Note: This post discusses pedophilia and a form of OCD that causes people to be uncertain of whether or not they're a pedophile. Because this uncertainty is a key cause of distress for people with OCD, we need to understand the fear around pedophilia first. This post begins with a discussion of pedophilia itself—a difficult topic for many.
There's a small number of things nobody wants to talk about: dangerous territories entered only by therapists, newscasters, and stand-up comedians. You can probably come up with most of them—imagine yourself around the dinner table with family or friends, and think of the last conversations you'd like to have.
One of these topics, pedophilia, summons an incredible outrage whenever it's brought up. Public reactions to recent news stories remind us of how serious we are about protecting children. And our outrage makes a lot of sense: nobody is more vulnerable than kids, and sexual advances on them are inherently violent. It's so disturbing to hear about these things because we wish deeply that they would never happen at all.
What's pedophilia and who has it?
Pedophilia is a sexual attraction to children. It was defined in the late nineteenth century but has been researched only in the past few decades. It's known as pedophilic disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the big book that most mental health clinicians in the United States use to diagnose their clients. A pedophile has intense urges toward, and fantasies about, children; these must persist for some period of time (six months according to DSM-5) and may or may not be acted upon. Not all pedophiles are child molesters, and vice versa—the former fantasize about children, and the latter sexually abuse them.
Different authorities disagree about the specifics, but pedophiles are generally thought to be over the age of 16 and at least five years older than the subject of their thoughts. The child they fantasize about is prepubescent—age 13 or younger, according to DSM-5 and a number of other resources. Psychiatric literature differentiates between people attracted to different age brackets, but they tend to be lumped together in public perception.
These details aside, pedophilia is one of the most feared psychiatric disorders. A 2015 study found that pedophiles are subject to anger and social rejection even if they haven't acted on their thoughts (a significant portion of respondents to one survey said pedophiles "should better be dead"). Many surveys rank child sexual abuse as worse than murder. And, as researchers have often suggested, these public beliefs probably discourage many pedophiles from getting help.
Pedophilia vs. Pedophilia OCD
Sexual thoughts and urges about prepubescent children are, by definition, enjoyable to pedophiles. They may feel ashamed about their thoughts, scared about what will happen because of them, resolutely opposed to acting on them, and so on; but children are still the primary (and sometimes the only) objects of their fantasizing.
Many non-pedophiles experience similar intrusive thoughts and urges, spontaneously and in opposition to their real desires. Someone with no history of pedophilic thoughts or urges might be hanging out with a child and suddenly think, What if I touched that kid right now? Although the thought seems very strange and disturbing, most people shake it off: That isn't me. I didn't like that. Oh well. It's by no means enjoyable, but the thought causes them no real disturbance. Like a random thought about driving off the road or shouting during a meeting, it fades quickly.
We all experience intrusive, unwanted thoughts about a wide range of topics
But another group responds very differently to these thoughts, which feel like a challenge to everything they believe they really are. They have a form of obsessive-compulsive disorder (OCD) referred to as Pedophilia OCD, or POCD. Subtypes like POCD aren't distinct conditions—they're convenient ways of referring to a specific, common set of OCD symptoms. Like any subtype, POCD involves obsessions (intrusive, unwanted thoughts) and compulsions (repetitive behaviors aimed at getting rid of the distress caused by obsessions). But with POCD, symptoms follow a very specific theme: unwanted sexual thoughts about children.
The crux of POCD is that people aren't sure if they really would act on their thoughts. They never feel certain that can trust themselves, and are prone to compulsively mitigating the risk they perceive. Their obsessions open up extremely disturbing, seemingly urgent questions at the core of their reality; compulsions tie things back together for a little while. For example:
- Obsession: What if I really did sexually abuse a child? —> Compulsion: Turning down babysitting jobs and avoiding children in public
- Could I really be a pedophile? —> Look up articles about famous pedophiles every day and compare oneself with them
- Suddenly picturing a sexual act with a child —> Make oneself list ten reasons they'd never be attracted to a child, rewrite it five times every night before bed
Research suggests that POCD, while common among people with OCD, is unnoticed and misdiagnosed in most patients. This suggests that the shame surrounding these thoughts is so strong that people don't even want to tell their therapists. That's why we need brave people to set a precedent and share their difficult stories.
We recently spoke with one of these brave people—we'll call her Kate—who lives in London with her partner and their two-year-old daughter. Like any parent, she's been working ever since her daughter's birth to figure things out.
The birth of her child brought Kate great joy. But only a few weeks later, deeply disturbing thoughts started popping into her head. These thoughts morphed over time, and brought her to a breaking point.
A Young Mom with Pedophilia OCD: Kate's Story
Before I had my daughter, I never paid attention to children. I didn't care for people’s baby showers or kids’ birthdays. I never paid attention to their vulnerability—they were just these little humans their parents wouldn't stop going on about.
That was until I had my own. For the first six months of my daughter’s life I had thoughts of killing her, it consumed my every waking moment. She had died a million times in my head. But one day that all changed.
I know this sounds clichéd, but I honestly remember it like it was yesterday. I was reading my usual Hollywood gossip pages when there was a story about Mark Salling, the bloke from Glee, being arrested for child pornography. And from that moment on it was like a switch was flicked in my head and my usual killing thoughts (which I had started to get used to) became more sinister. I started to have panic attacks. What if I molest my daughter? What if I'm a pedophile and don't know it?
I remember frantically ringing my father and telling him all of my worries while crying on the living room floor. I honestly thought I could turn into a pedophile overnight and harm my daughter. From then on, I was terrified to change her, bathe her—any time a body part of hers was exposed, I would have a panic attack.
It didn't end there. OCD wouldn't let me get away with it that easily. I was scared to walk past schools in case I looked like a pedophile, especially when it was break time and kids were playing on the playground. Did I look at them in a creepy way? Do I look like a pedophile?
I was broken.
This kind of OCD takes you into utter darkness, so much so that I contemplated ending my life because I couldn't cope with another thought. Even while writing this I'm very conscious of the language I use: I don't want someone to think that I am a pedophile.
You see, that's how fucked up OCD is: it convinces you that you are what it says you are, even with zero evidence. However, I have come to realise that OCD wants you to keep your thoughts secret. It doesn't want you to bring them into the light where they might have to face some rationality.
So, if you're suffering, what do you need to know?
Well, you need to see these pedophilic thoughts like any other intrusive thought, because that's all they are. The big difference between someone with OCD and a pedophile is how they react to the thought that they might be one.
“How do I know that I am not a pedophile?" I would ask you what happens when you have these thoughts…
Do you panic?
Avoid places where there are children?
Do you think you're a bad person?
Do you have compulsions that you use in order to rid yourself of the thoughts?
A big thanks to Kate for her bravery in sharing this story with people around the world. There's so much fear about the kinds of thoughts she experiences that very few people ever tell someone (even a therapist) about them.
If your own story is anything like Kate's, or you know someone who's struggling with pedophilic thoughts, help is available. (This is true for both pedophilia and OCD). For Pedophilia OCD, Kate wants to remind everyone that cognitive behavioral therapy (CBT) can be highly effective for many people.
Exposure and response prevention (ERP) is a particularly helpful type of CBT, specifically designed to help people face their obsessions and resist compulsions. In fact, it's the most effective and most widely-researched form of therapy for OCD. You can learn more about ERP and how our OCD-trained therapists are bringing it to you by scheduling a brief call with a member of the NOCD clinical team: