Have you ever had a sexual thought so unlike you, so foreign, that it felt like it came from outside your mind? Maybe you’ve imagined inappropriate interactions with people you care about, like family members, coworkers, or friends. These intrusive thoughts may feel completely at odds with your values, creating confusion, guilt, and anxiety.
As NOCD therapist April Kilduff, MA, LCPC, LMHC, explains, “It’s very common to have sexual thoughts. Often, your brain can produce these intrusive thoughts, but they don’t mean anything to you. They’re just blips of mental activity, even when they are strange.”
However, if these thoughts are recurring, overwhelming, and start affecting your relationships or daily activities, you could be dealing with a subtype of obsessive-compulsive disorder (OCD) called sexual OCD.
The good news? Sexual OCD is treatable, and you’re not alone in experiencing these thoughts. In this article, we’ll explore how you can manage it. We’ll also clear up some common myths surrounding this condition and provide expert insights on how to get the help you need.
What is sexual OCD?
Sexual OCD is a subtype of obsessive-compulsive disorder (OCD) characterized by intrusive, distressing sexual thoughts, images, or urges (obsessions) that conflict with your values. These thoughts trigger compulsions—mental or physical actions performed to relieve the anxiety caused by the obsessions. Common compulsions include mentally repeating words or phrases to neutralize the thoughts, avoiding triggering situations, or seeking reassurance. Unfortunately, these actions offer only temporary relief, trapping people in a cycle of obsessive thoughts and compulsive behaviors.
It’s important to recognize that even though the intrusive thoughts are sexual, they’re still part of OCD. You may have sexual obsessions, but you would never want to act on these thoughts. The discomfort stems from the contradiction between your values and the nature of the thoughts.
Sexual OCD can manifest in different ways, including:
- Sexual orientation OCD (SO-OCD): Doubt about one’s sexual orientation, often driven by intrusive thoughts that conflict with one’s true identity.
- Bisexual OCD: A form of SO-OCD focused on confusion about being bisexual.
- Relationship OCD (ROCD): Intrusive thoughts about one’s relationship.
- Religious (Scrupulosity) OCD: Obsessive worries about sexual misconduct or sin, often tied to religious beliefs.
- Pedophile OCD (POCD): Fear of being attracted to children, even though the person with OCD has no desire to act on such thoughts.
Sexual obsessions can overlap with other OCD themes, as well. “Sexual content can also fall under the harm OCD umbrella because you may be afraid you’re going to cause sexual harm,” says Zinman-Ibrahim.
Common sexual obsessions and compulsions
| Obsession | Compulsion |
| Sexual thoughts about a married person: A minister fears losing his ministry due to intrusive sexual thoughts about a church member. | Seeking reassurance: Asking others for confirmation that the thoughts are untrue. |
| Sexual thoughts about a student: A married teacher experiences intrusive sexual thoughts about a student. | Avoidance: Avoiding being around students or school-related situations. |
| Fear of taboo or immoral actions: Intrusive thoughts about incest or sexual violence. | Mental rituals: Trying to mentally neutralize the thoughts or replacing them with other thoughts. |
| Religious or sacrilegious thoughts: Obsessive thoughts about engaging in sexual acts in a place of worship. | Tapping or ritualized behavior: Repeating specific actions to feel “safe” from the intrusive thoughts. |
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Misconceptions about sexual OCD
If you’ve been struggling with guilt or self-blame due to intrusive sexual thoughts, it’s important to understand some common misconceptions about this OCD subtype. Recognizing the facts can help you seek professional help and begin managing your thoughts more effectively.
Myth: I must be a bad person because I have such bizarre sexual thoughts that don’t align with my morals.
Fact: Many people experience intrusive sexual thoughts that conflict with their values. However, while some can easily dismiss them, those with OCD may feel the need to perform compulsions to try to get rid of them.
Myth: I am likely to act on these disturbing sexual thoughts.
Fact: People with OCD are highly unlikely to act on their obsessions, as these intrusive thoughts go against their values and moral beliefs.
Myth: My sexual thoughts are the cause of my anxiety and fear.
Fact: The anxiety in OCD is caused by the reaction to the obsessive thought–not the thought itself. The fear comes from the distressing nature of the thought, not from any desire to act on it.
Myth: Sexual OCD is just a sexual problem or addition.
Fact: Sexual OCD is often misdiagnosed as a sexual issue, like a pornography addition. It’s actually an anxiety disorder where intrusive sexual thoughts trigger compulsions. Even professionals may misdiagnose it.
Myth: My sexual obsessions are just anxiety or depression.
Fact: Research shows that sexual obsessions are often misdiagnosed as other mental health conditions like anxiety, depression, or depressive rumination. However, the compulsive behaviors and distress caused by intrusive thoughts are key indicators of OCD.
Can I stop my sexual intrusive thoughts?
In a perfect world, it would be effortless to eliminate distressing thoughts–but that’s not how OCD works. As Zinman-Ibrahim explains, “the more you try not to do something, the more it happens. You can make your OCD worse and more intense, which can increase your distress.”
Instead of battling with your thoughts, the key is to change your relationship with them. Accepting that you cannot control every thought can help reduce their power and impact on your life.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Treatment for sexual OCD: exposure and response prevention (ERP) therapy
The most effective treatment for sexual OCD–and OCD in general–is exposure and response prevention (ERP) therapy. ERP is a specialized form of cognitive behavioral therapy (CBT) supported by decades of research and proven to help reduce OCD symptoms. Research shows that ERP therapy is highly effective, with 80% of people with OCD experiencing a reduction in their symptoms.
So, how does ERP work?
First, you and your therapist will create a hierarchy of your OCD triggers. These are situations or thoughts that cause you the most anxiety, ranked from least to most distressing. You will begin by confronting the least stressful triggers first, working your way up as you gain more confidence in handling your thoughts without resorting to compulsions.
For example, your therapist might ask you to visualize a sexual thought that causes discomfort, but instead of analyzing why it happens or reacting with anxiety, you’ll practice response prevention—actively resisting the urge to perform a compulsion, such as mentally neutralizing the thought or avoiding it altogether.
As ERP progresses, your brain begins to unlearn the automatic distress response that comes with obsessive thoughts. You’ll start realizing that the fear is tied to hypothetical scenarios, and not an immediate threat. Though you may continue to experience intrusive thoughts, the goal is to eventually let them pass without giving in to the compulsion or feeling overwhelmed.
Bottom line
Everyone has intrusive thoughts that are sexual in nature. However, if you’re having sexual obsessions that are causing significant distress, you’re probably doing everything in your power to get rid of them. While there’s no cure for intrusive thoughts—or OCD as a whole—many people are able to lead happy and fulfilling lives with ERP therapy.
If sexually intrusive thoughts are an ongoing problem, consider working with a therapist specializing in ERP to address your obsessions and compulsions and start your treatment journey.
Key takeaways
- Intrusive sexual thoughts are common and do not reflect your values or intentions.
- Sexual OCD is a subtype of obsessive-compulsive disorder that involves distressing sexual obsessions and compulsions.
- Sexual OCD is highly treatable with exposure and response prevention (ERP) therapy, a specialized form of cognitive behavioral therapy (CBT) designed to treat OCD.