Sexual Obsessions

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by M. Williams, Ph.D.

About Sexual Obsessions

Obsessive-compulsive disorder (OCD) involves sexual obsessions — unwanted thoughts or images that are upsetting or interfere with an individual's life, followed by compulsions — actions that temporarily relieve the anxiety caused by the obsessions. Sexual obsessions are involuntary, repetitive, and unwelcome. The individual cannot simply wish them away. Attempts to suppress sexual obsessions don't work and may in fact make the obsessions more severe.

Typical obsessive themes center on contamination, illness, worries about disaster, and orderliness. However, many people with OCD also obsess about violence, religious questions, or sexual experiences. A quarter of people with OCD may experience sexual obsessions.

Repetitive sexual thoughts are seen in many disorders besides OCD. For example, problematic sexual thoughts are common to people with paraphilias and sexual addictions, traumatic stress disorders, sexual dysfunction, and mania.

The recurrent sexual thoughts and feelings in these situations may be referred to as sexual obsessions. However the content, form, and meaning of the thought will vary depending on the specific features of the disorder. This is why a correct diagnosis is essential for someone experiencing sexual obsessions.

Sexuality Concerns in Obsessive-Compulsive Disorder (OCD)

The University of Pennsylvania is conducting a survey of people with obsessive-compulsive disorder (OCD) who have homosexuality anxiety. Homosexuality anxiety is a recognized symptom of OCD, sometimes referred to as "HOCD."

HOCD includes the following:

  • the obsessive fear of being or becoming homosexual
  • the experience of intrusive, unwanted mental images of homosexual behavior, and/or
  • the obsessive fear that others may believe one is homosexual.

A person may have only one of these facets of the disorder or a combination.

Why sex?

People with a predisposition to OCD will find something to obsess about. Since sex carries so much importance in most societies, it easily becomes a magnet for obsessions. Common themes include homosexuality, unfaithfulness, sex with children, AIDS, and profane thoughts combining religion and sex.

People with sexual obsessions may have legitimate concerns about their attractiveness, potency, or partner, which can serve as an unconscious catalyst for the obsessions. However, the meaning of the sexual obsessions is not connected to real problems experienced by the person with OCD in any obvious or realistic manner.

Sexual Obsessions Examples

Sexual obsessions take many forms. For example, a father might obsess about sexually abusing his beloved young daughter. He might wonder if these thoughts mean that he is a pedophile and worry that he could act them out, despite the fact that he has never sexually abused anyone and feels disgusted by the idea. A woman who has happily dated men all of her life might suddenly start to worry that her lukewarm feelings toward her boyfriend mean that she is a lesbian. She might then start to look at every woman wondering if, in fact, she is attracted to someone of the same sex. Another example is a man who worries that he may accidently impregnate a woman by shaking her hand because he was not careful enough in washing his hands after touching his genitals.

In the midst of the thoughts, the sexual obsessions may seem real. Occasionally individuals with OCD believe that their obsession is true, and in such a case they would be said to have "poor insight." But the vast majority of people with OCD recognize at some point that their fears are extreme and unrealistic. The problem is that even though they know the obsession is false, it feels real. These individuals can't understand why they are unable to dismiss the obsession from the mind. The obsession may temporarily go away in the face of a logical argument or reassurance from others, but may spike when caught off guard by a sexual trigger.

Sexual obsessions can be particularly troubling to the individual with OCD, as something important and cherished becomes twisted into its nightmarish opposite. People with sexual obsessions are particularly vulnerable to having co-occurring aggressive and religious obsessions, severe depressive symptoms, and higher rates of impulse control disorders.

Neverending whys

Obsessions are often viewed by the patient hypothetically. They may wonder, "What if I am really a homosexual?" "What if I really want to seduce my student?" "What if I got AIDS from visiting a prostitute while sleepwalking?" The chances of an obsession coming true is remote but often the concern can never be completely disproved (i.e. "What if I really was aroused by that picture of a child?") Arguing with a person with OCD is usually futile. Objective feedback contradicting the obsession is dismissed because it lacks one-hundred percent certainty. For someone with OCD, no possibility is ever remote enough to permanently banish the fear. Attempts to prove the unprovable leads to circles of doubt, reassurance seeking, and checking compulsions.

