Sexual Obsessions in OCD

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 OCD 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:

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

It has been estimated that between 6% and 24% 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.

It's important to keep in mind that these thoughts can occur with or without compulsions. Additionally, having such thoughts doesn't mean a person will act upon them.

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 with anxiety, 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. In contrast to someone who might be at risk for acting on this impulses, 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.

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

Treatment

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 their possible actions.

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 alongside ongoing 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 sexual obsession.

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. The thoughts you share will not only be held in the strictest confidence but be met with an open, non-judgmental attitude.

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Article Sources
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  1. U.S. National Library of Medicine. Genetics Home Reference. Obsessive-compulsive disorder. Updated May 12, 2020.

  2. Williams MT, Crozier M, Powers M. Treatment of Sexual-Orientation Obsessions in Obsessive-Compulsive Disorder Using Exposure and Ritual PreventionClin Case Stud. 2011;10(1):53-66. doi:10.1177/1534650110393732

  3. Vella-Zarb RA, Cohen JN, McCabe RE, Rowa K. Differentiating Sexual Thoughts in Obsessive-Compulsive Disorder From Paraphilias and Nonparaphilic Sexual DisordersCognitive and Behavioral Practice. 2017;24(3):342-352. doi:10.1016/j.cbpra.2016.06.007

  4. Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: A review and new directionsIndian J Psychiatry. 2019;61(Suppl 1):S85-S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18

Additional Reading
  • National Collaborating Centre for Mental Health (UK). Obsessive-Compulsive Disorder. National Center for Biotechnology Information. Published 2016.