Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Can I trust myself around children? A therapist’s advice

By Grant Stoddard

Aug 22, 20238 minute read

Reviewed byApril Kilduff, MA, LCPC

Around 2% of people—that’s tens of millions of people globally—will meet the diagnostic criteria for Obsessive-Compulsive Disorder (OCD) at some point in their lives. For some, the condition will focus on themes of contamination or symmetry. Others may find that their OCD latches on to their relationship or the meaning of life itself. 

Regardless of its topic of focus, this widely misunderstood condition will cause intense anxiety, steal hours of your day, and prevent you from being the best version of yourself. But when your intrusive thoughts and obsessions are focused on fears that you could be sexually attracted to children or abuse them, it can feel like you’re living in a nightmare—an experience that’s understandably difficult to share with anyone, especially a healthcare professional who would be mandated to report if there was any actual danger to minors.   

Though rarely portrayed in the media, pedophilia OCD (POCD) is a relatively common form of the disorder. In this article, we’ll explain why intrusive thoughts and obsessions about sexually harming children do not reflect OCD sufferers’ true desires or values. We’ll also take some time to explain what the OCD cycle is and how it can be broken with a specialized form of OCD treatment that’s highly effective and more accessible than ever.   

OCD explained 

Before we get into POCD and whether people who suffer from it can genuinely trust themselves around children, let’s take a step back to understand OCD more generally. 

It all starts with an intrusive thought. Intrusive thoughts are bizarre, unwanted ideas, words, urges, or mental images that appear randomly in people’s minds and are an incredibly common phenomenon among the general population. For most people, these thoughts are relatively easy to dismiss as unimportant. If you have OCD, however, dismissing these thoughts can feel impossible. You’ll find them intensely distressing or worrying, and you’ll feel driven to suppress them, avoid them, or figure out what they say about who you are. Within moments an innocuous, universal mental glitch has become an obsession—the O in OCD. 

The kinds of obsessions people with OCD have are widely varied. What they all have in common is that they produce a high level of distress or anxiety, and always go after what is most important and valued to each person. To reduce that distress or prevent something that they fear might happen, people with OCD engage in compulsions. Compulsions are repetitive behaviors or mental rituals done in response to obsessions, and can take many different forms, including asking for reassurance from others, avoiding certain situations, repeating certain words or phrases, praying excessively, researching one’s fears online, among many more. These compulsions may make people feel better for a little while, but they only end up strengthening and perpetuating the cycle of obsessions, anxiety, compulsions, and temporary relief. 

The nature of this cycle means that, without treatment, OCD symptoms tend to get worse over time if they’re not treated. Strained relationships, reduced productivity at work, and an inability to do the things you love to do are common consequences of untreated OCD. Sometimes, the condition can be completely debilitating, putting sufferers at a higher risk of developing other mental health conditions, substance use disorders, and even suicide. 

Tragically, people are especially likely to suffer in silence without accessing effective treatment when their obsessions are particularly taboo—such as intrusive sexual thoughts, images, or urges about minors.

What are ego-dystonic thoughts? 

A little earlier, we mentioned how people with OCD will believe their obsessive thoughts must mean something about themselves and, quite often, feel the need to figure out for sure if they’d ever act on them. The answer is a strong no; their thoughts don’t mean they’re any more likely to harm children than anyone else. If anything, they mean quite the opposite, because the obsessions people with OCD have are known as ego-dystonic.    

An ego-dystonic thought is a thought that directly opposes who you truly are, one that goes against your values, beliefs, and desires. That’s exactly why these thoughts cause so much distress: they clash with your real intentions and identity. 

“When someone with POCD is asking whether they can be trusted around kids, the answer is going to be yes,” says Aaron Hensley, MSW, LCSW, an OCD specialist at NOCD. “That’s because OCD is excellent at latching on to what you care about most and makes you obsess over the outcomes you’d want to see the least. An actual pedophile might be very concerned about the consequences of their actions, like getting caught or being judged harshly by others, but they would be less likely to grapple with what their desires mean or say about who they are. With someone who has OCD they’re the absolute opposite. They’re ego-dystonic.” Or perhaps, in more plain language: OCD is a liar.

