POCD: when OCD causes unwanted thoughts about children

A horrible thought flashes into your mind about a child. You feel sick with fear. Why did I think that? What does it mean about me? You start avoiding children, checking your reactions, searching online for answers, and the more you try to be sure, the worse it gets.

If this is happening to you, you’re not alone, and you’re not what you fear. This is a recognised theme of obsessive-compulsive disorder, often called POCD. Here’s what it is and how it’s treated.

What is POCD?

POCD isn’t a separate diagnosis. It’s a name people use for OCD focused on unwanted, intrusive thoughts, images, urges or doubts about children, often sexual, or about harming them. The NHS lists fear of harming others, including children, among common OCD obsessions.

What defines it is the distress. People with POCD are horrified by the thoughts. They spend huge amounts of energy trying to get rid of them, check them, or prove to themselves they’re not dangerous.

Why the thoughts don’t mean what you fear

• Almost everyone has intrusive thoughts. In a study across six continents, about 94% of people had an unwanted intrusive thought in the previous three months.
• OCD targets what you value most. It latches onto the thing that would horrify you, which is why caring, protective people are often the ones it targets.
• The distress is the clue. Thoughts that go against your values, and that you desperately want gone, are the hallmark of OCD.
• Thinking isn’t doing. Having an intrusive thought doesn’t make you more likely to act on it.

Common compulsions in POCD

• Checking your body’s reactions. Anxiety and hyper-focus on your body can create sensations in the groin, sometimes called the “groinal response”. People then fear this means attraction, and keep checking, which creates more sensations.
• Avoiding children, family events, parks, babysitting or certain TV shows.
• Seeking reassurance from others or online: “Does this mean I’m a bad person?”
• Mentally reviewing memories to check you haven’t done anything wrong.
• Testing yourself by deliberately imagining scenarios to see how you react.
• Confessing thoughts to others to relieve the guilt.

Each compulsion brings a moment of relief, then the doubt returns, often stronger. Our post on why reassurance keeps OCD going explains this loop.

Treatment that works

POCD is treated like any other form of OCD:

• Exposure and response prevention (ERP): with a trained therapist, you gradually face the thoughts and situations you’ve been avoiding, while resisting checking, reassurance and other compulsions. Over time, the thoughts lose their power.
• Medicine: SSRIs can help, sometimes at higher doses than for depression.
• Learning to let thoughts be there without arguing with them, analysing them or pushing them away.

It helps to find a therapist experienced in OCD, who will understand POCD and won’t be shocked. The International OCD Foundation (iocdf.org) has a directory of therapists trained in ERP.

Shame keeps people silent

Many people with POCD suffer alone for years because they’re terrified of what others would think. Clinicians who treat OCD hear these thoughts often. Telling a professional is the first step towards getting better.

When to get help

Talk to a doctor or OCD therapist if intrusive thoughts are causing distress, taking up lots of your time, or leading you to avoid people and places.

If thoughts feel like genuine wants or urges, rather than unwanted and distressing intrusions, talk to a mental health professional confidentially. And if you’re having thoughts of ending your life, which can happen when OCD feels overwhelming, call or text 988 (US) now, or 911 in an emergency.

Frequently asked questions

Does having POCD thoughts mean I’m a danger to children?

The thoughts in POCD are unwanted, distressing and against your values, which is what makes them OCD. Having intrusive thoughts doesn’t make you more likely to act on them. A therapist experienced in OCD can help you understand this and treat it.

What is the groinal response?

It’s a name for genital sensations that can happen when you’re anxious and paying close attention to your body. In POCD, people misread these sensations as attraction and keep checking, which creates more sensations and more fear. It’s a well-known part of how OCD works.

Can POCD be cured?

Many people recover or improve dramatically with ERP and sometimes medicine. The thoughts may still pop up occasionally, but they stop causing distress and controlling your life.

Should I tell someone about my thoughts?

Telling a professional who understands OCD is the most helpful step. Confessing repeatedly to loved ones for reassurance can become a compulsion, so it’s best to work out with a therapist what to share.

How Breatheasy can help

When an intrusive thought brings a wave of panic and an urge to check or seek reassurance, Breatheasy can help you ride it out. The “Ride out an urge” tool helps you watch the urge rise and fall without acting on it, the same principle as ERP. Luma is designed not to give endless reassurance about OCD doubts, because reassurance keeps them going. Breatheasy can support treatment but doesn’t replace it. Breatheasy is coming soon to iPhone and Android.

Sources

• Obsessive compulsive disorder (OCD): symptoms, NHS
• Obsessive-compulsive disorder, National Institute of Mental Health
• Part 1, You can run but you can’t hide: intrusive thoughts on six continents, Radomsky and others, Journal of Obsessive-Compulsive and Related Disorders, 2014
• International OCD Foundation