Sexual obsessions

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Sexual obsessions are persistent and unrelenting thoughts about sexual activity. In the context of obsessive-compulsive disorder (OCD), these are extremely common, [1] and can become extremely debilitating, making the person ashamed of the symptoms and reluctant to seek help. A preoccupation with sexual matters, however, does not only occur as a symptom of OCD, they may be enjoyable in other contexts (i.e. sexual fantasy).

Contents

Obsessive-compulsive disorder

Obsessive-compulsive disorder involves unwanted thoughts or images that are unsettling or interfere with an individual's life, followed by actions that temporarily relieve the anxiety caused by the obsessions. [2] Obsessions are involuntary, repetitive, and unwelcome. Attempts to suppress or neutralize obsessions do not work and in fact make the obsessions more severe, as trying to make sense of obsessions only gives them more attention and "fuel".

Typical obsessive themes center on contamination, illness, worries about disaster, and orderliness. However, people with OCD also obsess about violence, religious questions, and sexual experiences. [3] Up to a quarter of people with OCD may experience sexual obsessions, [4] and some OCD sexual obsessions have been linked to childhood sexual abuse of OCD sufferers. [5] Repetitive sexual thoughts are seen in many disorders in addition to OCD, but these disorders bear no relation to OCD. For example, sexual thoughts unrelated to OCD are common to people with paraphilias, post-traumatic stress disorder, sexual dysfunction, or sexual addiction. The recurrent sexual thoughts and feelings in these situations are sometimes referred to as sexual obsessions which may include a person's sexual orientation, doubts and or fears about being homosexual or being viewed by others as homosexual. [6] [7] [8] [9] However, their content, form, and meaning vary depending on the disorder, with OCD sexual obsessions being not only involuntary but also unwanted, and causing great mental distress and suffering for the person with OCD. [10]

Sexual focus

Because sex carries significant emotional, moral, and religious importance, it often becomes a magnet for obsessions in people predisposed to OCD. Common themes include unfaithfulness, deviant behaviors, pedophilia, the unfaithfulness or suitability of one's partner, and 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. [11]

Sexual obsessions take many forms. For example, a mother might obsess about sexually abusing her child. She might wonder if these thoughts mean that she is a pedophile and worry that she could act them out, despite the fact that she has never sexually abused anyone and feels disgusted by the idea. 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. [11] Patients may also experience fears that their obsessions have already been carried out, and this causes them great mental distress and suffering. The ignorance and misunderstanding of the general population about OCD, largely as a result of misinformation about the disorder, often leads to assumptions that sufferers are criminals or deviants. This can then reinforce the belief in the mind of the sufferer that they really have committed a crime or immoral act, when they have not, or lead to doubts. This causes great distress for an OCD sufferer, and occasionally leads to the sufferer making "confessions" – sometimes to the police – and suicidal thoughts or attempts. [12]

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 cannot understand why they are unable to dismiss the obsession from their minds. The obsession may temporarily subside in the face of a logical argument or reassurance from others, but may spike when caught off guard by a sexual trigger. [10]

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, [4] though the latter is less common in OCD patients.

Self-doubt

The obsessions often reflect a vulnerable self-theme where the person doubts their real or actual self. [13] Doubt and uncertainty linger with sexual obsessions. They provide several contradictions which include: uncertainty as to whether you would act on these or whether you have already acted upon them, and uncertainty as to whether you are liking the thoughts (even though you know you do not) needless to say these cause an increase in anxiety, doubt, and uncertainty. [14]

Another form of OCD that can take hold of a person involves obsessive doubts, preoccupations, checking, and reassurance seeking behaviors focusing on intimate relationships (ROCD). [15] As with sexual obsessions, and at times in response to them, a person may feel the need to end a perfectly good relationship based on their inability to feel how they want to. A person may continuously doubt whether they love their partner, whether their relationship is the "right" relationship or whether their partner "really" loves them. Another form of ROCD includes preoccupation, checking, and reassurance seeking behaviors relating to the partner's perceived flaws. [16] Instead of finding good in their partner, they are constantly focused on their shortcomings.

Avoidance

In the same way that those who have OCD fears of contamination avoid anything that will "contaminate" them (i.e., doorknobs, puddles, shaking hands), those who are suffering from such sexual obsessions may feel an overpowering need to avoid all contact with anything that can cause them to have anxiety, or "spike". Such avoidance may include: [17]

Sexual ideation

It cannot be overemphasized that the sexual obsessions in OCD are the opposite of the usual sexual daydream or fantasy. The thoughts are not really part of the person's identity, but they are the sort of thoughts or impulses the person with OCD fears that they may have. [13] [18] The sexual ideation in OCD is unpleasant and distressing for the person with OCD. 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. [10] 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. Therefore, OCD can decrease libido.

