Sexual obsessions involve unwanted sexual thoughts, such as the fear of being attracted to something unwanted, taboo, or morally “unacceptable.”

Sexual obsessions in OCD are recurrent unwanted sexual thoughts, such as the fear of being attracted to something unwanted, taboo, or morally “unacceptable” based on one’s particular worldview.  Although all forms of OCD can be debilitating, sexual obsessions can be especially confusing and disabling for sufferers because sexual obsessions target one’s fundamental identity as a social being.

In addition to anxiety, which characterizes most obsessions, individuals with sexual obsessions often experience extreme guilt, shame, hopelessness, and depression.  Individuals with OCD with sexual symptoms often mistakenly consider themselves deviant, disgusting, or evil.

Moreover, incorrect assumptions about the true causes of their unwanted sexual thoughts make them less likely to seek treatment or to share their symptoms with others.  In my Palm Beach County, South Florida psychological practice, I treat many individuals who have lived with sexual obsessions for many years before seeking treatment.

Sexual obsessions often leave one feeling isolated and alone.  Moreover, in efforts to avoid symptom triggers, people with unwanted sexual thoughts often drop out of school, quit their jobs, end relationships, or make other life-altering decisions that paradoxically make their symptoms worse.

What are Sexual Obsessions?

Sexual obsessions in OCD can take many forms. Most sexual obsessions involve unwanted thoughts, ideas, impulses, or images focusing on sexual content.  Some individuals with sexual obsessions are bombarded by unwanted urges to act in a sexual way toward children, animals, or other populations.  They might experience intrusive images of sexual organs, envision themselves performing unwanted sexual acts, or have persistent doubts about their own sexual identity.

They experience repetitive thoughts like:

• What if I’m attracted to that person?
• What if I lose control and act out sexually?
• What if I expose my genitals to that person?
• What if I secretly want to have sex with that person?

Sexual obsessions often involve the fear of secretly being gay (if one is actually straight), being sexually attracted to children (fear of pedophilia), being sexually attracted to animals (fear of bestiality), or being sexually attracted to dead things (fear of necrophilia).  In fact, the variety and forms that unwanted sexual thoughts can take are limited only by the breadth of the human imagination. Societal and personal beliefs about these topics often lead to extreme distress whenever these obsessions occur.  

Here are some common sexual obsessions / thoughts.

Types of OCD Sexual Obsessions / Thoughts

• Fear of being a pedophile or becoming a pedophile.
• (parents often fear being sexually attracted to their own children).
• Fear of being sexually attracted to animals.
• Fear of being sexually attracted to dead things.
• Fear of becoming gay (if straight) or fear of becoming straight (if gay).
• May also involve a fear of secretly being gay (or straight).
• Fear of being sexually attracted to religious persons.
• Fear of being sexually attracted to God.
• Fear of being sexually attracted to siblings, parents, or other relatives.
• Fear of becoming aggressive or violent during sex.

Many individuals with sexual obsessions spend significant amounts of time either berating themselves for having such thoughts or trying to convince themselves that the thoughts aren’t true.  In most cases, efforts to convince oneself that the thoughts are untrue is a form of mental reassurance, a ritual/compulsion that maintains the OCD cycle.

In cases of severe OCD, individuals may become confused about whether or not they have actually acted on their thoughts.  They may know logically that these events have not occurred, but OCD may cause them to doubt their memories.

Ways to Identify Sexual Obsessions in OCD

• What is the prevailing emotion you experience when having these thoughts?  Dread/guilt or desire/lust?  Dread, confusion, guilt, and despair commonly accompany sexual obsessions.
• What’s the difference between being a pedophile and having obsessions focusing on pedophilia?  Pedophiles enjoy the idea of having sex with children, whereas individuals with pedophilia related obsessions are often scared by the prospect of acting on their thoughts.
• Also regarding pedophilia: If you could be guaranteed that you wouldn’t get caught, would you want to act on your thoughts?  Pedophiles answer “Yes” to this question.  People with OCD answer “No” or “I don’t know” (due to OCD-related doubt).
• What’s the difference between being gay and having homosexual obsessions (HOCD)?  Gay individuals experience pleasure when having sexual thoughts involving same sex partners, whereas individuals with homosexual obsessions become scared or disgusted by these thoughts.
• It’s also important to recognize cases in which individuals with OCD fear that they might have to inevitably give into their impulses in order to keep “from going crazy”.  They might not want to act on their thoughts but they think, “What if my mind is never at peace until I act on my thoughts?”  The idea of having relief from their thoughts can then make them feel unsure about whether or not they want to act on them.

Please note that the above questions are over-simplifications of complex ideas.  If you have sexual obsessions, you would likely experience doubt and confusion over the answers to many of these questions.

Treatment of Sexual Obsessions / Thoughts in OCD

Treatment of sexual obsessions is complex and individualized.  In my Palm Beach Gardens, FL practice, I treat many individuals with OCD sexual obsessions using exposure and response prevention (ERP) and cognitive-behavioral therapy (CBT). Treatment involves confronting fear triggers in a systematic way while resisting rituals and avoidance behaviors. With consistent practice, these fear triggers lose their power over you.

Overcoming sexual obsessions is not based on definitively proving that these obsessions are unfounded. Although this outcome would be desirable (if possible), someone with a strong tendency toward OCD doubt can never eliminate all traces of doubt in a way that is fully satisfying. After all, if you have these types of symptoms, you’ve probably already spent months or years trying unsuccessfully to accomplish this goal.

Am I sure that I don’t secretly want to have sex with _________? Trying to answer this question with a resounding “No” is ultimately doomed to fail. It’s not the question itself that is the problem. It’s actually your exhaustive attempts to disprove the possibility that perpetuates your symptoms. I have discussed this idea in more detail in my posts on thought control and unwanted thoughts.

Instead, successful, effective treatment of OCD is based on learning to accept uncertainty about the things we can’t know for sure. You might not know with 100% certainty whether or not you could become a pedophile, but neither does anyone else. People without OCD-related sexual obsessions accept this doubt, without engaging in efforts to avoid or neutralize. This is the goal of treatment: to accept doubt without avoidance or neutralization. This is the key to breaking free from sexual obsessions and living a happy, healthy life.

My next post will discuss symptoms of homosexual OCD (HOCD), or the fear of becoming gay (or secretly being gay).

Questions? Comments? Struggling with OCD-related sexual obsessions? Sound off below.

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