Sexual obsessions
Encyclopedia
Sexual obsessions are obsessions with sex, and in the context of obsessive-compulsive disorder
(OCD) these are extremely common (Foa et al., 1995). It can become extremely debilitating, making the sufferer ashamed of the symptoms and reluctant to seek help. Preoccupation with sexual matters, however, does not only occur as a symptom of OCD and may be enjoyable in other contexts (i.e. sexual fantasy).
involves unwanted thoughts or images that are unsettling or interfere with an individual's life, followed by actions that temporarily relieve the anxiety caused by the obsessions (APA 2000). Obsessions are involuntary, repetitive, and unwelcome. Attempts to suppress or neutralise obsessions do not work and in fact make the obsessions more severe. OCD is considered an anxiety disorder
.
Typical obsessive themes center on contamination, illness, worries about disaster, and orderliness. However, people with OCD also obsess about violence, religious questions, and sexual experiences. Up to a quarter of people with OCD may experience sexual obsessions, and OCD sexual obsessions have been linked to childhood sexual abuse of OCD sufferers. Repetitive sexual thoughts are seen in many disorders in addition to OCD, but these disorders bear no relation to OCD. For example, sexual thoughts unrelated to OCD are common to people with paraphilia
s, post-traumatic stress disorder
, sexual dysfunction, sexual addiction
and as part of the normal fantasy life of the general population. The recurrent sexual thoughts and feelings in these situations are sometimes referred to as sexual obsessions. However, their content, form, and meaning vary depending on the disorder, with OCD sexual obsessions being not only involuntary but also unwanted, and causing great mental distress and suffering for the OCD patient.
, the unfaithfulness or suitability of one's partner, and profane thoughts combining religion and sex. People with sexual obsessions may have legitimate concerns about their attractiveness, potency, or partner, which can serve as an unconscious catalyst for the obsessions.
Sexual obsessions take many forms. For example, a father might obsess about sexually abusing
his daughter. He might wonder if these thoughts mean that he is a pedophile and worry that he could act them out, despite the fact that he has never sexually abused anyone and feels disgusted by the idea. Another example is a man who worries that he may accidentally impregnate a woman by shaking her hand because he was not careful enough in washing his hands after touching his genitals. Patients may also experience fears that their obsessions have already been carried out, and this causes them great mental distress and suffering. The ignorance and misunderstanding of the general population about OCD, largely as a result of gross misinformation about the disorder, often leads to assumptions that sufferers are criminals or deviants. This can then reinforce the belief in the mind of the sufferer that they really have committed a crime or immoral act, when they have not, or lead to doubts. This causes great distress for an OCD sufferer, and occasionally leads to the sufferer making 'confessions', sometimes to the police and suicidal thoughts or attempts.
In the midst of the thoughts, the sexual obsessions may seem real. Occasionally, individuals with OCD believe that their obsession is true, and in such a case they would be said to have "poor insight." But the vast majority of people with OCD recognize at some point that their fears are extreme and unrealistic. The problem is that even though they know the obsession is false, it feels real. These individuals can't understand why they are unable to dismiss the obsession from their minds. The obsession may temporarily subside in the face of a logical argument or reassurance from others, but may spike when caught off guard by a sexual trigger.
Sexual obsessions can be particularly troubling to the individual with OCD, as something important and cherished becomes twisted into its nightmarish opposite. People with sexual obsessions are particularly likely to have co-occurring aggressive and religious obsessions, clinical depression
, and higher rates of impulse control disorder
s, though the latter is less common in OCD patients.
Another form of OCD that can take hold of a person is a fear that they do not love their partner sufficiently (ROCD). As with sexual obsessions, and quite often in response to them, a person may feel the need to end a perfectly good relationship based on their inability to feel how they want to. Instead of finding good in their partner, they are constantly focused on their shortcomings. They often overexaggerate these "flaws" and use them to prove the relationship is fundamentally bad. Even when they know they love someone, they constantly check and reassure themselves that it is the right feeling. When they attempt to end the relationship, a surge of anxiety takes hold of them because, although free from the obsessive thoughts, they may realize that they prematurely ended a good relationship. The fact that they are unable to concentrate on anything but their partner's flaws causes the sufferer great anxiety, and often leads to a strained relationship.
