Sexual Obsessions in OCD

Obsessions are different from fantasies

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Obsessive-compulsive disorder (OCD) is characterized by compulsions and obsessions, which are thoughts, ideas or images that are unwanted, won't go away and extremely distressing or worrisome. Obsessions can relate to many themes, including violence, aggression, and even religion. Among the most troubling are sexual obsessions.

Sexual Obsessions and OCD

Although there is 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.

It's important to note that sexual obsessions can occur with or without compulsions, which are behaviors that you repeat over and over again.

It has been estimated that between 6 and 24 percent of people with OCD experience sexual obsessions. Of course, many people with OCD may be reluctant to disclose that they are experiencing such thoughts, so the actual number of people with OCD experiencing sexual obsessions may be much higher.

The majority of research suggests that men and women experience sexual obsessions at about the same rate. Not surprisingly, sexual obsessions often interfere with intimate relationships. It has also been suggested that sexual obsessions co-occur with obsessions related to violence or religion. Moreover, experiencing sexual obsessions may be linked to developing OCD at an early age.

Sexual Obsessions Are Not Sexual Fantasies

It is important to understand that sexual obsessions are not sexual fantasies.

Whereas sexual fantasies are typically 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 signifies that they could be a pedophile, rapist or sexually perverted in some manner.

It is important to remember that while a pedophile or rapist would enjoy imagining sexual situations involving children or violent sexual domination and may have even acted on such a fantasy, an individual with OCD experiencing a sexual obsession does not want to experience these thoughts, finds these thoughts extremely distressing and guilt-provoking, and does not want to act on them.

How to Treat Sexual Obsessions

Health care professionals who have training in OCD should immediately be able to recognize a sexual or violent obsession as a symptom of OCD, and in the absence of any other risk factors (e.g., previous conviction of a sexual offense or physical assault), will be able to quickly reassure you that there is nothing to be alarmed about.

In the end, no matter how embarrassing or distressing, your health care provider will be in the best position to help you if you disclose the full nature of the symptoms you are experiencing. However, it is also important to trust that your health care provider will work ensure your confidentiality to the extent that this is possible.

If you have any questions related to the confidentiality of your health information, don’t hesitate to inquire about the policies and procedures they have in place.

Sexual obsessions are treated in the same manner as other obsessions: using some combination of medication and/or cognitive and behavioral techniques. Exposure and response prevention therapy may be particularly important for treating sexual obsessions. 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 on the nature of the sexual obsessions.

Sources:

Gordon, W.M. "Sexual obsessions and OCD" Sexual and Relationship Therapy 2002 17: 343-354.

Grant, J.E., Pinto, A., Gunnip, M., Mancebo, M.C., Eisen, J.L., & Rasmussen, S.A. "Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder" Comprehensive Psychiatry 2006 47: 325-329.

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