The OCD sufferer may have a constant focus on not becoming aroused or checking that they do not become aroused, and this may lead to "groinal response". Many OCD sufferers take this groinal response as actual arousal, when in reality it is not. OCD sexual obsessions often result in guilt, shame, depression and may interfere with social functioning or work. Approximately 40% of sufferers (number could be higher due to the embarrassment associated) also report some accompanying physiological arousal. Reactions can include increased heart rate, a feeling of being turned on, and even erections, increased lubrication (in women), and orgasm. This response typically generates more confusion and uncertainty. However, this is a conditioned physiological response in the primitive thalamus of a brain which does not identify the thought as sex with a particular person, but just sex. This is generally not indicative of one's own personal desires. [14]

Treatment

People with sexual obsessions can 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 (typically in the case of psychoanalysts or psychodynamic therapists [19] ), sexual identity crisis, or hidden paraphilia. Such a misdiagnosis only panics an already distressed individual. 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. [4]

Medication

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 no longer have normal sexual attractions and are in fact deviant in some way. Some may wonder if medication is the answer to the problem. 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. [20]

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. [21] 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 often adjust the medications to overcome this side-effect. [20]

Sexual obsessions and sexual acts

Someone with a sexual obsession may have trouble performing sexual acts, for fear of thinking about deviant sexual behavior, and the fear of being tempted to perform such behavior when it would be harmful to them or to others. When a person with a sexual obsession masturbates, they may have the constant fear of picturing something unwanted and intrusive. Afterwards, they may feel guilty or shameful, as they may have been thinking about the object of their obsession during most or all of the sexual activity. Many people with this type of obsession are often reluctant to or avoid performing any type of sexual act.

Related Research Articles

<span class="mw-page-title-main">Obsessive–compulsive personality disorder</span> Personality disorder involving orderliness

Obsessive–compulsive personality disorder (OCPD) is a cluster C personality disorder marked by a spectrum of obsessions with rules, lists, schedules, and order, among other things. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety of situations. The cause of OCPD is thought to involve a combination of genetic and environmental factors, namely problems with attachment.

<span class="mw-page-title-main">Kleptomania</span> Inability to resist the urge to steal

Kleptomania is the inability to resist the urge to steal items, usually for reasons other than personal use or financial gain. First described in 1816, kleptomania is classified in psychiatry as an impulse control disorder. Some of the main characteristics of the disorder suggest that kleptomania could be an obsessive-compulsive spectrum disorder, but also share similarities with addictive and mood disorders.

Scrupulosity is the pathological guilt/anxiety about moral or religious issues. Although it can affect nonreligious people, it is usually related to religious beliefs. It is personally distressing, dysfunctional, and often accompanied by significant impairment in social functioning. It is typically conceptualized as a moral or religious form of obsessive–compulsive disorder (OCD), The term is derived from the Latin scrupus, a sharp stone, implying a stabbing pain on the conscience. Scrupulosity was formerly called scruples in religious contexts, but the word scruple now commonly refers to a troubling of the conscience rather than to the disorder.

In psychoanalysis, egosyntonic refers to the behaviors, values, and feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image. Egodystonic is the opposite, referring to thoughts and behaviors that are conflicting or dissonant with the needs and goals of the ego, or further, in conflict with a person's ideal self-image.

Thought broadcasting is a type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence. The person may believe that either those nearby can perceive their thoughts or that they are being transmitted via mediums such as television, radio or the internet. Different people can experience thought broadcasting in different ways. Thought broadcasting is most commonly found among people that have a psychotic disorder, specifically schizophrenia.

<span class="mw-page-title-main">Intrusive thought</span> Unwelcome involuntary thought, image or idea

An intrusive thought is an unwelcome, involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are associated with obsessive-compulsive disorder (OCD), Tourette's syndrome (TS), depression, body dysmorphic disorder (BDD), and sometimes attention-deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD, post-traumatic stress disorder, other anxiety disorders, eating disorders, or psychosis. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes.