Not looking at (for instance) another member of the same sex in the face,
avoiding locker rooms, showers, and beaches, etc. It can also mean avoiding sexual situations with members of the opposite sex, for fear of what a particular circumstance (not being aroused enough, intrusive thoughts, etc.) might mean. A sufferer may also avoid hugging children, including their own, a compulsion which may cause severe damage to the well-being of the child. It may cause social problems as the sufferer avoids being with gay
, or straight, friends, or people with children. The social isolation feeds the anxiety, and therefore the OCD.
Sexual obsessions in OCD rarely produce sexual arousal because anxiety and arousal cannot occupy the same space. As a result, OCD usually decreases sex drive. However, the sufferer's constant focus on not becoming aroused or checking that they do not become aroused may lead to 'groinal response'. Many OCD sufferers take this groinal response as actual arousal, when in reality it is not. OCD sexual obsessions often result in guilt, shame, depression and may interfere with social functioning or work.
On the subject of sexual arousal. Maybe 40% of sufferers (number could be higher due to the embarrassment associated) also report some accompanying physiological arousal. Reactions can include increased heart rate, a feeling of being turned on, and even erections, increased lubrication (in women), and orgasm. This response typically generates more confusion and uncertainty. Normally however this is a conditioned physiological response in the primitive thalamus of a brain which does not identify the thought as sex with a particular person, just sex. This is generally not indicative of one's own personal desires. (Osgood-Hynes)
crisis, or hidden paraphilia. Such a misdiagnosis only panics an already distressed individual. Fortunately, sexual obsessions respond to the same type of effective treatments available for other forms of OCD: cognitive-behavioral therapy and serotonergic
antidepressant medications (SSRIs). People with sexual obsessions may, however, need a longer and more aggressive course of treatment.
(i.e. Viagra, Cialis) are not the answer for people with untreated OCD. The sexual organs are working properly, but it is the anxiety disorder that interferes with normal libido
.
Medications specifically for OCD (typically SSRI medications) will help alleviate the anxiety but will also cause some sexual dysfunction in about a third of patients. For many the relief from the anxiety is enough to overcome the sexual problems caused by the medication. For others, the medication itself makes sex truly impossible. This may be a temporary problem, but if it persists a competent psychiatrist can often adjust the medications to overcome this side-effect.
Obsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...
(OCD) these are extremely common (Foa et al., 1995). It can become extremely debilitating, making the sufferer ashamed of the symptoms and reluctant to seek help. Preoccupation with sexual matters, however, does not only occur as a symptom of OCD and may be enjoyable in other contexts (i.e. sexual fantasy).
Obsessive-compulsive disorder
Obsessive-compulsive disorderObsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...
involves unwanted thoughts or images that are unsettling or interfere with an individual's life, followed by actions that temporarily relieve the anxiety caused by the obsessions (APA 2000). Obsessions are involuntary, repetitive, and unwelcome. Attempts to suppress or neutralise obsessions do not work and in fact make the obsessions more severe. OCD is considered an anxiety disorder
Anxiety disorder
Anxiety disorder is a blanket term covering several different forms of abnormal and pathological fear and anxiety. Conditions now considered anxiety disorders only came under the aegis of psychiatry at the end of the 19th century. Gelder, Mayou & Geddes explains that anxiety disorders are...
.
Typical obsessive themes center on contamination, illness, worries about disaster, and orderliness. However, people with OCD also obsess about violence, religious questions, and sexual experiences. Up to a quarter of people with OCD may experience sexual obsessions, and OCD sexual obsessions have been linked to childhood sexual abuse of OCD sufferers. Repetitive sexual thoughts are seen in many disorders in addition to OCD, but these disorders bear no relation to OCD. For example, sexual thoughts unrelated to OCD are common to people with paraphilia
Paraphilia
Paraphilia is a biomedical term used to describe sexual arousal to objects, situations, or individuals that are not part of normative stimulation and that may cause distress or serious problems for the paraphiliac or persons associated with him or her...
s, post-traumatic stress disorder
Post-traumatic stress disorder
Posttraumaticstress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity,...
, sexual dysfunction, sexual addiction
Sexual addiction
Sexual addiction is a popular model to explain hypersexuality—sexual urges, behaviors, or thoughts that appear extreme in frequency or feel out of one's control...
and as part of the normal fantasy life of the general population. The recurrent sexual thoughts and feelings in these situations are sometimes referred to as sexual obsessions. However, their content, form, and meaning vary depending on the disorder, with OCD sexual obsessions being not only involuntary but also unwanted, and causing great mental distress and suffering for the OCD patient.