Scenario: Paula

Paula is meeting up with a good friend she hasn’t seen in a few months when she has a sudden, brief thought about her friend’s fourteen-year-old son being handsome. Paula’s OCD means that this perfectly normal observation gets lodged in her mind and becomes an obsession. In short order, she’s ruminating on grave doubts about who she is and whether she’s a monster.  

“If I found my friend’s kid attractive, that means I must be a pedophile. What other explanation is there?” 

“What if I act on my thoughts next time? What if Paula wasn’t there with me? Can I ever trust myself around minors?” 

“I just can’t stop thinking about that thought I had. That must mean it’s important.”

This uncertainty provokes a lot of anxiety for Paula. To reduce her distress, Paula engages in several compulsions, including reviewing her past interactions with children, researching in countless online forums about what makes someone a pedophile, and avoiding any scenario where children will be present. When her friend asks her to come over to a family barbeque, Paula scrambles to devise excuses for her inability to make it and any other subsequent dates. 

These compulsions give Paula a momentary escape from her anxiety, but her fears and compulsions gradually occupy more and more of her time. She pulls back from all social activities and public areas where children may be present, and her relationships with friends and family become strained. 

Though Paula may have mentally acknowledged that her friend’s son had become tall and handsome since she’d last seen him, she is not a pedophile. The obsessive thought that she could act on her casual observation—or that the observation itself is meaningful or dangerous—has all the hallmarks of OCD. 

Luckily, in her ceaseless quest for reassurance that she is not, in fact, a pedophile, Paula happens upon an article much like this one. Not only does the article suggest that her experience could be OCD, it lets her know that a highly effective treatment for the condition exists.   

Exposure and response prevention (ERP): reclaiming control

Considered the “gold-standard” therapy for OCD, exposure and response prevention (ERP) therapy was developed back in the 1960s, specifically for the treatment of OCD. ERP is designed to help people confront their obsessions or distressing thoughts while refraining from performing compulsive behaviors. 

Exposing yourself to situations or triggers that typically provoke anxiety, then deliberately resisting the urge to engage in compulsive behaviors allows you to interrupt the vicious cycle that keeps OCD going. When you no longer rely on compulsions for a short-term escape from your obsessions and discomfort, your brain can learn that your intrusive thoughts about harming children don’t mean anything about who you are, and that you can tolerate uncomfortable feelings rather than avoiding them.

ERP has proven to be highly effective in helping people manage OCD symptoms. Numerous studies have shown that it can significantly reduce the severity of obsessions and compulsions, leading to improved daily functioning and a better quality of life in around two thirds of people with OCD, often in just a few months of regular sessions and homework.

“There are a whole lot of exposures we can do with people who have POCD,” explains Hensley. “We might do what we call imaginal exposures that look at your imagined worst-case scenario. I might ask them, ‘If you were at the park with a child, what are you afraid will happen? Are you gonna be cast out from society? What are your deepest fears there?’ Then, we work up from there. I’ve used stock images of children and asked the person with POCD to compliment the child’s appearance in a normal and healthy way. It’ll make them a bit uncomfortable, but it helps them learn that they can sit with that discomfort without turning to compulsions. It doesn’t mean anything about who they are or what they’re going to do.” An OCD Specialist, like those at NOCD, will recognize POCD as a painful disorder to be treated, not an actual threat to be reported.

Your therapist will provide support, guidance, and feedback throughout the process. They’ll help you navigate difficult emotions and challenges that often arise during treatment. ERP often includes assignments to practice outside of therapy sessions—often perfectly normal activities like walking by a nearby park rather than avoiding it, or watching a movie that features a child actor. These assignments reinforce what you’ve learned and help generalize the skills to real-life situations.

Living with ego-dystonic thoughts related to children or any other distressing topic can be incredibly challenging, but it’s important to remember that these thoughts don’t define you. By understanding that intrusive thoughts are inconsistent with your true self and engaging in ERP treatment, you can overcome the grip of obsessions and compulsions. You deserve to lead a fulfilling life that aligns with your values and aspirations, and ERP can help you get there. 

Getting the help you need

If you think you may have POCD and want to learn how ERP can treat it, schedule a free 15-minute call with the NOCD Care team to discover how we can help you. 

All of our therapists specialize in OCD and receive ERP-specific training. You can also get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.

We specialize in treating Harm OCD

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