Deciphering Sexually Intrusive Thoughts with ERP Treatment
Updated Oct 9, 2024Sexual obsessions or sexual “deviance”? This is a question that will haunt you if you have OCD with sexually intrusive thoughts. We all have thoughts sometimes that go against our true selves and values (even the therapists at Virtual CBT Psychotherapy).
Our society has a “don’t ask/don’t tell” culture, so we tend not to talk about some of our embarrassing thoughts. As a result, people may feel even more isolated with OCD obsessions. If you struggle with OCD, it is treatable with ERP.
Sexual OCD is one of our Clinic’s specialties. Book a free consultation with us to learn how an ERP therapist can help. * Must be an Ontario resident. Learn about our therapy fees.
Sexual Obsessions in OCD
The key difference between sexual obsessions in OCD and sexual “deviance” is how you act and feel when you have an unwanted thought. A person with OCD would likely never act on their sexual thoughts. They feel shame, guilt, disgust, anxiety, and extreme distress when they think of it. If you have OCD with sexual obsessions, you are likely haunted by these thoughts. You do all you can to avoid them or neutralize them. But, this makes the thoughts come back stronger.
Some common sexual obsessions are:
Questioning your sexual orientation (e.g. Am I gay? Am I a lesbian? Am I bisexual?). Learn more about sexual orientation obsessions.
Having sexual thoughts of children or animals (e.g. I could be a pedophile). Learn more about POCD.
Incest (e.g. What if I enjoy sex with my brother? Or you see naked images of your family members). To learn more about incest OCD, read our blog post.
Combining sex and religion.
Aggressive sexual thoughts (e.g. images of raping someone) about someone.
If you have these thoughts and they are bothersome, you are not alone! You may have OCD with sexual obsessions.
Reach out today for a free consultation with an OCD or ERP therapist. Our fees are often covered by your benefits. Call your benefits provider today to see if you have coverage for psychological services.
"Every human being has intrusive thoughts to some degree; it's a natural part of the human experience. However, for individuals with Obsessive-Compulsive Disorder, these intrusive thoughts become persistent, distressing, and disruptive to daily life." (American Psychiatric Association, 2013).
Common OCD Rituals
People with OCD may develop many rituals. They do this in response to sexual obsessions. Some common rituals associated with OCD sexual obsessions include:
Mental Rituals: They involve repeating things in your head, which eases your anxiety. Examples include mentally praying, counting, or repeating certain phrases to counteract the obsessions. It’s common for therapists (who aren’t experienced with OCD) to teach clients to “talk back” and say “It’s my OCD”. People often try to replace their intrusive thoughts with positive ones. Mental rituals are sneaky and sometimes the toughest to break. An ERP therapist can help with this.
Avoidance Behaviours: People may avoid situations. They avoid people or things that trigger their sexual obsessions. This avoidance can limit their daily life and relationships. It leads to loneliness and distress. For example, you may avoid men if you fear being gay. Or, you may avoid children if you fear being attracted to them.
Checking: Some people may repeatedly check their bodies. They do this to look for signs of arousal or problems. They are seeking reassurance that their intrusive thoughts are unfounded. This checking gives brief relief. But, it also feeds the obsession long-term.
Internet Searching: Many with sexual obsessions in OCD browse the internet excessively. They seek reassurance online about sexual thoughts and behaviours. They may spend hours researching or seeking validation. This continues the cycle of obsession and compulsion.
Physical Rituals: People engage in physical rituals. These include washing, showering, and grooming excessively. They do this to cleanse themselves. They feel contaminated by impure sexual thoughts. This behaviour provides temporary relief. But, it also reinforces the belief that the thoughts are dangerous or unacceptable.
Reassurance Seeking: They constantly seek reassurance from others. They ask partners, friends, or therapists about the meaning or morality of their sexual thoughts. Reassurance-seeking behaviours can strain relationships and exacerbate feelings of guilt and shame.
Ritualized Confessions: Some people confess their intrusive sexual thoughts or fears to others. They do this to lessen guilt or anxiety. But, this confession ritual brings temporary relief. Then, it brings more anxiety and the need for more reassurance.
These rituals provide a brief relief from distress. But, they keep the cycle of obsession and compulsion in OCD going. Over time, they can significantly interfere with daily functioning and quality of life. Therapies like Exposure and Response Prevention (ERP) can help. ERP helps people in slowly cutting and ending these compulsive actions.
If you have been seeing a therapist who is not trained in ERP, they have been inadvertently teaching you “tools” that have become rituals. No need to panic - this is very common! An ERP therapist can help you decipher between rituals and healthy coping strategies.
Prevalence of Sexual OCD
Sexual OCD is more common than many people realize. OCD affects about 1-2% of the general population. It is difficult to estimate the exact percentage of people who struggle with sexual OCD. We can conclude that sexual obsessions are a prevalent theme among those with the disorder. We find that most people who come to use for OCD, have a subtheme of sexually intrusive thoughts.
Many people with OCD experience intrusive thoughts related to various themes. We find sexual obsessions are among the most distressing for folks. Despite its prevalence, sexual OCD often remains underreported and misunderstood. This can lead to feelings of isolation and shame for those affected. Many people may worry that they are unique in their struggles. But recognizing that sexual obsessions are a recognized aspect of OCD can help reduce stigma. It can also encourage people to seek the support they need.
