will they be able to help you work through these issues.

How To Treat Sexual Obsessions

If you're grappling with complications caused by OCD, you should of course seek out a health care professional who has been trained to treat the condition. Not every mental health care professional will have expertise in this particular area. Once you have pinpointed the appropriate health care provider, it is in your best interests to be open with them. If you give them the chance, they can help to treat your obsessions.

Much like other OCD-related obsessions, sexual obsessions can best be treated using a multidisciplinary approach. In the case of obsessions, the best treatment is typically a combination of medication and cognitive behavioral therapy techniques. This type of therapy stresses changes in behavior and/or thoughts (sometimes called cognitions). It involves examining any harmful thought patterns you're experiencing and coming up with plausible alternatives that are more realistic and less threatening. 

Exposure and response prevention therapy may also be effective.

 For example, if you were experiencing a sexual obsession about having sexual relations with a relative, you might audiotape yourself recounting this obsession in great detail and then listen to the tape over and over again, until hearing the obsession no longer generates anxiety. A variety of exposure exercises can be developed depending upon the nature of your particular sexual obsession.

If you feel ready to work through this with a professional, make sure you take the time to find the right OCD therapist for you.

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