Obsessive Compulsive Disorder (OCD) is a common mental health condition characterised by persistent, unwanted thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) that individuals feel compelled to perform. While people are often familiar with the more stereotypical OCD presentations, such as contamination OCD (e.g. excessive handwashing) and checking OCD (e.g. checking windows, doors, and taps), there are equally common presentations of OCD that are less talked about. This is often due to the shame and guilt surrounding these types of OCD because they are often the most seemingly “taboo”.
I wanted to write this blog post to educate the layperson about other common OCD presentations to help inform and reduce the stigma surrounding these types of OCD and, equally, to normalise and reassure those suffering with these OCD types. You are not alone; many people struggle with these forms of OCD, which we can treat effectively using cognitive behavioural therapy (CBT). If you’d like to explore how CBT can help you with OCD, you can contact me here.
Here, I will list the most frequent OCD obsessions/themes that I see in my clinic. This is by no means an exhaustive list, and OCD can present in many different ways. However, I have listed some of the most common themes that, in my experience, we are not discussing and normalising enough.
- Obsessions about being a paedophile: Perhaps one of the most stigmatised and misunderstood OCD themes is paedophilic obsessions, also known as ‘P-OCD’. People with these obsessions experience intrusive thoughts or images of engaging in inappropriate sexual behaviour with children, despite having no desire to act on these thoughts. The shame and fear associated with paedophilic obsessions can be overwhelming, leading many to suffer in silence rather than seek help. Typical compulsions may involve monitoring/checking oneself for genital arousal in response to these thoughts, mental argument, excessive reassurance seeking (e.g. googling to see if this is really ‘P-OCD’ or not), and trying to find “evidence” that one is not attracted to children. It's crucial to recognise that having these thoughts does not equate to being a danger to children, and providing support and understanding is essential for those struggling with this type of OCD. This type of OCD usually makes up about 70% of the OCD cases that I see at any one time. It is extremely distressing but extremely common.
- Obsessions about harming yourself or others: These obsessions involve intrusive thoughts of causing deliberate harm to oneself or others (this could be strangers or loved ones), often leading to intense feelings of guilt and shame. Individuals may go to great lengths to prevent these feared outcomes, engaging in compulsive behaviours to try and prevent themselves from acting on these thoughts or as a means of neutralising their intrusive thoughts. This type of OCD can be particularly distressing when the intrusive thoughts/images are focused on loved ones (e.g. your partner or children). Typical behaviours associated with this type of OCD include avoidance of harm objects (e.g. knives) or situations (e.g. public transport or driving), trying to keep tight control of your actions and body (e.g. crossing arms), reassurance seeking (e.g. googling and looking for reassurance forums or social media), and rumination (e.g. mentally arguing with oneself and trying to find evidence of not wanting to act on these thoughts).
- Sexual obsessions: Another common OCD theme that is not discussed often enough is intrusive thoughts of a sexual nature. These intrusive thoughts can be distressing and disturbing, often involving fears of committing sexual acts that go against one's values or orientation. Common intrusive thoughts may include thoughts of sexual acts with an inappropriate person (e.g. a family member), sex with an authority figure (e.g. boss at work), sexual acts against one’s preference, and doubts about one’s sexual orientation. Despite their prevalence, sexual obsessions are rarely discussed openly due to the shame and embarrassment they evoke. As a society, we struggle to talk about sex at the best of times, so it is no wonder people who experience these sexual obsessions find it difficult to discuss! It's essential for us to create a safe space where individuals feel empowered to seek support without fear of judgment.
- Perinatal, postnatal, and parental OCD: Perinatal OCD refers to obsessive-compulsive symptoms that occur during pregnancy (and up to a year post-birth), while postnatal OCD occurs after childbirth. Equally, parental OCD refers to any time during the perinatal period and beyond and can affect anyone who is a parent. These OCD subtypes can involve intrusive thoughts or fears related to the baby or child’s safety, usually about harming them in some way either deliberately or accidentally. This may include violent thoughts/images, paedophilic thoughts/images, and contamination fears. Parents may feel reluctant to seek support for this type of OCD due to a fear of health professionals mistaking their anxiety for actual intention to act on such thoughts, or due to worry that they will think they cannot take care of their baby. Thankfully, these types of OCD are becoming more well-known and better understood within healthcare settings, but it is important that we continue to educate healthcare professionals about these OCD subtypes and think about how we can best support the parents who are struggling.
It is worth noting that with all of the above OCD subtypes, there is no desire or intention to act on the intrusions. Often, this is where people with OCD get stuck. Common responses to reading blog posts like this might be “but what if this doesn’t apply to me? What if I am the exception?”. This can lead to further rumination and compulsions and keep you stuck in the OCD cycle. If you need further help getting unstuck from the OCD trap, I’d love to hear from you. You can fill out a contact form here, and we can discuss the ways in which CBT could be helpful for you.