Sexual focus
Because sex carries significant emotional, moral, and religious importance, it often becomes a magnet for obsessions in people predisposed to OCD. Common themes include unfaithfulness, deviant behaviors, pedophiliaPedophilia
As a medical diagnosis, pedophilia is defined as a psychiatric disorder in adults or late adolescents typically characterized by a primary or exclusive sexual interest in prepubescent children...
, the unfaithfulness or suitability of one's partner, and profane thoughts combining religion and sex. People with sexual obsessions may have legitimate concerns about their attractiveness, potency, or partner, which can serve as an unconscious catalyst for the obsessions.
Sexual obsessions take many forms. For example, a father might obsess about sexually abusing
Child sexual abuse
Child sexual abuse is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include asking or pressuring a child to engage in sexual activities , indecent exposure with intent to gratify their own sexual desires or to...
his daughter. He might wonder if these thoughts mean that he is a pedophile and worry that he could act them out, despite the fact that he has never sexually abused anyone and feels disgusted by the idea. Another example is a man who worries that he may accidentally impregnate a woman by shaking her hand because he was not careful enough in washing his hands after touching his genitals. Patients may also experience fears that their obsessions have already been carried out, and this causes them great mental distress and suffering. The ignorance and misunderstanding of the general population about OCD, largely as a result of gross misinformation about the disorder, often leads to assumptions that sufferers are criminals or deviants. This can then reinforce the belief in the mind of the sufferer that they really have committed a crime or immoral act, when they have not, or lead to doubts. This causes great distress for an OCD sufferer, and occasionally leads to the sufferer making 'confessions', sometimes to the police and suicidal thoughts or attempts.
In the midst of the thoughts, the sexual obsessions may seem real. Occasionally, individuals with OCD believe that their obsession is true, and in such a case they would be said to have "poor insight." But the vast majority of people with OCD recognize at some point that their fears are extreme and unrealistic. The problem is that even though they know the obsession is false, it feels real. These individuals can't understand why they are unable to dismiss the obsession from their minds. The obsession may temporarily subside in the face of a logical argument or reassurance from others, but may spike when caught off guard by a sexual trigger.
Sexual obsessions can be particularly troubling to the individual with OCD, as something important and cherished becomes twisted into its nightmarish opposite. People with sexual obsessions are particularly likely to have co-occurring aggressive and religious obsessions, clinical depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
, and higher rates of impulse control disorder
Impulse control disorder
Impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder, kleptomania, pathological gambling, pyromania , and three body-focused repetitive or compulsive behaviors of trichotillomania , onychophagia and dermatillomania...
s, though the latter is less common in OCD patients.
Self-Doubt
Obsessions often reflect a vulnerable self-theme where the person doubts their real or actual self. Doubt and uncertainty linger with sexual obsessions. They provide several contradictions which include: uncertainty as to whether you would act on these or whether you have already acted upon them, and uncertainty as to whether you are liking the thoughts (even though you know you don't) needless to say these cause an increase in anxiety, doubt, and uncertainty.Another form of OCD that can take hold of a person is a fear that they do not love their partner sufficiently (ROCD). As with sexual obsessions, and quite often in response to them, a person may feel the need to end a perfectly good relationship based on their inability to feel how they want to. Instead of finding good in their partner, they are constantly focused on their shortcomings. They often overexaggerate these "flaws" and use them to prove the relationship is fundamentally bad. Even when they know they love someone, they constantly check and reassure themselves that it is the right feeling. When they attempt to end the relationship, a surge of anxiety takes hold of them because, although free from the obsessive thoughts, they may realize that they prematurely ended a good relationship. The fact that they are unable to concentrate on anything but their partner's flaws causes the sufferer great anxiety, and often leads to a strained relationship.
Avoidance
In the same way that those who have OCD fears of contamination avoid anything that will 'contaminate' them (i.e., doorknobs, puddles, shaking hands), those who are suffering from such sexual obsessions may feel an overpowering need to avoid all contact with anything that can cause them to have anxiety, or 'spike'. Such avoidance may include:Not looking at (for instance) another member of the same sex in the face,
avoiding locker rooms, showers, and beaches, etc. It can also mean avoiding sexual situations with members of the opposite sex, for fear of what a particular circumstance (not being aroused enough, intrusive thoughts, etc.) might mean. A sufferer may also avoid hugging children, including their own, a compulsion which may cause severe damage to the well-being of the child. It may cause social problems as the sufferer avoids being with gay
Gay
Gay is a word that refers to a homosexual person, especially a homosexual male. For homosexual women the specific term is "lesbian"....
