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“Am I a Pedophile?” The difference between POCD and pedophilia

9 min read
Patrick McGrath, PhD
All types of OCD include obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, feelings, urges and doubts, while compulsions are repetitive physical or mental actions performed in an attempt to relieve distress and anxiety.

There’s a small number of things nobody ever wants to talk about. You can probably come up with most of them—imagine yourself around the dinner table with family or friends, and think of the last conversations you’d like to have.

One of these topics, pedophilia, is likely to summon strong feelings whenever it’s brought up. Public reactions to news stories can remind us of how serious we are—or should be—about protecting children. And our outrage makes a lot of sense: nobody is more vulnerable than kids, and sexual advances on them are inherently violent. It’s so disturbing to hear about these things, because we wish deeply that they would never happen at all.

But for some people, these rightfully strong feelings can give rise to other negative outcomes, like Pedophilia OCD (POCD), which involves distressing, intrusive thoughts or worries about the possibility of being attracted to children. But before we get into a discussion about pedophilia OCD, we first need to understand pedophilia itself—likely a difficult topic for many.

What is pedophilia and how is it identified?

Pedophilia is a sexual attraction to children. It was defined in the late nineteenth century but has been researched only in the past few decades. It’s known as pedophilic disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the big book that most mental health clinicians in the United States use to diagnose their clients. A pedophile has intense urges toward, and fantasies about, children; these must persist for some period of time (six months according to DSM-5) and may or may not be acted upon. Not all pedophiles are child molesters, and vice versa—pedophiles fantasize about children, and child molesters sexually abuse them.

Different authorities disagree about the specifics, but pedophiles are generally thought to be over the age of 16 and at least five years older than the subject of their thoughts. The child they fantasize about is prepubescent—age 13 or younger. These details aside, pedophilia is one of the most feared psychiatric disorders. A 2015 study found that pedophiles are subject to anger and social rejection even if they haven’t acted on their thoughts (a significant portion of respondents to one survey said pedophiles “should better be dead”). Many surveys rank child sexual abuse as worse than murder. And, as researchers have often suggested, these public beliefs probably discourage many pedophiles from getting help.

Pedophilia vs. Pedophilia OCD

Sexual thoughts and urges about prepubescent children are, by definition, enjoyable to pedophiles. They may feel ashamed about their thoughts, scared about what will happen because of them, resolutely opposed to acting on them, and so on; but children are still the primary (and sometimes the only) objects of their sexual fantasy.

However, many non-pedophiles experience similar intrusive thoughts and urges, spontaneously and in opposition to their real desires. Someone with no history of pedophilic thoughts or urges might be hanging out with a child and suddenly think, What if I touched that kid right now? Although the thought seems very strange and disturbing, most people shake it off: That isn’t me. I didn’t like that. Oh well. It’s by no means enjoyable, but the thought causes them no real disturbance. Like a random thought about driving off the road or shouting during a meeting, it fades quickly.

But another group responds very differently to these thoughts, which feel like a threat to everything they believe they really are. They have a form of obsessive-compulsive disorder (OCD) referred to as pedophilia OCD, or POCD. Like any subtype of OCD, POCD involves obsessions (intrusive, unwanted thoughts) and compulsions (repetitive behaviors aimed at getting rid of the distress caused by obsessions). But with POCD, symptoms follow a very specific theme: unwanted sexual thoughts about children.

The crux of POCD is that people aren’t 100% sure if they really would act on their thoughts. They never feel certain that they can trust themselves, and are prone to compulsively mitigating the risk they perceive. This might look like: 

Obsession: What if I sexually abused a child and somehow forgot?
Compulsion: Turning down babysitting jobs and avoiding children in public

Obsession: Could I really be a pedophile?
Compulsion: Look up articles about famous pedophiles every day and compare oneself with them

Obsession: Suddenly picturing a sexual act with a child
Compulsion: Make oneself list ten reasons they’d never be attracted to a child and reading it silently every day

Typically, POCD compulsions revolve around past, present and future behavior. Here are some examples:

  • Mentally reviewing present and past experiences for “evidence” of pedophile behavior
  • Looking for events in your past that may have lead you to have pedophilic thoughts today
  • Ruminating on whether you could become a pedophile in the future and brainstorming preventative measures
  • Checking if you have a physical sensation or groinal response after seeing a child
  • “Testing yourself” to see if you are still attracted to adults
  • Avoiding places where children might hang out
  • Watching documentaries on pedophiles to collect “evidence” by self-comparison
  • Being hypervigilant around children and reviewing other’s behavior around children, comparing it with your own.