Awareness of sexual OCD is crucial, as it can lead to better understanding and more effective treatment options. If you or someone you know is dealing with these intrusive thoughts, remember that help is available, and you don’t have to face this alone.
Treatment for Sexually Intrusive Thoughts
There are a variety of treatment options for sexual OCD. The person may have to try therapy or a combination of psychotherapy and medications. Here are some treatment options for sexual OCD:
1. Exposure and Response Prevention (ERP or EX/RP)
One of the most effective treatments for sexual OCD is a type of therapy called Exposure and Response Prevention (ERP). This therapy involves gradually exposing you to the thoughts or situations that trigger your anxiety. It also involves resisting compulsive behaviours (e.g. reassurance, mental rituals).
You might start by discussing your fears in a safe environment, then gradually face those fears in a controlled way. Over time, this can help reduce the power of those intrusive thoughts and lessen the anxiety they cause. Some people use the word "desensitize" to explain the process of ERP. Many clients find that with practice, sexual thoughts become less overwhelming. They can also learn to respond to them without getting caught in a cycle of fear and avoidance.
Learn more about ERP for intrusive thoughts (OCD).
Can ERP Reduce Intrusive Thoughts?
Yes, ERP can help reduce intrusive thoughts, including sexual obsessions. While the thoughts may not disappear completely, the therapy teaches you how to change your relationship with them. Instead of reacting with fear or anxiety, you’ll learn to view them as just thoughts—nothing more. This shift can make them less distressing and easier to manage.
2. Cognitive Behavioural Therapy (CBT)
Cognitive Behavioral Therapy (CBT) can also be beneficial. CBT helps you identify and challenge the negative thoughts that contribute to your anxiety. By reframing those thoughts, you can develop healthier perspectives. For example, instead of believing that having a particular thought means you will act on it, CBT can help you recognize that thoughts do not define who you are. Learn more about inference-based CBT for OCD.
3. Medication for OCD
For some people, medication can also be an effective part of treatment. Antidepressants, particularly SSRIs can help reduce the intensity of obsessive thoughts and anxiety. If you're considering medication, it’s important to discuss this option with a healthcare provider who understands OCD. A great first step is to make an appointment with your doctor or ask for a referral to see a psychiatrist.
4. Lifestyle Changes
Making certain lifestyle changes can complement your treatment. Regular exercise, maintaining a balanced diet, and practicing mindfulness can all contribute to reducing anxiety. Mindfulness, in particular, teaches you to stay present and observe your thoughts without judgment. Mindfulness can make it easier to cope with intrusive thoughts.
5 Tips for Managing Sexual OCD
Practice Acceptance. Acknowledge that intrusive thoughts are a symptom of OCD, not a reflection of who you are. Accepting the thoughts without judgment can help reduce their power over you.
Engage in ERP. Consider working with a therapist trained in Exposure and Response Prevention (ERP). Facing your fears can help you learn to manage anxiety and lessen the hold of intrusive thoughts.
Limit Avoidance Behaviours. Avoiding triggers can reinforce your fears. Instead, expose yourself to situations that provoke anxiety in a controlled way. You can find a support person or a therapist to help.
Stay Active. Regular physical activity can help reduce anxiety and improve mood. Find an activity you enjoy, whether it’s walking, dancing, or yoga, and make it a regular part of your routine.
Practice Mindfulness. Engage in mindfulness or relaxation techniques, such as meditation or deep breathing exercises. These practices can help you stay grounded and manage anxiety when intrusive thoughts arise. It's best to schedule your mindfulness practices so that they do not become rituals.
5 Tips for Family Members of Someone with Sexual OCD
Educate Yourself. Learn about OCD and sexual obsessions to better understand what your loved one is experiencing. Knowledge can reduce stigma and help you provide informed support.
Listen Without Judgment. Create a safe space for your loved one to express their feelings and thoughts. Listen to your loved one without dismissing their concerns or providing unsolicited advice.
Encourage Professional Help. Gently suggest seeking help from a therapist who specializes in OCD. Support them in finding resources and attending appointments if they’re comfortable with that.
Be Patient and Understanding. Recognize that managing OCD is a journey with ups and downs. Offer reassurance and patience as they navigate their feelings, and avoid placing pressure on them to "just get over it."
Promote Healthy Boundaries. While it's important to be supportive, also encourage your loved one to engage in their treatment independently. Avoid enabling compulsive behaviours and respect their need for space.
By offering support and understanding, you can make a significant difference in the life of someone dealing with sexual OCD.
Connect with an OCD or ERP Therapist
Our online clinic has many ERP therapists to choose from. They have been trained and supervised in ERP: Alpar, Celissa, Anneliese, Jennifer O’Connor, Alana Weinberg, and Dr. Steinhart.
Our ERP therapists can provide therapy to anyone in Ontario (over the age of 12). Did you know that video or virtual ERP is as effective as in-person? So why not start therapy from the comfort of your home?
Our fees. Call your benefits provider to see if you are covered for psychological services.
ReferencesAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).