, or straight, friends, or people with children. The social isolation feeds the anxiety, and therefore the OCD.
Sexual ideation
It cannot be overemphasized that the sexual obsessions in OCD are the opposite of the usual sexual daydream or fantasy. The thoughts are not really part of the person's identity, but they are the sort of thoughts or impulses the person with OCD fears that he/she may have (Aardema & O'Connor, 2003, 2007). The sexual ideation in OCD is unpleasant and distressing for the person with OCD. The individual with OCD does not want the thought to become real. The idea of acting out the obsession fills the OCD victim with dread (Gordon 2002). The sexual ideation in such situations is termed "ego-dystonic" or ego-alien, meaning that the behavior and/or attitudes are seen by the individual as inconsistent with his or her fundamental beliefs and personality.Sexual obsessions in OCD rarely produce sexual arousal because anxiety and arousal cannot occupy the same space. As a result, OCD usually decreases sex drive. However, the sufferer's constant focus on not becoming aroused or checking that they do not become aroused may lead to 'groinal response'. Many OCD sufferers take this groinal response as actual arousal, when in reality it is not. OCD sexual obsessions often result in guilt, shame, depression and may interfere with social functioning or work.
On the subject of sexual arousal. Maybe 40% of sufferers (number could be higher due to the embarrassment associated) also report some accompanying physiological arousal. Reactions can include increased heart rate, a feeling of being turned on, and even erections, increased lubrication (in women), and orgasm. This response typically generates more confusion and uncertainty. Normally however this is a conditioned physiological response in the primitive thalamus of a brain which does not identify the thought as sex with a particular person, just sex. This is generally not indicative of one's own personal desires. (Osgood-Hynes)
Treatment
People with sexual obsessions can devote an excessive amount of time and energy attempting to understand the obsessions. They usually decide they are having these problems because they are defective in some way, and they are often too ashamed to seek help. Because sexual obsessions are not as well-described in the research literature, many therapists may fail to properly diagnose OCD in a client with primary sexual obsessions. Mental health professionals unfamiliar with OCD may even attribute the symptoms to an unconscious wish, sexual identitySexual identity
Sexual identity is a term that, like sex, has two distinctively different meanings. One describes an identity roughly based on sexual orientation, the other an identity based on sexual characteristics, which is not socially based but based on biology, a concept related to, but different from,...
crisis, or hidden paraphilia. Such a misdiagnosis only panics an already distressed individual. Fortunately, sexual obsessions respond to the same type of effective treatments available for other forms of OCD: cognitive-behavioral therapy and serotonergic
Serotonergic
Serotonergic or serotoninergic means "related to the neurotransmitter serotonin". A synapse is serotonergic if it uses serotonin as its neurotransmitter...
antidepressant medications (SSRIs). People with sexual obsessions may, however, need a longer and more aggressive course of treatment.
Medication
Many people with sexual obsessions are alarmed that they seem to lose their sex drive. People with OCD may see this as evidence that they no longer have normal sexual attractions and are in fact deviant in some way. Some may wonder if medication is the answer to the problem. Medication is a double-edged sword. Drugs specifically for erectile dysfunctionErectile dysfunction
Erectile dysfunction is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance....
(i.e. Viagra, Cialis) are not the answer for people with untreated OCD. The sexual organs are working properly, but it is the anxiety disorder that interferes with normal libido
Libido
Libido refers to a person's sex drive or desire for sexual activity. The desire for sex is an aspect of a person's sexuality, but varies enormously from one person to another, and it also varies depending on circumstances at a particular time. A person who has extremely frequent or a suddenly...
.
Medications specifically for OCD (typically SSRI medications) will help alleviate the anxiety but will also cause some sexual dysfunction in about a third of patients. For many the relief from the anxiety is enough to overcome the sexual problems caused by the medication. For others, the medication itself makes sex truly impossible. This may be a temporary problem, but if it persists a competent psychiatrist can often adjust the medications to overcome this side-effect.