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Sexual obsessions in OCD: three cases

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When sexual thoughts become the focus of OCD doubt

Sexual obsessions in OCD may concern a person’s sexual orientation, the fear of being a paedophile or the possibility of becoming sexually attracted to animals. The thoughts feel intrusive and unwanted. The problem lies in the meaning attached to them and in repeated attempts to determine with certainty what they mean.

Bodily sensations cannot tell someone with certainty who they are attracted to. The body can react without a corresponding experience of desire, and tension or heightened attention can make ambiguous sensations highly noticeable. In OCD, such sensations can prompt further investigation: Was that arousal? What does it mean? The more the person checks, the more sensations there are to analyse.

The thought may be treated as possible evidence of identity, intention or risk. Having a thought can feel almost the same as wanting or doing it. When the thought keeps returning, that in itself may feel like a sign that it matters, and the person may believe that thoughts and feelings ought to be completely controllable.

Sandra, Søren and Karsten each have their own story, and the content of their OCD differs. For all three, doubt leads them to monitor, analyse and avoid in an attempt to find an answer that feels completely certain.

Sexual Orientation OCD: when the body must provide the answer

Sandra

“Sandra!” her mother called from the kitchen. “Dinner’s ready!”

“Yes, Mum, I’ll be there in a minute.” Sandra was looking at clothes online, something she usually loved. Lately, that enjoyment had become mixed with unease. She had begun having many thoughts about girls and whether she was actually attracted to girls rather than boys. She therefore watched closely to see how her body reacted when she looked at the female models wearing the clothes: Did she feel anything sexual? She could remain caught up in the question for a long time and was therefore often late for dinner.

Sandra had just turned 15 and had moved from a small village school to a larger school in town. Her first day had gone well, and she had soon got talking to the others. One of the girls had complimented her new blouse. At first, Sandra was pleased. Then the questions came. Was it because Sandra had seemed interested? Was she interested? Did her clothes say something about her sexuality?

Ever since she was little, Sandra had tended to think a great deal about things. For a while, she had ruminated about whether she was truly happy and how anyone could know that they were happy. Now her rumination centred on her sexual orientation. She found it distressing that she could not work out what her own sexual orientation was. How did anyone know whether they were attracted to boys, girls or both?

She also began monitoring her bodily reactions when she was with the girls in her class. Her attention became so inwardly focused that she sometimes lost track of the conversation. In the evenings, the thoughts continued and made it difficult to sleep.

Doubt about sexual orientation is not in itself OCD. In Sexual Orientation OCD, the question keeps returning and demands an answer with no doubt remaining. The doubt may concern whether a person’s orientation is different from what they had previously assumed, whether it has changed or whether they can trust their own experience at all.

For many people, the distress lies in the demand to resolve the doubt, not in any particular sexual orientation. In Sandra’s case, the body is used as a measuring instrument expected to provide an unequivocal answer.

Body scanning may involve looking at different people while checking whether sexual sensations arise. Attention may also turn to voice, clothing, movements or behaviour, as though such signs could reveal a definitive answer. The problem is that each check creates new material to interpret.

The search for certainty may also continue online or in conversations with others. The person may compare their own story with those of others, read accounts of people coming out or repeatedly ask how other people perceive their sexuality. The answer may bring relief for a moment, but it does not end the investigation.

Read more about Sexual Orientation OCD →

Paedophilia OCD: when shame and avoidance take over

Søren

As a child, Søren was quiet and very caring. In the evenings, he could sit for a long time with his pet rabbit, Ninus, because he was afraid that it might feel lonely or be frightened of the dark. He was also helpful and loved cooking with his mother.

When Søren was 11, he had a disturbing thought that he might stab his mother with a knife while they were chopping vegetables. He tried to push the thought away, but it kept returning. Søren loved his mother and became afraid that the thought meant he was a bad person. He therefore began avoiding the kitchen when she was cooking.

When Søren was 15, he watched a television report about the sexual abuse of children. Images and thoughts from the report resurfaced over the following days and caused him great distress. He tried to push them away, but they persisted. Søren began wondering whether he himself could be a paedophile and whether the fact that they kept returning meant that he was.

