Imagine one day that you are walking past an elementary school playground. You glance over at the children and, out of the blue, a thought enters your head: “Did I just look at those kids in a creepy way?” Your brain immediately begins to doubt/analyze whether your glance was creepy and you are flooded with terror: “Why would I be staring at kids?” “Do other people do this?” “Was I physically attracted to one of them?” “Is there something wrong with me?” “Did I do something inappropriate?” “Did I get aroused by the children?” “Am I a pedophile?” “Am I going to become a pedophile?” “What does this mean that I am even thinking these thoughts?”
The next time that you are in a similar situation, you were probably acutely aware and on guard for whether there were any intrusive thoughts present. Now whenever you walk by a school or a playground, you avoid eye contact with everyone. You check where your hands are to make sure that you wont accidentally touch a child inappropriately and you are on guard and panicked that you will experience more intrusive thoughts that suggest feelings for children. You may even check your genitals for signs of arousal. You worry others are looking at you and you may even begin to question what you have done. You feel your only option is to escape in order to protect the innocence of these children. You may feel that you are a monster and a bad person for having these thoughts in your brain. What you may not realize, is that you may be suffering from a very common form of Obsessive Compulsive Disorder (OCD), called Pure-O. And you are not alone.
Purely-Obsessional OCD, also known as Pure-O, is one of the most common, yet lesser known, manifestations of OCD. Fortunately, recent mainstream media attention, and a new website called www.intrusivethoughts.org, are helping raise awareness of the disorder and the different forms it comes in. People with Pure-O experience minimal observable compulsions, compared to those who experience the typical form of OCD (checking, hand-washing, etc.). While ritualizing and neutralizing behaviors do take place, they are mostly of a cognitive basis. The primary anxiety-reducing vehicle is mental rumination.
Purely-Obsessional OCD often takes the form of horrific intrusive thoughts of a distressing or violent nature and the sufferer spending a great deal of mental effort trying to check, neutralize, and avoid certain thoughts. The internal verbal behaviors encompass excessive ruminations, thought loops, mental checking, and mental avoidance of certain thoughts. Endless amounts of time is spent attempting to answer the unanswerable questions that the OCD posits. OCD is masterful at deceiving the sufferer by saying “if you just spend a little time on this question, you will figure it out and feel so much better!” Because the threat feels so real, it is extremely difficult to resist the siren’s call of mental rumination. The most imperative item on the agenda becomes gaining certainty. Often times, sufferers will replay past scenarios, making sure to examine every single “fact” that was present.
Within the subset of Pure-O, several themes tend to co-occur including fears related to pedophilia (pOCD) sexuality (hOCD), incest, bestiality and the primary romantic relationship (rOCD). This article concentrates on pedophilia OCD (pOCD). An individual living with pOCD can be simultaneously flooded with unwanted thoughts or images related to any and all of these themes. Patients have asked, “If I am attracted to a child of the same sex then doesn’t that mean I’m gay and shouldn’t be married?” If left unchecked, pOCD can bleed into numerous areas in one’s life.
In contrast, the DSM-V defines pedophilia as “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children” (APA, 2013). The diagnosis of pedophilia has absolutely nothing to do with the diagnosis of pOCD. Despite this clear distinction, your pOCD will undoubtedly be persuading you that you belong in the true pedophile category rather than the pOCD category, your therapist doesn’t really understand or your therapist is wrong. An individual living with pOCD is no more likely to be a pedophile than an individual who does not have pOCD. This is a disorder of anxiety and uncertainty, not sexual urges and behaviors. In regards to pOCD, the primitive worry-brain has randomly selected this theme as the topic that feels like it must be resolved immediately.
An individual suffering with pOCD will experience intrusive thoughts or images (spikes) accompanied by terrorizing anxiety. The OCD has the ability to produce doubt or question memories, real or imagined. Additionally, sexual urges are monitored and encoded as part of the evidence-gathering process. The presence of an erection or vaginal lubrication is closely examined for signs of arousal. Based on the importance that pOCD places on sexual attraction, your brain constantly draws attention to sexual arousal. This increased monitoring allows for a case of mistaken identity in which any microscopic movement is determined to be arousal towards children. Taken together, unwanted thoughts, images and urges can persuade an individual with pOCD that they are a sexual deviant.