Sexual obsessions in the doc

Obsessive-compulsive (DOC) disorder is a mental disorder characterized by the presence of Recurring intrusive thoughts (obsessions) e repetitive and forced behaviors (Compulsions) put in place to cancel or reduce the discomfort associated with doubts, impulses and unwanted mental images. The doc tends to be persistent over time and highly disabling in the subjective functioning of the individual.

The obsessive contents of DOC patients may vary enormously in the content and the most frequent symptomatological dimension is that relating to fears of contamination (APA, 2013).

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Among the various identified dimensions, the Obsessions with sexual contentwhich fall within the so -called ‘unacceptable thoughts’, include all fears relating to their sexual impulses and their nature. The prevalence, between 3% and 24% in subjects with DOC, could be underestimated precisely because of the socially stigmatized content of these obsessions. In fact, despite the sexual obsessions They have been mentioned for years in the literature, there are few research aimed at the prevalence rates and clinical characteristics of these patients.

From the results of the few studies carried out, the presence of sexual obsessions In DOC subjects it seems to correlate with diagnosis of bipolar and tic disorder, as well as having response rates to the lower treatment and greater consequences on sexual dissatisfaction than other types. These data seem to be only partially confirmed by a study (Grant et al., 2006) on a large clinical champion of 293 patients with DOC whose about 25% had had Obsessions with sexual content In their clinical history and about 13% they had sexual obsessions at present.

This portion of 39 subjects-compared with the rest of the sample patients-had a younger age of debut and access to treatment but, contrary to expectations, there were no differences with the other group in terms of comorbilities, severity of symptoms, degree of insight, quality of life and socio-relational operation.

In particular, the sexual content obsessions include:

Doubts of being able to be homosexual (Sexual Orientation OCDHomosexual DOC): examples of these fears are intrusive doubts like: “What if I were homosexual?”, “Maybe I am attracted by the other men/women”.
Fears of being able to be sexually aggressive towards others or perverse: the fears of losing control and becoming sexually violent or unrefinibly attracted by objects or people deemed socially unacceptable (“and I became a rapist?”, “What if I discovered that I am necrophilic or sexually excited by animals?”
Fears of being able to be pedophile (Pedophilia- Themed OCDDOC with pedolific content): examples of these doubts are thoughts of the type “What if I liked children?” Or “if I found myself alone with a child as I could be sure not to abuse him/her?”
Unacceptable sexual images or sexual images aimed at family members (incestuous) or religious figures (blasphemies): these include intrusive mental images and/or selfish impulses with sexual content considered perverse because they are associated with sacred figures or family members.

In general, people haunted by sexual obsessions They experience lives of guilt and intense fear. These emotions are contained or temporarily attenuated through compulsive behavior as requests for reassurances to others, search for information relating to the feared theme (homosexuality, perversions, pedophilia, etc.), repeated controls of one’s degree of sexual excitement in the face of feared stimuli.

Other means of self-abstunction can mentally include activating situations to look for data to confirm or disconnects with their fear: for example, some subjects revive the gestures just carried out in the presence of another person of the same sex on a mental level in search of signals of “femininity” or “attraction” towards the person present.

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Very often people with DOC with sexual content They undergo real ‘tests’ aimed at eliminating intrusive doubts: in fact they tend to analyze their reactions in the face of activating stimuli; such as people of the same sex, children, family members, sexual images with a perverse content, etc. These tests often have a paradoxical effect because the subject – analyzing themselves in the grip of their obsessive anxiety – tends to poorly interpret the physiological sensations associated with anxious activation as if they were confirming an excitatory activation of a sexual nature.

Finally, i subjects suffering from sexual obsessions of which we are talking, they arrive at levels of anxiety so constant and intense as to have to resort to avoidance of situations and stimuli activating obsessions. Consequently it often happens that these patients find themselves – to reduce intrusive thoughts – to avoid gyms, swimming pools and changing rooms or films with sex scenes between people of the same, when the problem is a homosexual doc. In the case of pedophilic fears, people often avoid places crowded with children or try not to be alone with a minor. The fears of being able to be violent, perverse or attracted by family and/or friends are often faced by avoiding closeness with certain people perceiving “at risk” while the unacceptable thoughts with blasphemous content often lead to avoiding images and sacred places. This follows a progressive compromise of the individual and professional functioning of the individual, as well as a serious subjective discomfort, with themes of profound self-denigration and frequent suicidal thoughts.

The subjects who have described usually come to the professional attention of the professional when the symptoms are now very disabled, you want for their experiences of shame compared to thoughts, both for the little knowledge of the Obsessive-compulsive disorder. When the psychotherapist is faced with a client with recurring images with sexual content, continuous checks in the face of materials with sexual content or avoidance of people and/or places, it can be difficult to perform an adequate differential diagnosis.

What are sexual obsessions or are not?

Some authors (Bruce, Ching & Williams, 2017) have in detail illustrated the differential characteristics between the DOC with pedophilic fears and the actual pedophile disorder, highlighting criteria of diagnostic distinction which then are also fundamental for the others types of sexual obsessions.

In particular, the subjects with pedophilic obsessions They perceive anxiety and fear because they fear being attracted to children and do not experience any pleasure when they have thoughts about it. In addition, these people often tend to avoid being alone with minors. Individuals suffering from pedophilia instead tend to seek sexual arousal through closeness with children and/or pedo-pornographic material, perceive sexual attraction rather than discomfort and present behaviors for the search for contact with the object of desire: they create situations in which they can be alone with minors and try to earn their trust. They often also have sexual fantasies with pedophilic content and acts of self-eroticism with extreme gratification.

As we can see, the difference between the two profiles is clear. Particular case is made up of what is described as a selfish pedophile. In fact, there are cases in which individuals, despite being attracted to children or young kids, deliberately choose not to follow this impulse. These subjects can be disturbed by the wishes taken due to their religious and/or moral principles (APA, 2013). In these cases, the differential diagnosis with the Pedophilic content DOC can be more complex. And the authors advise to ask a series of targeted questions (“His sexual fantasies include children?”, “Do you feel excited in front of images of children or in front of adults?”, “Has ever masturbated thinking about a child or a boy?”). Finally, it should be remembered that the use of child pornography is a necessary criterion for the formal diagnosis of pedophilia in DSM 5 (APA, 2013).

In summary, the DOC with sexual content It is a symptomatological dimension of the obsessive-compulsive disorder often under-staged in the prevalence rates and difficult to evaluate/differentiate from a diagnostic point of view. In the psychotherapeutic field, therefore, what we need to respond to these critical issues is a greater attention to the phenomenon of sexual obsessions and its clinical characteristics, evaluation tools aimed at specific symptoms and, no less important, greater training in terms of differential diagnosis and treatment.

What are sexual obsessions or are not?

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