Research suggests that POCD, while common among people with OCD, is unnoticed and misdiagnosed in most patients. This suggests that the shame surrounding these thoughts is so strong that people don’t even want to tell their therapists. That’s why we need brave people to set a precedent and share their difficult stories.

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Specialized OCD treatment is more accessible than ever. NOCD accepts most major insurance plans to help you start getting better.

A young mom with pedophilia OCD: Kate’s story

For the first six months of my daughter’s life I had thoughts of killing her; it consumed my every waking moment. She had died a million times in my head. But one day that all changed.

I was reading my usual Hollywood gossip pages when there was a story about Mark Salling, the actor from Glee, being arrested for child pornography. And from that moment on it was like a switch was flicked in my head and my usual killing thoughts (which I had started to get used to) became more sinister. What if I molest my daughter? What if I’m a pedophile and don’t know it?

I honestly thought I could turn into a pedophile overnight and harm my daughter. From then on, I was terrified to change her, bathe her—any time a body part of hers was exposed, I would have a panic attack.

It didn’t end there. OCD wouldn’t let me get away with it that easily. I was scared to walk past schools in case I looked like a pedophile, especially when it was break time and kids were playing on the playground. Did I look at them in a creepy way? Do I look like a pedophile?

This kind of OCD takes you into utter darkness, so much so that I contemplated ending my life because I couldn’t cope with another thought. Even while writing this I’m very conscious of the language I use: I don’t want someone to think that I am a pedophile.

You see, that’s how screwed up OCD is: it convinces you that you are what it says you are, even with zero evidence. However, I have come to realize that OCD wants you to keep your thoughts secret. It doesn’t want you to bring them into the light where they might have to face some rationality.

So, if you’re suffering, what do you need to know? Well, you need to see these pedophilic thoughts like any other intrusive thought, because that’s all they are. The big difference between someone with OCD and a pedophile is how they react to the thought that they might be one.

“How do I know that I am not a pedophile?”

It bears repeating that sexual thoughts and urges about prepubescent children are, by definition, enjoyable to pedophiles. This is not the case for people with pedophilia OCD. A quick gut check is to ask you what happens when you have these thoughts:

If the answer to any of these questions is yes, or you relate to Kate’s story, it could be time to be evaluated for pedophilia OCD.

Talk therapy doesn’t work for OCD. This does.

NOCD clinicians are trained to treat OCD with the only solutions proven to work for over 80% of people.

You can recover from POCD—Here’s how treatment works

Exposure and response prevention (ERP) therapy, conducted by a licensed OCD therapist, is the best way to recover from OCD—including pedophilia OCD. This unique therapy is specifically designed to help people face their obsessions and resist compulsions.

A typical ERP exercise program will start slow so you don’t become overwhelmed, then gradually and intentionally approach more difficult therapy exercises as you get more comfortable. For example, you might start by simply saying some uncomfortable words out loud in therapy sessions: “pedophile,” “child molester,” and so on. Later, you might watch a YouTube video with children in it, or spend time with a friend who has a young child. Later on, you’ll be prepared to do something like going out in public where children might be present, like a restaurant or movie theater, learning to engage in the parts of your life that POCD has taken away from you.

If at any point the ERP exercise feels suddenly overwhelming, you are able to take a step back and revisit a former step before moving on to the next level. Taking a step back is part of the learning process, and never a failure. The possibilities of ERP are endless, creative, flexible and effective.

Where to find treatment for POCD

If you come away from this article with anything, let it be hope: you can access effective, evidence-based treatment for POCD. You don’t have to live like this forever, and you don’t have to keep your distressing experiences to yourself—even if it feels impossible to share your intrusive thoughts with anyone right now.

I know from extensive personal experience that POCD is something you can recover from, and that help is available to you. Here at NOCD, every one of our therapists has intensive, specialized training in treating taboo OCD subtypes like pedophilia OCD, and they’re uniquely prepared to get you on the road to recovery.

NOCD Therapists specialize in treating P-OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

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