Obsessive-compulsive disorder Obsessive-compulsive disorder 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 Obsessions are involuntary, repetitive, and unwelcome. Attempts to suppress or neutralize obsessions do not work and in fact make the obsessions more severe, as trying to make sense of obsessions only gives them more attention and "fuel".
OCD is sometimes considered an anxiety disorder. However, people with OCD also obsess about violence, religious questions, and sexual experiences. For example, sexual thoughts unrelated to OCD are common to people with paraphilias , post-traumatic stress disorder or sexual dysfunction, sexual addiction.
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 person with OCD. Common themes include unfaithfulness, deviant behaviors, pedophilia , the unfaithfulness or suitability of one's partner, and 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.
For example, a mother might obsess about sexually abusing her child. She might wonder if these thoughts mean that she is a pedophile and worry that she could act them out, despite the fact that she 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.
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. 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 cannot 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. People with sexual obsessions are particularly likely to have co-occurring aggressive and religious obsessions, clinical depression , and higher rates of impulse control disorders ,  though the latter is less common in OCD patients.
Self-doubt[ edit ] Obsessions often reflect a vulnerable self-theme where the person doubts their real or actual self. They provide several contradictions which include: A person may continuously doubt whether they love their partner, whether their relationship is the "right" relationship or whether their partner "really" loves them. Another form of ROCD includes preoccupation, checking, and reassurance seeking behaviors relating to the partner's perceived flaws.
Avoidance[ edit ] In the same way that those who have OCD fears of contamination avoid anything that will "contaminate" them i. Such avoidance may include: 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. The social isolation feeds the anxiety, and therefore the OCD. Sexual ideation[ edit ] It cannot be overemphasized that the sexual obsessions in OCD are the opposite of the usual sexual daydream or fantasy.
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. Therefore, OCD can decrease libido. The OCD sufferer may have a constant focus on not becoming aroused or checking that they do not become aroused, and this 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. 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.
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, but just sex. This is generally not indicative of one's own personal desires. Second generation atypical anti-psychotics, such as Olanzapine Zyprexa , have been proven to induce de-novo OCD in patients. 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 typically in the case of psychoanalysts or psychodynamic therapists  , sexual identity 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: People with sexual obsessions may, however, need a longer and more aggressive course of treatment. 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 dysfunction i. 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. 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. When a person with a sexual obsession masturbates, they may have the constant fear of picturing something unwanted and intrusive. Afterwards, they may feel guilty or shameful, as they may have been thinking about the object of their obsession during most or all of the sexual activity.
Many people with this type of obsession are often reluctant to or avoid performing any type of sexual act.