if any, between POCD and true pedophilia? How does one know which they have? If someone is a pedophile, should they seek therapy or have themselves locked away?

A: Pedophiles are sexually attracted to children and prefer children over age-appropriate partners. Many refuse to acknowledge that it is harmful to children and justify acting on their preference. In POCD, on the other hand, the focus is on the OCD. People with POCD are afraid they might be attracted to children, know that it is both illegal and harmful, and check and double check their own thinking to make sure they aren’t pedophiles. They become obsessed with the topic and do everything they can to prove to themselves that they are not ever going to act inappropriately.The thoughts go around and around and around, interfering with the person’s ability to be comfortably with children or to function socially. It can be so disturbing that the person withdraws from society as a way to protect both self and others from what he (usually it’s a “he” but there have been cases of “shes”) believes he might do. Having the thoughts of POCD doesn’t make a person a pedophile. Molesting children does.

Proper diagnosis is essential to treatment. In some cases, what looks like symptoms of pedophilia is caused by an undiagnosed and untreated mental illness (like antisocial personality disorder, bipolar disorder, or ADHD). In some cases, the apparent pedophilia is the result of a brain tumor or lesion. Treatment of the underlying disorder ends the behaviors.

Genuine pedophilia and POCD are both treatable conditions. Prozac has been used for both. Anti-androgens are sometimes helpful for the pedophile who feels such a strong attraction to kids that he wants medical help to manage his sexual impulses toward children. Anafranil is sometimes used for OCD. For more information about psychopharmacological treatment, you should see your psychiatrist. Therapy by someone who has experience with the diagnosis is an important concurrent treatment for both conditions.

We don’t lock people up in the U.S. for having thoughts, even thoughts about illegal or immoral behaviors. People go to jail for their actions. People with pedophilia can learn the necessary impulse control so they don’t act on their thoughts. People with POCD can get relief from the constant anxiety that they might do something that they find detestible.

I wish you well.
Dr. Marie