Obsessive compulsive disorder - OCD treatment and therapy from NOCD

How can I deal with unwanted sexual dreams? Advice from a therapist

Jul 24, 20238 minute read

Reviewed byPatrick McGrath, PhD

As a therapist, I get asked all the time about dreams: what they mean, how to cope with the ones that leave us feeling unsettled. Dreams can be some of the most disconcerting mental phenomena, because we have truly no control over what we experience in our dreams. More importantly, when we dream, we are not conscious, so we don’t really have a choice in how we respond to them, either. 

The most disturbing recurring dream that I’ve personally had? The one where I’m being intimate with my husband… who suddenly turns into my father. Yes, unwanted dreams of a sexual nature can be particularly alarming. And you’re certainly not alone if you’ve experienced them. Here are some of the scenarios I’ve heard:

Common worries about sexual dreams

  • “Am I actually gay? Why am I having sex with women in my dreams?”
  • “I’m dreaming about having sex with all of my family members. What’s wrong with me?”
  • “The other night I dreamt I was having sex with my mom and was enjoying it.” 
  • “I woke up to a violent sexual dream and found myself to be aroused.”
  • “In my dream I was touching someone I know who might have been a minor. I must be a horrible person.”

After waking up from one of these unwanted sexual dreams, many people are left feeling anxious, fearful, ashamed, disgusted and worried that their dreams mean something. What if those unwanted, intrusive sexual dreams mean that deep down, there is something dark and sinister lurking inside of me? What if my dreams are an expression of what I truly want and I’m in denial about it? 

Let’s explore the real nature of sexual dreams, and how to find relief in your waking and sleeping hours alike.

What causes dreams to be sexual in nature? 

The most common theories and explanations of dreams come from the physiological and psychological perspectives. The physiological perspective asserts that our dreams are simply neural firings in the brain. Essentially, the theory states that during sleep, more or less disordered brain activity occurs and the brain tries to find a way to make sense of it. Meanwhile, the psychological perspective states that dreaming is a way for us to process issues in our lives. 

Regardless of the reason for my intrusive sexual dream—whether it’s a physiological or psychological process at play—I know that when I open my eyes, these dreams have no place in my awake life. In fact, I know I don’t even really need to figure out why I had the dream or what it meant. Bottom line: It’s not typically useful to try to find the “hidden explanation” in a dream, especially if doing so will only leave you anxious or distraught. 

Why do intrusive sexual dreams leave me shaken up after? 

You might be wondering if it is normal to feel shaken up after waking from an intrusive sexual dream. The answer is yes: It’s common for people to experience a blip of anxiety or panic, disgust, shame or confusion after experiencing something shocking in the dream realm. Most of the time, however, these emotions fade quickly as one drifts back to sleep or gets out of bed and starts their day. In other words, they can eventually shrug it off as an utterly bizarre dream and move on with their day.

But for others, these dreams can be intensely worrying, triggering fears about what they mean. They might even feel the need to engage in behaviors during the day that are aimed at “getting rid of” the unpleasant dream or the lingering emotional effects. In these cases, it’s possible that intrusive sexual dreams may be indicative of a mental health disorder like post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD).

You can develop PTSD after living through or seeing a traumatic event. And while several criteria need to be met for diagnosis of PTSD, one of symptoms that can occur with PTSD is recurring nightmares about the traumatic event. If someone has experienced a sexual trauma, for instance, this trauma may manifest in sexually intrusive nightmares. If you have experienced a sexual trauma and are experiencing recurring dreams or nightmares about the event, it is a good idea to be evaluated by a mental health professional to determine if there is in fact a diagnosis of PTSD. 

How do I know if my unwanted sexual dream is an OCD dream?

OCD is defined by two aspects: obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, urges, and images that cause distress. Compulsions are the repetitive mental or physical behaviors that people feel compelled to engage in to eliminate the anxiety or distress that is caused by those obsessions. Compulsions offer only temporary relief, until inevitably the obsession occurs again. That’s when the compulsion is repeated, and over time this pattern of obsessions and compulsions can take up more and more hours of a person’s day, interfering significantly in their lives.