Sexual obsessions can occur with or without compulsions. A compulsion can be a behavioral act or a mental ritual. Examples of mental rituals include silent prayers, repeating special phrases (i.e. "I truly love my wife,") and mental arguments with oneself about the validity of the obsession. Compulsions are performed as an attempt to counteract the obsession. Compulsions temporarily reduce anxiety, but ultimately they make the OCD more severe. This type of checking can be extremely destructive to the person with sexual obsessions as they use very the existence of the behavior as a sign that they are in fact sexually deviant.

Examples of compulsions

Below are some examples of sexual obsessions followed by a possible compulsion. Keep in mind that for each person, the content of the obsession and resulting compulsion may vary.

Sexual Obsession Sexual Compulsion

Fear that one is a pedophile

Looking at pictures of children on the internet to see if the images produce arousal

Fear that one is homosexual

"Coming out" to one's spouse and coworkers

Fear that one's genitals are contaminated

Excessively washing the genitals with bleach or laundry detergent

Fear that one will rape an attractive woman

Refusing to look at young women who are wearing skirts

Sexual fantasy?

It cannot be overemphasized that the sexual obsessions in OCD are the opposite of the usual sexual daydream or fantasy. Normal sexual fantasies are enjoyable and generally harmless. They may consist of wishes or memories of past sexual experiences. However, the sexual ideation in OCD is unpleasant and distressing. The individual with OCD does not want the thought to become real. The idea of acting out the obsession fills the OCD victim with dread. Sexual obsessions in OCD rarely produce sexual arousal because anxiety and arousal cannot occupy the same space. As a result, OCD usually decreases sex drive. OCD sexual obsessions result in guilt, shame, and interfere with social functioning or work.

Treatment

People with sexual obsessions devote an excessive amount of time and energy in attempts at understanding the obsessions. They usually decide they are having these problems because they are defective in some way, and they are often too ashamed to seek help.

Because sexual obsessions are not as well described in the research literature, many therapists may fail to properly diagnose OCD in a client with this manifestation of the disease. Mental health professionals unfamiliar with OCD may even attribute the symptoms to an unconscious wish, sexual identity crisis, or hidden paraphilia. Such a misdiagnosis can cause the patient to become even more upset and confused. Fortunately, sexual obsessions respond to the same type of effective treatments available for other forms of OCD — cognitive-behavioral therapy and medication. People with sexual obsessions may, however, need a longer and more aggressive course of treatment.

Medication to restore libido

Many people with sexual obsessions are alarmed that they no longer seem to have any sex drive. People with OCD may see this as evidence that they are no longer attracted to the opposite sex and are in fact deviant in some way. Some may wonder if medication is the answer to the problem. Medication is a double-edged sword. Drugs specifically for sexual problems (i.e. Viagra, Cialis) are not the answer for people with untreated OCD. The plumbing is working fine, rather it is the anxiety that kills libido.

Medications specifically for OCD (typically SSRI antidepressants) will help alleviate the anxiety but will also cause some sexual dysfunction in about a third of patients. For many the relief from the anxiety is enough to overcome the sexual problems caused by the medication. For others, the medication itself makes sex truly impossible. This may be a temporary problem, but if not a competent psychiatrist can adjust the medications to overcome this unpleasant side-effect.

More about treatment for OCD...

Sources:

  • WM Gordon. (2002) Sexual obsessions and OCD, Sexual and Relationship Therapy, Vol. 17, No. 4. (Related link.)
  • JE Granta, A Pintob, M Gunnipb, MC Mancebob, JL Eisenb, SA Rasmussen. (2006). Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder. Comprehensive Psychiatry, 47: 325-329.  
  • A Bystritsky. (2004). Current Pharmacological Treatments for Obsessive-Compulsive Disorder. Essent Psychopharmacol 5:4.
 
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