Sexual Obsessions: Misunderstood and Misdiagnosed

Extreme and unusual sexual thoughts are often under-reported and under-treated.

Posted Apr 21, 2020

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By John Hart, Ph.D.

People who repeatedly experience extreme and unusual thoughts of a troubling sexual nature may suffer from an often-misdiagnosed sexual obsession. Sexual obsessions are a type of obsessive-compulsive disorder (OCD), which affects a significant percentage of the 1 in 40 people who suffer from OCD. Research and clinicians have found that this condition is under-reported, under-recognized and undertreated.

Individuals suffering with sexual obsession experience unwanted thoughts that he or she considers disturbing—or even horrifying—because the thoughts are so uncharacteristic of his or her personal world view and moral system. For some, these thoughts can be so intense that they physically feel as though they could be true, but typically, the person knows they are not true. It can be common for the individual to worry that if these distressing thoughts continue or even intensify, he or she may act upon them. Other times people may know that they would never act on their obsessions but the experience of having the thoughts seems like a moral violation.

Unfortunately, many people with sexual obsessions are misdiagnosed with another psychiatric disorder or are in denial of their already established sexual orientation. For example, recent research has shown that many mental health professionals will misdiagnose pedophilic obsessions with pedophilia, risking unnecessary and troubling reports to authorities.

Sexually intrusive thoughts may involve:

  • Unpleasant, intrusive thoughts inconsistent with one’s sexual orientation
  • Thoughts about doing awful, improper or embarrassing acts of a sexual nature that the individual doesn’t want to do (including sexual acts with children or authority figures)
  • Thoughts about forcing someone to do something sexually or of being forced to perform a sexual act
  • Repeating an action or following a special routine because of sexually intrusive thoughts
  • Mentally performing an action or saying prayers to get rid of an unwanted or unpleasant sexual thought

Sexual Obsession Suffering Can Intensify If Left Untreated

People who are plagued by these thoughts often misinterpret their anxious reactions as an impulse to do these things or a sign of arousal. Many OCD mental health care specialists consider these thoughts to be “ego-alien,” with alien meaning they are differing in nature or character, typically to the point of incompatibility. Simply stated, these obsessions are contrary to the individual’s moral compass.

People who suffer from sexual obsession will never act upon their disturbing thoughts because they are so far from their nature. However, the disgust they develop for themselves as a result of having these thoughts can create a crippling fear that can impair everyday functioning, forcing them to shutter themselves at home or to avoid interaction with people, even friends and family.

Other complications can include:

  • Intense shame and guilt
  • Fears of social rejection (real or perceived)
  • Greater personal significance attached to their thoughts than for other sufferers of OCD
  • Overuse of a self-punishing thinking style to control or suppress thoughts and images
  • Less self-compassion than other forms of OCD as well as other conditions

Although this painful condition may feel embarrassing to discuss, trained mental health care professionals assure individuals that help is available and leaving the disorder untreated or self-treating may amplify the severity of the condition. Individuals who suspect they might be experiencing sexual obsession or have a loved one who is facing these scenarios should seek assistance. Here are some suggested steps:

  • Find a qualified specialist in OCD who utilizes cognitive-behavioral therapy with exposure and response prevention, which guides the patient through their obsessional experience of distress to help them develop a tolerance to their distress and reduce their compulsive behaviors and avoidance of valued behavior and normal daily behaviors. A trained health care professional can work with an individual to create techniques for themselves to cope with the emotional and physical disruptiveness of their obsessive thoughts.
  • Learn more information online at the International OCD Foundation, a nonprofit which helps those affected by OCD and related disorders to live full and productive lives; or the Peace of Mind Foundation, a nonprofit which improves the quality of life of OCD sufferers and caregivers through education, research, support, and advocacy. Visit the Psychology Today Therapy Directory to find an OCD specialist near you. 

John Hart, Ph.D. is the Anxiety Disorders Consultant with The Menninger Clinic, where he has been affiliated for over three decades. He was with the Menninger Clinic OCD Treatment Program since its inception and has presented nationally and published extensively on the nature and treatment of OCD disorders.

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