Sexual Obsessions and OCD - Characteristics and Complications

What Is Sexual Obsession as Seen in Obsessive-Compulsive Disorder?

Sexual obsessions in people with obsessive-compulsive disorder (OCD) constitute unwanted and intrusive sexual thoughts and images that cause considerable anxiety to the patient. An estimated 16.8 % of patients with OCD are affected by concurrent sexual obsessions.

Who Is Affected by Sexual Obsessions in OCD?

• Men and women may both be affected, although men are more commonly associated with the problem of sexual obsessions. However, men and women who suffer from OCD demonstrate similar risk potential for developing sexual obsessions.

• Children, particularly teenagers, have also reported sexual obsessions and the deep-seated feelings of guilt that this evokes in them.

What Is Obsessive-Compulsive Disorder?

A patient displaying obsessions (frequent, repetitive thoughts and sensations) and compulsions (urge to repeat a habitual tendency over and over again) may be diagnosed with obsessive-compulsive disorder (OCD). The obsessions and compulsions experienced are accompanied by signs of anxiety and distress. The patient may also feel a sense of disgust at their obsessions. This is especially prevalent among those suffering from sexual obsessions with OCD since their obsessions occasionally border on obscene, inappropriate, or unacceptable sexual imagery and ideas.

What Characteristics Do People Affect With Sexual Obsessions in OCD Display?

• Sexual obsessions are autogenous (they appear from within the person or themselves).

• These obsessions are accompanied by distress and extreme concern, with patients worrying about whether or not they are normal, whether their sexual orientation will change, and so on.

• Affected individuals will go to great lengths to suppress, and hide their tendencies, and constantly fear that they will act on their obsessions.

• Sexual obsessions do not bring relief or pleasantness to the patient, but they cause extreme worry.

• Contrary to their worries, affected individuals with OCD rarely carry through their sexual obsessions. However, they actively avoid situations that stimulate their thoughts in most cases.

• These individuals may persistently avoid touching people and walk with their hands in their pockets while maintaining a distance from others. In addition, they may avoid eye contact, particularly with the group that they are afraid they harbor sexual feelings.

• Often, the affected individuals are convinced that others can see or understand their thoughts and feelings reflected in them. However, the anxiety and the sexual obsessions are actually within themselves only.

• Studies have shown that many people have sexual thoughts about sexual activity outside the realm of what is considered normal. However, what is essential is their reactions to it or the significance they ascribe to these thoughts. People with OCD are highly affected by their sexual thoughts and tend to attach great significance to them. They consider their sexual thoughts as indicative of their ability to harm. This leads to discomfort and stress, accompanied by avoidance and constant reassurance-seeking behaviors.

What Themes Do Sexual Obsessions in OCD Commonly Follow?

Sexual obsessions in OCD may involve:

• Incest: Sexual activity with a family member.

• Bestiality: Sexual activity with an animal or animals.

• Sexual violence and abusive sexual patterns.

• Sexual Slavery: Forcing someone into unnatural or unwanted sexual acts in the manner of an enslaved person by withholding their autonomy and rights.

• Pedophilia: A penchant for sex with or a sexual attraction to underage children.

• Infidelity: Being sexually unfaithful to one’s partner or spouse.

• Homosexual thoughts (in heterosexual people).

• In children (especially teenagers), these obsessions usually take the form of anxiety about their sexual orientation or fear of touching their friends. At times it is misunderstood as a sexual overture. They may also worry when they accidentally brush against people, fearing that it will be considered a non-consensual physical or sexual touch. Some children constantly fear that they will rape someone or engage in incestuous acts even if they have no desire.

What Are the Complications of Experiencing Sexual Obsessions?

People suffering from intrusive sexual obsessions can experience intense disgust for themselves which leads to avoidance of people and social situations. Affected individuals may be consumed by feelings of:

• Shame.

• Self-hatred.

• Guilt.

• Fear of rejection.

• The need to self-punish to avoid sexual thoughts and imagery.

What Is the Difference Between Sexual Obsessions and Sexual Fantasies?

Sexual obsessions and sexual fantasies are two different entities. Sexual fantasies are linked to pleasure or desire. They may be attainable or not attainable.

Sexual obsessions are thoughts that are considered unwanted or distressing. These thoughts are related to anxiety, shame, immense fear, worry, guilt, and self-disgust. The individual may be worried and be judgemental about these thoughts.

What Are Sexually Intrusive Thoughts?

Sexually intrusive thoughts or sexual obsessions are genuine worries of a person. These worries are related to one’s sexual tendencies. Sexual tendencies may take many forms such as

• Incent means having sex with family members.

• Bestiality means having sex with animals.

• Thoughts of sexual abuse, molestation, and sexual violence.

• Pedophilia means to have sex with children.

• Blasphemous sex means having sex in religious places where people worship.

• Thoughts of sadism, masochism, and enslavement.

• Sexual behavior that is not accepted by the society.

• Thoughts of gay sex.

Sexually intrusive thoughts are considered normal. It may affect individuals of any age or gender.

How Can Sexual Obsessions in OCD Be Treated?

1. Medications: Serotonergic medications such as Fluoxetine and Citalopram have been recommended for the clinical management of sexual obsessions and have shown better results in treating sexual obsessions than in other sexual behavioral disorders.

2. Psychotherapy: Psychotherapy for sexual obsessions relies on cognitive behavioral therapy (CBT).

The two forms of CBT used for the treatment of sexual obsessions in OCD include:

• Mindfulness-Based CBT: This method is an amalgamation of mindfulness exercises and cognitive therapy. Initially, it was structured to prevent depressive episodes but has shown some success with sexual obsessions and OCD.

• Exposure With Response Prevention (ERP): This therapy works on the principle of exposure to the feared stimuli and avoidance of the resulting behavior. In this case, patients may be repeatedly exposed to situations that trigger their sexual obsession-related anxiety. When they are exposed enough times, they gradually lose the associated anxiety and learn to prevent or avoid the response they are naturally inclined to.

Is Therapy Effective in People With Sexual Obsessions?

Mindfulness-based cognitive behavioral therapy and exposure to response prevention therapy have been known to provide some relief. However, there is an element of sexual obsessions with obsessive-compulsive disorder that may be difficult to treat. People with sexual obsessions often display schizotypic personalities (schizotypic personalities are liable to develop schizophrenia and tend to show certain behaviors and signs indicative of but less severe than schizophrenia). These individuals are challenging to treat, and therapy may be ineffective or less effective than expected.

Conclusion:

It can be exhausting to live with excessive anxiety and fear regarding one’s sexual thoughts (despite having no active desire to carry through on any of them). However, on a positive note, those affected should understand that their repulsion is proof that they will not engage in such activities. Furthermore, engaging in sound therapy and constant practice of the same can lead to better results and reduce anxiety while also giving one the confidence to interact socially without fearing any negative consequences.