Do you ever have sexual thoughts that are so unlike who you are that they seem to come from outside of your mind? You may imagine touching someone inappropriately or having disturbing thoughts involving family members or coworkers. The first thing you should know is that having unwanted, sexually intrusive thoughts isn’t unusual. In fact, many people have them from time to time.
“It’s very common to have sexual thoughts,” says April Kilduff, MA, LCPC, LMHC, a licensed therapist and Clinical Trainer at NOCD. “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.”
But if your thoughts are disrupting your life, it may be a condition called sexual obsessive-compulsive disorder (OCD), says Kilduff. Sexual OCD involves unpleasant, intrusive, recurring sexual thoughts, mental images, sensations, and/or urges (called obsessions), and mental and physical actions (compulsions) that are done to relieve the distressing feelings caused by these thoughts.
Fortunately, sexual OCD is a highly treatable condition–which we’ll cover in this article. Given that anything revolving around sex can be seen as taboo for many, it’s not too surprising that this OCD subtype is often misdiagnosed and misunderstood. That said, we’ll also debunk some common myths and provide some insights from OCD experts on how you can seek help.
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What is OCD?
People with OCD can experience various situation-related obsessions—some may have to do with contamination, cleanliness, or a need for symmetry, while others may involve a fear of harming themselves or others or distressing sexual thoughts.
As mentioned, OCD is characterized by two main symptoms: obsessions and compulsions.
Obsessions involve a persistent pattern of unwanted thoughts, urges, sensations, feelings, and/or mental images that may cause constant worry, doubt, fear, or anxiety.
Because you can’t suppress the disturbing thoughts that show up in your mind, OCD will demand that you engage in compulsions. A compulsion is something you feel you must do to manage the anxiety and distress caused by your obsessions. Some examples of compulsions include:
- Repeatedly checking doors, locks, stoves, etc.
- Excessively cleaning or organizing
- Repeating acts, such as tapping and walking back and forth through a doorway several times
- Seeking constant reassurance from others
- Ruminating
- Counting
- Avoiding certain places or situations, or avoiding the people involved in intrusive thoughts
The problem with performing compulsions is that the relief is usually short-lived, which is why many people get stuck in an ongoing OCD cycle of obsessions and compulsions.
What is sexual OCD?
Even if the content of your intrusive thoughts is sexual, understand that it is all still OCD. Sexual OCD—as well as other subtypes—is not a formal diagnosis, but can be super helpful when it comes to discussing your symptoms. “There’s just OCD with intrusive thoughts that happen to be sexual in nature,” says Tracie Zinman-Ibrahim, MA, LMFT, CST, Chief Compliance Officer at NOCD. “People often freak out because they’re like, ‘I have sexual OCD.’ No, you don’t—you just have OCD, and that’s what your intrusive thoughts consist of.”
Several OCD subtypes may cause sexually intrusive thoughts, including:
Sexual obsessions can occur with other 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.
People often freak out because they’re like, ‘I have sexual OCD.’ No, you don’t—you just have OCD, and that’s what your intrusive thoughts consist of.
Tracie Zinman-Ibrahim, MA, LMFT, CST
Sexual OCD obsessions
It’s important to understand that intrusive thoughts linked with OCD are ego-dystonic— meaning that they conflict with your values and personal beliefs. In other words, if you have OCD, you do not wish to act on your thoughts. “OCD only attacks the things we care about, which is why it feels so distressing,” says Zinman-Ibrahim. “It’s not complimentary—it doesn’t make you feel good.”
To demonstrate this dichotomy, here are some examples of sexual OCD symptoms and how they can contradict a person’s ethical and moral beliefs.
- A dedicated minister lives in fear of losing his ministry due to repetitive, intrusive sexual thoughts about a married church member.
- A happily married school teacher, devoted to family and educational values, is overwhelmed with feelings of disgust and anxiety related to ongoing intrusive sexual thoughts about a student.
- A teenage athlete in a long-term heterosexual relationship is obsessed with sexual orientation doubts resulting from repetitive, intrusive mental images of a same-sex teammate.
