Paedophilic Obsessive-Compulsive Disorder (POCD) II

Part II: The Help Available For Sufferers Of POCD

It can feel frightening to seek help for mental health disturbances at the best of times, but due to the nature of the problem, for sufferers of POCD, the prospect of seeking treatment can be horrifying.  However, it’s important to remember that POCD is a form of OCD, and will be treated by clinicians in much the same way.  An evidence-based treatment for OCD, and therefore POCD is cognitive behavioural therapy (CBT).  CBT is incredibly versatile and can be used to treat several problems.  For POCD, therapists will often draw upon a mixture of cognitive, behavioural, and mindfulness-based techniques.

Cognitive Approaches For POCD

Magnifying and Minimizing

Cognitions, that is., thoughts, are central to CBT.  They influence how we feel and therefore how we behave in response.  Thus, in the treatment of POCD, cognitive approaches will emphasise the importance of recognising and noticing inaccurate, and unhelpful beliefs relating to fears around paedophilia.  It might be that you have a tendency toward magnifying and minimizing, that is, you magnify the unhelpful worries, and minimise anything you do or feel that could counter your fears. For example, one client was able to spend an enjoyable weekend with his partner and young nephew without harming him but his mind minimised this fact, and magnified the intrusive thought “Well, you would have done something if you were alone with him”.

Black-and-White Thinking

Another maladaptive thinking style that cognitive approaches might address is black-and-white thinking, this is the idea of thinking in extreme terms, such as, “Because I had that intrusive thought, I am a paedophile“.  Cognitive therapy helps individuals challenge distorted thinking styles, not by replacing them with positive thoughts, but rather by offering a more balanced view that is realistic and objective.

Behavioural Approaches For POCD

Behavioural CBT draws on Exposure and Response Prevention (ERP) to treat POCD.  This involves retraining yourself to resist compulsions and confronting anxieties in a paced and manageable way.  It’s likely that before this point individuals are partaking in reassuring or avoidant behaviours. ERP asks individuals to confront the feared situation instead, without using reassuring behaviours. This could mean re-engaging with tasks that involve children you know without engaging in rituals or resisting the urge to modify your behaviour due to fears like avoiding children you would normally see. Instead, you would be asked to resume usual activities with children (like bathing your child) and/or take part in cognitive or imaginal exposures like confronting and welcoming the intrusive thoughts to diminish their strength over time.

Mindfulness For POCD

Mindfulness is about being consciously present in our thoughts, emotions, bodily sensations, or environment.  Mindfulness teaches the importance of simply observing these, not judging, or reacting to them.  Understandably, therefore, mindfulness is a valuable aspect of CBT work, especially for anxiety ‘disorders’, like POCD, which are maintained by mental rituals.  Mindfulness allows us to notice the act of ritualising, to observe the thoughts attached, and to realise there are other more helpful ways we might respond.  In this way we can learn to confront and accept intrusive thoughts, to expose ourselves to a new way of being, that is, responding in a way that may not feel right, and in addition, learn that rather than punish ourselves, we can be non-judgemental and accepting.  In this way, mindfulness allows us to learn that thoughts are simply thoughts, and we can give them a bit of headspace so that gradually they lose power.

Is CBT Telling Me To Accept Something That Goes Against Everything I Believe?

No.  CBT attempts to teach you to accept your anxiety provoking thoughts, discomforts, and fears as valid.  Treatment is geared toward highlighting that these very worries demonstrate your strong moral values and desire to not harm.  Acceptance of this is what can strengthen your ability to identify new and more helpful ways of responding to challenging thoughts and fears.

Clarifying POCD & ERP

Why POCD Occurs

POCD can emerge in various ways, for some it’s a new theme.  That is, they have experienced OCD before and POCD is the ‘flavour of the month’.  For others, it can happen after having children, or for other reasons that may or may not relate to having children, such as deciding to plan a family.  Whether you’ve had experience of OCD or not, however, it is no less frightening.  But one thing you might know if you have experienced OCD is how it works, and that offers the advantage of knowing that you are not an awful person who should be locked away, rather, you are again suffering with a form of OCD, but knowledge is power, and you can beat it.

Why POCD Must Be Treated

Although CBT treatment for POCD has proven effective, even with the preceding explanation, it is likely still a frightening prospect.  Being asked to confront thoughts that scare and sicken you will be unwelcome news indeed, but what is the alternative? You have tried avoidance and rituals and yet, here you are.  POCD wants to control you, it wants you to submit to its will, to exhaust you by having you worry about all aspects of your life; what you do, where you go, who you interact with, how you interact with children, what you watch, and buy, POCD wants all of you, yes even your identity is at stake.  POCD wants you to lose everything by learning that you are the thing you fear the most, a paedophile.

How ERP Will Help

Thus ERP, rather than something to be feared and avoided (as the POCD wants), is the very thing that might save you from this onslaught.  ERP will teach you how to combat POCD’s tyranny and it will never ask you to do anything that infringes on your values, like harming a child.  However, this does not mean it will be easy, you will be tested and asked to experience unpleasant thoughts, feelings, and situations, but you’re already doing this at the hands of POCD.  The difference is that when you suffer because of ERP, you are learning something, you are moving in a progressive direction because as you gradually begin to experience less anxiety, you start to feel that bit more free of POCD’s wretched hold on your life, you can start to do the things you used to without being misjudged and punished by POCD.

But How Do I Know I’m Not A Paedophile?

This is one of the traps that POCD sets for you; the need to prove to yourself that you are not the thing you fear the most.  You will likely have searched online, watched some shows, and talked to people about paedophiles, essentially, you’ve been looking for information because you must convince yourself that you aren’t sexually attracted to children.

You do this because you want reassurance, you want to be 100% certain that you are not a paedophile.  This sends you into the obsessive-compulsive cycle of POCD, you are searching for the gold at the end of the rainbow, but there is no such proof to be found, for you, or me, because we cannot prove a negative.  So instead of chasing certainty, we might instead strive for confidence, faith, and trust in our core selves. This is difficult when one is consumed by OCD, however, by being open to uncertainty, we can live in ways that do not strengthen POCD’s stranglehold, for example by undertaking endless research.

Seeking to prove a negative is also accompanied by another less sophisticated trap of OCD.  This is the belief that if you are capable of harming a child, then you will.  Capability however would not stand up in a court of law, if it did, we would all likely be behind bars for something.  It is therefore important to separate a possibility from a probability, just because I can do something, doesn’t mean I will.  So, if you are having horrible intrusive thoughts about children right now, then this is your current experience right now, and that is all.

Do Not Suffer Alone Needlessly

It is important to realise that you are not alone in this, and there is nothing inherently wrong with you.  You might be struggling with thoughts and feelings about children that disgust and frighten you because you have a common mental health condition called OCD, of which one variation is POCD.  But just as the disorder was triggered or developed, it can be treated effectively like any other mental health disorder when the right treatment is used.  So, if you or someone you know is suffering with POCD, access the antidote.