Gradually, he began avoiding programmes and conversations about sexual abuse, as well as anything else that reminded him of the subject. He also began avoiding places where there were children. At the same time, a new doubt arose: Could he already have done something sexually abusive and simply not remember it?

Whenever he did find himself around children, he would spend hours afterwards reviewing the situation from beginning to end to determine whether he might have done something wrong. At family gatherings, he kept his distance from the children to make sure that he did nothing. Søren told no one about the thoughts. He feared that other people would misunderstand them.

Several years later, Søren had married and was expecting his first child. OCD began taking up more space again. He sought help from a psychologist and spoke about the thoughts for the first time.

Few OCD themes are as deeply taboo as doubts about possible sexual interest in children. In Paedophilia OCD, the shame can therefore be immense. The intrusive thought is treated as possible evidence of sexual interest or risk: What if the thought reveals who I am? What if I could act on it?

In Paedophilia OCD, the unwanted doubt is followed by repeated attempts to establish what the thought means. Fear of being misunderstood may also cause the person to keep the thoughts hidden for a long time.

Søren’s mental review functions as an internal check: he replays the situation to prove that he has not sexually harmed anyone. Avoidance is intended to prevent the doubt from arising again. Both strategies reduce the distress briefly but leave the question open. His fear of harming his mother was based on the same demand for certainty, even before OCD took on a sexual theme.

Read more about Paedophilia OCD (P-OCD) →

When the content of OCD changes

Karsten

Karsten was still a child when he was told that he had OCD. He did not really understand what that meant. His mother explained that it had to do with him washing his hands again and again, staying up all night to check doors and windows, and having to count his toys. Five toys had to stand on each shelf of the bookcase; otherwise, Karsten would have terrible thoughts that his family would come to harm – and then, of course, it would be his fault.

The psychologist had also explained that thoughts are not dangerous and that an unpleasant thought cannot make anything happen. Karsten understood this, but when the thoughts came, he still felt he had to respond.

By the time Karsten turned 18, OCD was taking up very little space, and he moved away from home to live independently. The move was stressful. As he put his belongings away, one unpleasant thought after another appeared. His belongings had to be positioned “just right” or something terrible would happen. He finished unpacking but found it difficult to shake the feeling that something was still wrong.

After a while, Karsten became lonely. He bought a dog called Freja, who quickly became his best friend and made everyday life easier. During the same period, OCD began taking up more space again.

Karsten had met a girl he cared about. At the same time, he began ruminating about his sexuality: Was he actually attracted to men? The thought frightened him because the relationship meant a great deal to him. One day, a new thought appeared: What if he was sexually attracted to animals? Karsten felt sick at the thought but believed it had to mean something because it kept returning.

He began to fear that he might act on the thoughts and harm Freja. When he gave Freja to his parents, he was devastated. He explained that he no longer had time to look after her.

Gradually, he stayed at home to avoid encountering other dogs. He did not feel able to control his thoughts and was convinced that he might act on them. When his mother visited one day and saw how badly he was doing, he told her about the thoughts.

For Karsten, the theme of OCD changes. Previously, his doubt concerned dirt, locks, order and his family’s safety. Later, it turns to sexual orientation and the fear of being attracted to animals. The content changes, but each time the thought is treated as a serious threat that demands a certain answer.

When OCD doubt centres on something of great personal importance, the consequences of being wrong can feel particularly serious. Karsten treats the intrusive thought as possible evidence of a desire and therefore does not dare leave the question open.

Karsten uses rumination to try to determine what the thoughts mean. Avoidance is intended to prevent him from feeling the doubt again. First he leaves Freja with his parents, then he stays away from other dogs, and finally his life becomes confined to his home. The strategies provide a brief pause, but at the same time they make his world smaller and the thoughts more significant.

Read more about sexual obsessions in OCD →

Different themes – the same demand for certainty

For each of them, the doubt has to be resolved with certainty, whether it concerns sexual orientation, children or animals. The thought takes on greater significance because the person tries to establish what it reveals about identity, intention or risk.

They monitor their bodily reactions, search for information, ask others, review situations mentally or avoid them. The strategies differ, but they serve the same purpose: to remove the doubt. Relief lasts only briefly, and the need for a certain answer returns.

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