POCD is simply obsessional OCD with the pedophile theme. That is, the person worries that they are a pedophile, that they are aroused by children and that they want to have sex with children. This is only one of many themes that pure obessional OCD takes. It seems to be increasing in recent times due to the mass hysteria surrounding pedophilia and child molesting in general.
Since writing articles on theme, I have received many requests for help from people who fear that they may be suffering from this condition. In working with someone with the pedophile theme, it is essential first of all to figure out whether there is any actual pedophilia going on. I have dealt with a large number of persons with this worry so far, and I haven’t met a pedophile yet. I assume that pedophiles are simply not going to come to me for help.
However, in a number of cases, the line between pedophilia and POCD is quite difficult to discern. The following case will illustrate some of the difficulties involved.
A young man, age 28, came seeking help with a possible case of pedophile theme OCD. He laid out a very confusing and complicated case that was hard to figure out.
He said he was seeing a therapist. I asked for the diagnosis given by the therapist, who was an expert in OCD. The therapist said it was POCD and not pedophilia. I asked what the basis for the diagnosis was.
The man said that the therapist said the thoughts, etc. were ego-dystonic, therefore they were OCD. I agreed with this in principle. Ego-dystonic, ego-alien, etc. thoughts will generally tend to be OCD and not something else. A true pedophilic orientation is probably not truly ego-dystonic in nature.
I asked the man whether or not he resisted the thoughts. He said he tried to, but was not always successful due to the thoughts fighting back. He then said that he had “wars in his mind” going on pretty much 24-7 over this issue. This seemed to clinch that we were dealing with OCD here and not something else. OCD thoughts are resisted but not always successfully since the thoughts fight back. As they fight back, one ends up with a war in one’s mind.
An attempt was made to discern the man’s true sexual orientation. It is my opinion that true, fixated preferential pedophilia (the only kind I am concerned with) comes on at a very young age, at the latest 13-14 and often much younger.
The man had engaged in some child sex play involving other boys. Child sex play is often found in the background of people with POCD and serves to the feed the pedophile fears. The sex play involved swatting each other on the rear end or something to that effect. The man admitted that it had been arousing.
However, as his sex drive came on, he had only a strong orientation towards females of his own age and up. He had no attraction towards males or children.
He had a good, strong, healthy sex drive along these lines until guilt triggered the child sex play memories, and he started worrying about whether or not he was a pedophile. This occurred at around age 16. The thoughts had continued and only increased in the ensuing 12 years.
Curiously, though he was clearly heterosexual, the POCD took the form of thoughts about boys, which didn’t make much sense to me. As he worked deeper and deeper into this guilt and POCD worry syndrome, he began to feel his normal attraction to females diminishing.
At the same time, he was awkward in school and frequently bullied. Girls were mean to him, and he was rejected countless times. This led to plunging self-esteem and increased POCD symptoms.
He then went to college and majored in History, but the symptoms only got worse. He ended up having relationships with women, including a sexual one recently. However, either the POCD or the anxiety in general took out his sex drive such that he simply had little to no drive anymore. He could barely sustain an erection. The relationship with the woman failed due to chronic impotence, tragically at the young age of his mid-20′s.
Later his sex drive came back to some extent, but even then, although he was able to ejaculate, he could only get partial erections.
This long, drawn out and sad history had taken a heavy toll on his self-esteem. Self-esteem issues were obvious on first talking to him over the phone, when he displayed a meek and self-apologetic demeanor. He also had heavy defenses up in that he didn’t want to deal with some of the self-effacing behaviors or the self-esteem issue.
He also had a somewhat wooden and heavily intellectualized voice which lacked emotional depth and sounded like “Spock” on Star Trek. He was told that the wooden and intellectualized demeanor would result in problems in dealing with others, particularly females, who would see it as lack of emotionality.
I informed him that the self-esteem issues were primary here and were feeding into the POCD and vice versa. I feel that self-esteem is very hard to build up from a base of nothing. Generally, good high self-esteem is based on success in life, which builds confidence at least and egotism at most. If one is not having any successes, it’s hard to build up self-esteem where successes seem to be a requirement. I feel that building self-esteem may be one of the toughest therapeutic issues out there.
When asked how the pedophilic thoughts felt, he admitted that he found them somewhat arousing, though he also felt terrified, horrified, sick and nauseous. The dominant emotions associated with the pedophilic thoughts seemed to be fear and sheer terror. This seemed more in line with POCD than with pedophilia.
I told him I agreed with the diagnosis the therapist had made, that this was POCD and not pedophilia.
Cases where the POCD comes on early in life such as the teen years in males are bound to cause much confusion. I do not believe that people develop pedophilia after puberty, and certainly not after puberty and against their will. Feelings of sickness, nausea, fear, terror and the like, whether or not accompanied by sexual arousal, seem to point towards POCD.
A good strong normative sex drive towards age appropriate or older and mature peers is a good guess that there is no pedophilia going on. Where a strong and healthy age-normal sex drive radically diminishes or vanishes over time to be replaced by a terror-stricken pedophilic “attraction,” this will look like POCD.
People do not develop strong, healthy age-appropriate drives only to see them vanish in front of their eyes to be replaced by a frightening pedophilic orientation. Any case of radical diminishment of a healthy and normative drive and its replacement by a frightening new drive, all occurring against the person’s will, after ages 13-15, is typically indicative of some sort of sexual OCD.
This case also shows, sadly, the dramatic effects of sexual OCD or possibly just anxiety on the strong sex drive of a young man. The sexually diminishing effects of anxiety or sexual OCD are in need of further investigation.
The following schemata illustrates the case above well:
True attraction: Mature females
Fake attraction: Male children