POCD: When you think you’re a pedophile
Whatever form OCD presents in an individual, it is likely the person believes it is the worst possible type of the disorder there can be. That said, there is probably no crueller form of OCD than OCD with pedophile obsessions.
Commonly referred to in online communities as POCD, pedophile OCD is typified by thoughts that a sufferer could or will harm children, usually in a sexual way. It can manifest in several ways. Some sufferers believe they have committed some kind of sexual offence against a child, perhaps by touching inappropriately. Others believe they will harm a child, often their own children but other children are just as often involved in the thoughts. Still others face repeated instances of sexual imagery involving children.
POCD is a specific theme of OCD. It involves obsessions (intrusive thoughts, images, urges, impulses) and compulsions (ruminating, avoiding children, confessing and others). It causes the sufferer to question their sexual identity and question whether they are pedophiles. Ruminating on the question of whether or not the individual is a pedophile or not can be nearly endless.
There is evidence that suggests people with pedophile OCD contemplate or attempt suicide more than with other OCD themes. These people feel that they would rather die than harm a child — the paradox of this OCD theme where sufferers are tormented about thoughts of sex and children yet the actual thought of harming a child is extremely repugnant.
Sufferers of pedophile OCD may take great pains to hide their thoughts from others. Because of the subject matter and that child abuse is illegal, people with POCD may be loathe to talk about their conditions out of fear of being branded a pedophile and/or losing access to their children. The fear is not necessarily groundless.
A recent study looked at how well mental health professionals identified OCD symptoms. All participants were members of the American Psychological Association (APA). 42.9% misidentified sexual obsessions about children, with over a third classifying the problem as pedophilia. (Glazier, K., Calixte, R., Rothschild, R., & Pinto, A. (2013). High rates of OCD symptom misidentification by mental health professionals. Annals of Clinical Psychiatry, 25(3), 201-209.)
I have personally run into several people on online forums who clearly suffered from POCD but ran afoul of misdiagnoses. One of those people was reported to the police as a possible pedophile and had to endure having his life put under a microscope because his assessor believed he was a danger to children.
It would be a good idea for people who believe they suffer from pedophile OCD to cautiously approach a mental health professional and discuss the professional’s experience in dealing with people with that particular theme of OCD.
Pedophile obsessions can be compounded by the experience of groinal responses. These are sensations in the groin that are common with sexual obsessions. Although automatic and meaningless, sufferers can attach meaning to them and become to believe that the sensations are evidence that their thoughts are true.
People with POCD are not pedophiles. In fact, they are probably the safest people to be around children because they are hyperaware of what they are doing and tend to be overly careful with children.
At the end of the day, pedophile OCD is still OCD. This OCD theme is treated the same way as other OCD themes. Cognitive Behavioral Therapy is the standard treatment for Obsessive Compulsive Disorder. On the cognitive side the sufferer can be helped to understand that his thoughts are not intentions, that the thoughts of children and sex are thrust upon him, and that he does nothing to make the thoughts appear. On the behavioral side sufferers can benefit from Exposure and Response Prevention Therapy, exposing themselves to obsessions and working hard to not perform compulsions in response.