The obsessive–compulsive spectrum is a model of medical classification where various psychiatric, neurological and/or medical conditions are described as existing on a spectrum of conditions related to obsessive–compulsive disorder (OCD). "The disorders are thought to lie on a spectrum from impulsive to compulsive where impulsivity is said to persist due to deficits in the ability to inhibit repetitive behavior with known negative consequences, while compulsivity persists as a consequence of deficits in recognizing completion of tasks." OCD is a mental disorder characterized by obsessions and/or compulsions. An obsession is defined as "a recurring thought, image, or urge that the individual cannot control". Compulsion can be described as a "ritualistic behavior that the person feels compelled to perform". The model suggests that many conditions overlap with OCD in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to various pharmacotherapies. Conditions described as being on the spectrum are sometimes referred to as obsessive–compulsive spectrum disorders.

<span class="mw-page-title-main">Compulsive behavior</span> Habit and impulse disorder

Compulsive behavior is defined as performing an action persistently and repetitively. Compulsive behaviors could be an attempt to make obsessions go away. Compulsive behaviors are a need to reduce apprehension caused by internal feelings a person wants to abstain from or control. A major cause of compulsive behavior is said to be obsessive–compulsive disorder (OCD). "The main idea of compulsive behavior is that the likely excessive activity is not connected to the purpose to which it appears directed." There are many different types of compulsive behaviors including shopping, hoarding, eating, gambling, trichotillomania and picking skin, itching, checking, counting, washing, sex, and more. Also, there are cultural examples of compulsive behavior.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders.

A transformation obsession is a lesser known symptom and manifestation of obsessive compulsive disorder (OCD).

Primarily obsessional obsessive–compulsive disorder, also known as purely obsessional obsessive–compulsive disorder, is a lesser-known form or manifestation of OCD. It is not a diagnosis in the DSM-5. For people with primarily obsessional OCD, there are fewer observable compulsions, compared to those commonly seen with the typical form of OCD. While ritualizing and neutralizing behaviors do take place, they are mostly cognitive in nature, involving mental avoidance and excessive rumination. Primarily obsessional OCD takes the form of intrusive thoughts often of a distressing, sexual, or violent nature.

<span class="mw-page-title-main">Obsessive–compulsive disorder</span> Mental and behavioral disorder

Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and feels the need to perform certain routines (compulsions) repeatedly to relieve the distress caused by the obsession, to the extent where it impairs general function.

The biology of obsessive–compulsive disorder (OCD) refers biologically based theories about the mechanism of OCD. Cognitive models generally fall into the category of executive dysfunction or modulatory control. Neuroanatomically, functional and structural neuroimaging studies implicate the prefrontal cortex (PFC), basal ganglia (BG), insula, and posterior cingulate cortex (PCC). Genetic and neurochemical studies implicate glutamate and monoamine neurotransmitters, especially serotonin and dopamine.

<span class="mw-page-title-main">Effects of stress on memory</span> Overview of the effects of stress on memory

The effects of stress on memory include interference with a person's capacity to encode memory and the ability to retrieve information. Stimuli, like stress, improved memory when it was related to learning the subject. During times of stress, the body reacts by secreting stress hormones into the bloodstream. Stress can cause acute and chronic changes in certain brain areas which can cause long-term damage. Over-secretion of stress hormones most frequently impairs long-term delayed recall memory, but can enhance short-term, immediate recall memory. This enhancement is particularly relative in emotional memory. In particular, the hippocampus, prefrontal cortex and the amygdala are affected. One class of stress hormone responsible for negatively affecting long-term, delayed recall memory is the glucocorticoids (GCs), the most notable of which is cortisol. Glucocorticoids facilitate and impair the actions of stress in the brain memory process. Cortisol is a known biomarker for stress. Under normal circumstances, the hippocampus regulates the production of cortisol through negative feedback because it has many receptors that are sensitive to these stress hormones. However, an excess of cortisol can impair the ability of the hippocampus to both encode and recall memories. These stress hormones are also hindering the hippocampus from receiving enough energy by diverting glucose levels to surrounding muscles.

In psychology, relationship obsessive–compulsive disorder (ROCD) is a form of obsessive–compulsive disorder focusing on close or intimate relationships. Such obsessions can become extremely distressing and debilitating, having negative impacts on relationships functioning.