This OCD cycle, as it’s called, is important to keep in mind when trying to assess if your unwanted sexual dreams may be related to OCD. When a person without OCD wakes up after an intrusive sexual dream, they may feel distressed and anxious, but they do not regularly engage in compulsive behavior to find relief. However, if a person feels the need to engage in compulsive behaviors like reassurance-seeking or body checking after experiencing an intrusive sexual dream, then we might start looking to understand if OCD is present. Let’s consider David’s experience:  

David is a gay man who has recently been experiencing intrusive sexual dreams about having sex with his female coworkers. David wakes from these dreams feeling highly distressed and confused, and finds himself thinking about the dreams throughout his day. He wonders if maybe his dreams are trying to tell him something. 

David has also started seeking out sexual behavior with his husband, if possible, when he wakes up feeling panicked. He thinks if he is able to become aroused with his husband after waking from the dreams, this means that he does not have to worry that he isn’t gay. If he is unable to engage in a sexual act with his husband, he watches gay pornography and masturbates to reassure himself that he is in fact gay. But time and time again, the worries and feelings of uncertainty return.

These intrusive sexual dreams have started to affect his work life, as he feels anxious and distracted during the day after he awakes. David is now anxious about going to sleep. He tries to stay awake longer and wake earlier in the hopes he won’t have an intrusive dream again. David’s talk therapist believes it is necessary to evaluate him for OCD.  

As you can see, David’s example illustrates how dreams may be triggers for anxiety and compulsive behaviors in someone with OCD. Let’s take a look at some common obsessions and compulsions that may be present for someone who experiences intrusive sexual dreams.

Common obsessions about sexual dreams:

  • I am a bad person because I am having these dreams. 
  • These dreams hold a deeper meaning about who I am, and I must find out what that is. 
  • It’s only a matter of time before these things I’m dreaming about happen in real life.
  • What if I act out my dreams while I’m asleep? 
  • Avoiding going to sleep for fear of dreaming
  • Researching dream meaning incessantly
  • Seeking reassurance about sexual dream content from loved ones, friends, or therapists
  • Self-medicating with drugs or alcohol to avoid awareness of dreams
  • Mental reviewing/rumination: Continuously thinking about an unwanted dream during the day
  • Avoiding people who are in one’s sexual intrusive dreams

If your dreams are really related to OCD, then you will need a specific type of therapy. The therapy that is proven to work for OCD is called exposure and response prevention therapy (ERP). Let’s dig into what this entails.

ERP is a radically different approach from more traditional talk therapy, much of which tries to dig up the past for analysis. However, this approach taken in talk therapy often only makes OCD worse. ERP, on the other hand, is a more behavioral approach that can provide great relief from the cycle of OCD and reduce one’s long-term anxiety over their intrusive sexual dreams. Most people who do ERP with a trained OCD therapist experience a decrease in OCD symptoms, reduced anxiety and distress, and increased confidence in their ability to face their fears. 

Your therapist will guide you in resisting the urge to respond to fear and anxiety by doing compulsions that only make them worse. Over time, this allows you to tolerate anxiety about your dreams, without relying on compulsions to feel better. 

Examples exposures for OCD and intrusive sexual dreams may include:

  • Writing a script where the intrusive sexual dream happens in real life
  • Spending time with people who are triggers for intrusive sexual dreams
  • Thinking about the dream while with the person
  • Not avoiding sleep

If these things feel terrifying right now, that’s okay. The important thing to know about ERP is that you’ll work alongside a therapist to build a list of the things that frighten you—from least to most scary. Using that list, you’ll start with the things that are more tolerable, so you can build confidence before moving on to your more intense fears. 

Where to get the help you need

Remember, you are not alone. Many people who have suffered from the fear of intrusive sexual dreams have overcome this fear with the proper treatment. If you’re struggling with OCD, anxiety disorders, or PTSD—or think you might be—I strongly encourage you to learn more about NOCD’s evidence-based, accessible approach to treatment. At NOCD, all therapists specialize in OCD and receive ERP-specific training.

We specialize in treating Sexuality and Gender OCD

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