Why ERP is Effective for POCD
Images of yourself engaging in abhorrent acts. Questions like, “What if I actually wanted to do this?” Doubts about interactions you might have had with children. Thoughts of being doomed to a solitary life because somehow you feel convinced that you are a danger to children.
These are just some of the obsessions that individuals with pedophilia OCD might experience. Pedophilia OCD, or POCD, a subtype of OCD, is characterized by the presence of unwanted thoughts, images, and/or urges of a sexual nature related to children as well as behaviors intended to decrease the distress caused by these thoughts, images, and urges. People with POCD are distinctly different from pedophiles in that these thoughts are morally repugnant to them. Unlike pedophiles, who fantasize about sexual interactions with children (and find these fantasies pleasurable), people with POCD experience these thoughts like a relentless horror film on repeat in their mind.
Unfortunately, POCD is often misunderstood and misdiagnosed. The sense of shame that surrounds this particular subtype can discourage people with these obsessions from seeking treatment. Even when they are in treatment, individuals might be scared to fully disclose their obsessions due to fears that they will be reported to law enforcement or that their children will be taken from them, for example.
In reality, POCD is treatable just like any other subtype of OCD, with exposure and response prevention (ERP) therapy. It could be helpful to think of ERP as a tool that can be used for all OCD subtypes. The way the tool is used might differ depending on the theme of obsessions, but the principles remain the same: purposely approach things that bring on obsessional distress and actively resist engaging in any behaviors — both overt and covert — that aim to reduce that obsessional distress.
For individuals with POCD, this might look like:
- Looking at photos of children in children’s clothing catalogs
- Watching videos of children on YouTube
- Saying hello to a child at the store or at the park
- Spending time with children in their lives
Just like with other forms of OCD, response prevention is the secret sauce that makes ERP so effective. For individuals with POCD, their compulsions might look less like what people traditionally think of when they imagine compulsions (e.g. overt repetitive behaviors) and more like excessive worrying. For example, someone with POCD might spend hours trying to come up with proof that they would never hurt a child, or they might try to think about all the ways they can keep themselves far from children in the future. They might spend sleepless nights wondering when they will feel better or how they can properly pay for the mental crime of having these thoughts in the first place. Individuals with POCD might distance themselves from others, particularly the children in their families, in order to prevent their worst fears from coming true.
With ERP, these individuals would work to reduce and eliminate these dysfunctional anxiety reduction strategies. It is important to step back from the content of the OCD and recognize that, at its core, OCD is fear of the unknown, whether it is the unknown of the past, or the unknown of the future. In ERP treatment, individuals with POCD practice accepting that predicting or trying to control the future with 100% certainty, as well as having 100% certainty about the past, is impossible. They purposely resist any attempts to “figure it out” as they remind themselves that these attempts are running toward a moving finish line. They practice acknowledging the difference between possibility and probability, between thoughts and actions, between feeling like they cannot tolerate uncertainty and ambiguity and experiencing, through exposure and response prevention, that they can.
In these ways, ERP treatment for POCD is no different than ERP for any other OCD subtype. ERP treatment provides hope to people with OCD. At the beginning of treatment, individuals with OCD might feel like they are powerless. They might feel like their lives are being held hostage by OCD, like they have somehow forever lost the person that they were before these awful thoughts took hold. ERP, by encouraging people to face their fears and change their behavioral and cognitive responses to these fears, is like going headfirst through a dark tunnel.
But when it comes to OCD, the best way out is through.
If you are experiencing the symptoms of POCD, then please consider giving NOCD a call. A free 15-minute call can put you on the path to ERP with a qualified and affordable ERP specialist. You can also join our POCD community and get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.