Sexual obsessions
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[edit] Sexual Obsessions: A Symptom of Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) involves obsessions -- unwanted thoughts or images that are upsetting or interfere with an individual's life, followed by compulsions -- actions that temporarily relieve the anxiety caused by the obsessions (APA 2000). Obsessions are involuntary, repetitive, and unwelcome. Attempts to suppress obsessions do not work and in fact make the obsessions more severe. OCD is considered an anxiety disorder.
Typical obsessive themes center on contamination, illness, worries about disaster, and orderliness. However, people with OCD also obsess about violence, religious questions, and/or sexual experiences. Up to a quarter of people with OCD may experience sexual obsessions (Grant et al, 2006).
Repetitive sexual thoughts are seen in many disorders in addition to OCD. For example, sexual thoughts are common to people with paraphilias, post-traumatic stress disorder, sexual dysfunction, sexual addiction and as part of the normal fantasy life of the general population. The recurrent sexual thoughts and feelings in these situations are sometimes referred to as sexual obsessions. However their content, form, and meaning vary depending on the disorder (Gordon 2002).
[edit] The Sexual Focus
Since sex carries so much emotional, moral, and religious importance, it easily becomes a magnet for obsessions in people predisposed to OCD. Common themes include homosexuality, unfaithfulness, deviant behaviors, pedophilia, AIDS, and profane thoughts combining religion and sex. People with sexual obsessions may have legitimate concerns about their attractiveness, potency, or partner, which can serve as an unconscious catalyst for the obsessions.
[edit] Examples of Sexual Obsessions
Sexual obsessions take many forms. For example, a father might obsess about sexually abusing his beloved young daughter. He might wonder if these thoughts mean that he is a pedophile and worry that he could act them out, despite the fact that he has never sexually abused anyone and feels disgusted by the idea. A woman who has happily dated men all of her life might suddenly start to worry that her lukewarm feelings toward her boyfriend mean that she is a lesbian. She might then start to look at every woman wondering if, in fact, she is attracted to someone of the same sex. Another example is a man who worries that he may accidentally impregnate a woman by shaking her hand because he was not careful enough in washing his hands after touching his genitals (Williams 2007).
In the midst of the thoughts, the sexual obsessions may seem real. Occasionally individuals with OCD believe that their obsession is true, and in such a case they would be said to have "poor insight." But the vast majority of people with OCD recognize at some point that their fears are extreme and unrealistic. The problem is that even though they know the obsession is false, it feels real. These individuals can't understand why they are unable to dismiss the obsession from the mind. The obsession may temporarily go away in the face of a logical argument or reassurance from others, but may spike when caught off guard by a sexual trigger (Gordon 2002).
Sexual obsessions can be particularly troubling to the individual with OCD, as something important and cherished becomes twisted into its nightmarish opposite. People with sexual obsessions are particularly likely to have co-occurring aggressive and religious obsessions, clinical depression, and higher rates of impulse control disorders (Grant et al, 2006).
[edit] The Role of Self-Doubt
Obsessions are often viewed by the patient as a series of "What if"s. They may wonder, "What if I am really a homosexual?" "What if I really want to seduce my student?" "What if I got AIDS from visiting a prostitute while sleepwalking?" The chance of an obsession coming true is remote but often the concern can never be completely disproved (i.e. "What if I really was aroused by that picture of a child?") Arguing with a person with OCD is usually futile. Objective feedback contradicting the obsession is dismissed because it lacks one-hundred percent certainty. For someone with OCD, no possibility is ever remote enough to permanently banish the fear. Attempts to prove the unprovable leads to circles of doubt, reassurance seeking, and checking compulsions (Gordon 2002).
Sexual obsessions can occur with or without compulsions. A compulsion can be a behavioral act or a mental ritual. Examples of mental rituals include silent prayers, repeating special phrases (i.e. "I truly love my wife,") and mental arguments with oneself about the validity of the obsession. Compulsions are performed as an attempt to counteract the obsession. Compulsions temporarily reduce anxiety, but ultimately they make the OCD more severe. This type of checking can be extremely destructive to the person with sexual obsessions as they use very the existence of the compulsive behavior as a sign that they are in fact sexually deviant.
[edit] Sexual Fantasy
It cannot be overemphasized that the sexual obsessions in OCD are the opposite of the usual sexual daydream or fantasy. Normal sexual fantasies are enjoyable and generally harmless. They may consist of wishes or memories of past sexual experiences. However, the sexual ideation in OCD is unpleasant and distressing. The individual with OCD does not want the thought to become real. The idea of acting out the obsession fills the OCD victim with dread (Gordon 2002). The sexual ideation in such situations is termed "ego-dystonic" or ego-alien, meaning that the behavior and/or attitudes are seen by the individual as inconsistent with his or her fundamental beliefs and personality.
Sexual obsessions in OCD rarely produce sexual arousal because anxiety and arousal cannot occupy the same space. As a result, OCD usually decreases sex drive. OCD sexual obsessions result in guilt, shame, and interfere with social functioning or work.
[edit] Treatment
People with sexual obsessions devote an excessive amount of time and energy attempting to understand the obsessions. They usually decide they are having these problems because they are defective in some way, and they are often too ashamed to seek help.
Because sexual obsessions are not as well-described in the research literature, many therapists may fail to properly diagnose OCD in a client with primary sexual obsessions. Mental health professionals unfamiliar with OCD may even attribute the symptoms to an unconscious wish, sexual identity crisis, or hidden paraphilia. Such a misdiagnosis only panics an already distressed individual. Conceptualizing a problem such as homosexuality fears as a struggle with "coming out of the closet" can cause the patient to become even more upset and confused (Gordon 2002). Fortunately, sexual obsessions respond to the same type of effective treatments available for other forms of OCD -- cognitive-behavioral therapy and serotonergic antidepressant medications (SSRIs). People with sexual obsessions may, however, need a longer and more aggressive course of treatment (Granta et al, 2006).
[edit] Medication for Sexual Obsessions
Many people with sexual obsessions are alarmed that they seem to lose their sex drive. People with OCD may see this as evidence that they are no longer attracted to the opposite sex and are in fact deviant in some way. Some may wonder if medication is the answer to the problem. Medication is a double-edged sword. Drugs specifically for erectile dysfunction (i.e. Viagra, Cialis) are not the answer for people with untreated OCD. The sexual organs are working properly, but it is the anxiety disorder that interferes with normal libido.
Medications specifically for OCD (typically SSRI medications) will help alleviate the anxiety but will also cause some sexual dysfunction in about a third of patients (Bystritsky 2004). For many the relief from the anxiety is enough to overcome the sexual problems caused by the medication. For others, the medication itself makes sex truly impossible. This may be a temporary problem, but if it persists a competent psychiatrist can adjust the medications to overcome this side-effect.
[edit] Related Links
[edit] References
- A Bystritsky. (2004). Current Pharmacological Treatments for Obsessive-Compulsive Disorder. Essent Psychopharmacol 5:4.
- American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition – Text Revision, Washington D.C., USA: American Psychiatric Press.
- WM Gordon. (2002) Sexual obsessions and OCD, Sexual and Relationship Therapy, Vol. 17, No. 4.
- JE Grant, A Pintob, M Gunnipb, MC Mancebob, JL Eisenb, SA Rasmussen. (2006). Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder. Comprehensive Psychiatry, 47: 325-329.
- MT Williams. BrainPhysics Mental Health Resource, accessed 01/20/2007.