Sexual OCD compulsions
Compulsions in sexual OCD may involve mental compulsions that play out in your head, are physically performed, or both. But Kilduff notes that people with sexual OCD may experience mental compulsions rather than behavioral ones.
Physical compulsions of sexual OCD may involve:
- Checking body sensations in situations that activate obsessions—like checking your sexual arousal level.
- Watching porn to see if you have a groinal response.
- Distancing yourself from people or situations that trigger sexual thoughts.
- Repeatedly tapping to relieve anxiety caused by intrusive sexual thoughts. While tapping can apply to OCD in general, Kilduff says it can show up in sexual OCD, as well. “Some people believe that tapping something in a specific way is ‘magical’ because it will prevent bad things from happening,” she explains.
And here are some examples of mental compulsions tied to sexual OCD:
- Repeatedly praying for the unwanted sexual thoughts to stop.
- Trying to neutralize your obsessions by replacing sexual thoughts with good thoughts.
- Ruminating on where the origin of the sexually intrusive thoughts came from.
- Reassuring yourself that your sexual urges involving a friend or neighbor are untrue.
- Checking whether your emotions remain consistent, regardless of unwanted sexual images involving something distressing, like cheating on your spouse.
Misconceptions about OCD with sexual themes
If you’ve been overwhelmed with guilt or self-blame about disturbing sexual thoughts, it may help to learn about some common misperceptions about this subtype of OCD. Knowing the facts may encourage you to seek professional help to learn about managing your unwanted thoughts.
- Myth: I must be a bad person because I have such bizarre sexual thoughts that don’t align with my morals.
- Fact: Many people have random intrusive sexual thoughts that don’t align with their principles. However, while some people can easily disregard these thoughts, if you have OCD, you may perform compulsions to try and get rid of them.
- Myth: I am likely to act on some of my disturbing sexual thoughts.
- Fact: People with OCD are not known to act on their obsessions, as these intrusive thoughts go against who they are and their values.
- Myth: My sexual thoughts are the cause of my anxiety and fear.
- Fact: The underlying cause of OCD symptoms is the reaction to the obsessive thought—not the thought itself.
It’s not unusual for people with sexual OCD to be confused about the cause of their symptoms. Kilduff says that even psychologists who don’t specialize in OCD can get it wrong. “OCD is commonly misdiagnosed as a sexual problem or condition, such as a pornography addiction or PTSD,” she says.
Research shows that sexual obsessions are commonly misdiagnosed as anxiety, depression, and depressive ruminations, which involves repetitive thinking about negative feelings and distress and their causes and consequences.
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How to stop sexually intrusive thoughts
In a perfect world, there would be a way to just stop the distressing thoughts—but that’s just not the case. “People try to replace, neutralize, and change thoughts, and that just doesn’t work,” says Zinman-Ibrahim. “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.”
So, how should you deal with sexually intrusive thoughts? The best treatment for sexual OCD—or any type of OCD, for that matter—is exposure and response prevention (ERP) therapy. ERP is a specialized therapy that is supported by decades of research to be the most effective method for treating OCD symptoms. “I’ve seen patients make significant progress with ERP, often sooner than they expected,” says Kilduff.
How does ERP work? First, your therapist will have you list your fears or triggers, ranking them from the least to the most problematic based on the stress level associated with each one. Initially, you’ll work on facing fears that cause the least amount of stress and gradually work towards the highest-ranked ones on your list.
For example, your therapist may ask you to visualize a sexual image you’ve been experiencing, one you consider to be least distressing. But instead of starting to ruminate on why you keep having this picture in your head, your therapist will guide you on ways to avoid engaging in a compulsion—a strategy known as response prevention.
Over time, ERP trains your brain to stop associating obsessive thoughts with the urge to do compulsions. Your brain learns that OCD is sending out false distress signals for something that isn’t actually a threat. You’ll be able to deal with sexual obsessions better than before, realizing that all of the fear was linked to hypothetical situations. You might still have obsessive thoughts, but most of the time, you can learn to just let them float on by without getting distressed or compulsively reacting to them.
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 support.
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.