Sexual Obsessions in OCD

How Sexual Obsessions Differ From Sexual Fantasies

Model poses as a man with substance/medication-induced psychotic disorder
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Obsessive-compulsive disorder (OCD) is characterized by compulsions (an uncontrollable impulse to perform an act, often repetitively) and obsessions (the inability to stop thinking about a certain topic or image without anxiety).

Within the realm of obsessions, a person with OC may become fixated on thoughts of violence, aggression, contamination, or even religion. Among the most troubling, however, are sexual obsessions.

Sexual Obsessions and OCD

Although a person may experience a wide range of sexual obsessions, common themes involve those that may be considered forbidden, such as:

  • Homosexuality
  • Sexual abuse or violence
  • Sexual thoughts about friends
  • Incest
  • Infidelity
  • Sexual sadism or masochism
  • Sexual enslavement
  • Beastiality
  • Underage sex
  • Sex and religion as a form of blasphemy

The thoughts can occur with or without compulsions, and having such thoughts doesn't mean a person will act upon them.

It has been estimated that between six percent and 24 percent of people with OCD will experience some form of sexual obsession. The number may be even higher given that most people are reluctant to share such thoughts. While people tend to identify sexual obsession as a primarily male characteristic, research suggests that men and women with OCD will experience them at more or less at the same rate.

Sexual obsessions can interfere with intimate relationships, particularly if they co-exist with thoughts of violence, suspicion, or doubt. In some cases, the person with OCD may have obsessive doubts about an intimate partner and become fixated on thoughts or mental images about infidelity. When this happens, rather than looking for the good in a partner, the person with OCD will look for flaws and shortcomings.

Sexual Obsessions Are Not Sexual Fantasies

Sexual obsessions are not the same thing as sexual fantasies. Whereas sexual fantasies are typically related to pleasure or desire, attainable or not, sexual obsessions are unwanted and distressing thoughts that are typically associated shame or self-loathing.

People with OCD will often worry that a forbidden or illegal sexual obsession may one day lead them to act upon those desires, whether it be about pedophilia, rape, or sexual violence. The key psychological difference is that a person with OCD will find the obsession immoral and feel repelled at the thought of acting upon it.

This is not necessarily the case with persons who perpetrate rape or pedophilia who, despite knowing the behavior is wrong, typically act upon such thoughts as a pathological form of self-gratification.

Sexual obsession in OCD tends not to be delusional (founded untrue thoughts). Rather, it is characterized by contradictions by which a person may experience arousal and self-loathing at the same time and actively avoid situations that are connected to those thoughts, such as:

  • Avoiding gyms, public restrooms, or situations that elicit homosexual thoughts
  • Avoiding schools or playgrounds where children gather
  • Avoiding hugging or close contact with an object of desire

If accompanied by sexual compulsion, a person with OCD may become abnormally preoccupied with pornography and/or masturbation as "outlets" for the unwanted thoughts.

How to Treat Sexual Obsessions

Mental health professionals trained in OCD will recognize sexual obsession as a symptom of the disorder and, in the absence of any risk factors (such as a conviction for a sexual crime), will help the person understand the nature of the obsession and minimize any fears as to what the thoughts "say" about the person and/or his or her possible actions.

If you are experiencing obsessive and unwanted thoughts about sex, it is important to disclose the full nature of the experience, however distressing or embarrassing they may seem. It requires you to trust your mental health provider and understand that the thoughts you share will not only be held in the strictest confidence but be met with an open, non-judgmental attitude.

Within the construct of OCD, sexual obsessions are treated in exactly the same way as any other obsession. The treatment may involve a combination of medications to alleviate anxiety and/or depression alongside on-going psychotherapy, typically in the form of cognitive-behavioral therapy (CBT) or exposure and response prevention (ERP) therapy.

With ERP, exercises may involve the recounting of your sexual obsession on audiotape after which you would listen to the tape over and over until the obsession no longer generates anxiety. A variety of other exposure exercises can be developed depending on the nature of the sexual obsession.

View Article Sources
  • Vella-Zarb, R.; Cohen, J.; McCabe, R. et al. "Differentiating Sexual Thoughts in Obsessive-Compulsive Disorder From Paraphilias and Nonparaphilic Sexual Disorders ." Cognitive and Behavioral Practice. 2017; 24(3):342-52. DOI: 10.1016/j.cbpra.2016.06.007.