The delayed-maturation theory of obsessive–compulsive disorder suggests that obsessive–compulsive disorder (OCD) can be caused by delayed maturation of the frontal striatal circuitry or parts of the brain that make up the frontal cortex, striatum, or integrating circuits. Some researchers suspect that variations in the volume of specific brain structures can be observed in children that have OCD. It has not been determined if delayed-maturation of this frontal circuitry contributes to the development of OCD or if OCD is the ailment that inhibits normal growth of structures in the frontal striatal, frontal cortex, or striatum. However, the use of neuroimaging has equipped researchers with evidence of some brain structures that are consistently less adequate and less matured in patients diagnosed with OCD in comparison to brains without OCD. More specifically, structures such as the caudate nucleus, volumes of gray matter, white matter, and the cingulate have been identified as being less developed in people with OCD in comparison to individuals that do not have OCD. However, the cortex volume of the operculum (brain) is larger and OCD patients are also reported to have larger temporal lobe volumes; which has been identified in some women patients with OCD. Further research is needed to determine the effect of these structural size differences on the onset and degree of OCD and the maturation of specific brain structures.

Safety behaviors are coping behaviors used to reduce anxiety and fear when the user feels threatened. An example of a safety behavior in social anxiety is to think of excuses to escape a potentially uncomfortable situation. These safety behaviors, although useful for reducing anxiety in the short term, might become maladaptive over the long term by prolonging anxiety and fear of nonthreatening situations. This problem is commonly experienced in anxiety disorders. Treatments such as exposure and response prevention focus on eliminating safety behaviors due to the detrimental role safety behaviors have in mental disorders. There is a disputed claim that safety behaviors can be beneficial to use during the early stages of treatment.

<span class="mw-page-title-main">Jonathan Abramowitz</span> American clinical psychologist

Jonathan Stuart Abramowitz is an American clinical psychologist and Professor in the Department of Psychology and Neuroscience at the University of North Carolina at Chapel Hill (UNC-CH). He is an expert on obsessive-compulsive disorder (OCD) and anxiety disorders whose work is highly cited. He maintains a research lab and currently serves as the Director of the UNC-CH Clinical Psychology PhD Program. Abramowitz approaches the understanding and treatment of psychological problems from a cognitive-behavioral perspective.

The Dimensional Obsessive-Compulsive Scale (DOCS) is a 20-item self-report instrument that assesses the severity of Obsessive-Compulsive Disorder (OCD) symptoms along four empirically supported theme-based dimensions: (a) contamination, (b) responsibility for harm and mistakes, (c) incompleteness/symmetry, and (d) unacceptable (taboo) thoughts. The scale was developed in 2010 by a team of experts on OCD led by Jonathan Abramowitz, PhD to improve upon existing OCD measures and advance the assessment and understanding of OCD. The DOCS contains four subscales that have been shown to have good reliability, validity, diagnostic sensitivity, and sensitivity to treatment effects in a variety of settings cross-culturally and in different languages. As such, the DOCS meets the needs of clinicians and researchers who wish to measure current OCD symptoms or assess changes in symptoms over time.

Inferential confusion is a meta-cognitive state of confusion that becomes pathological when an individual fails to interpret reality correctly and considers an obsessional belief or subjective reality as an actual probability. It causes an individual to mistrust their senses and rely on self-created narratives ignoring evidence and the objectivity of events. These self-created narratives come from memories, information, and associations that aren't related- therefore, it deals with the fictional nature of obsessions. It causes the individual to overestimate the threat.

References

  1. ↑ Williams MT, Farris SG (May 2011). "Sexual orientation obsessions in obsessive-compulsive disorder: prevalence and correlates". Psychiatry Research. 187 (1–2): 156–159. doi:10.1016/j.psychres.2010.10.019. PMC   3070770 . PMID   21094531.
  2. ↑ American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5). Arlington, VA: American Psychiatric Publishing.
  3. ↑ Williams MT, Mugno B, Franklin M, Faber S (2013). "Symptom dimensions in obsessive-compulsive disorder: phenomenology and treatment outcomes with exposure and ritual prevention". Psychopathology. 46 (6): 365–376. doi: 10.1159/000348582 . PMC   3992249 . PMID   23615340.
  4. 1 2 3 Grant JE, Pinto A, Gunnip M, Mancebo MC, Eisen JL, Rasmussen SA (2006). "Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder". Comprehensive Psychiatry. 47 (5): 325–329. doi:10.1016/j.comppsych.2006.01.007. PMID   16905392.
  5. ↑ Caspi A, Vishne T, Sasson Y, Gross R, Livne A, Zohar J (2008). "Relationship between childhood sexual abuse and obsessive-compulsive disorder: case control study". The Israel Journal of Psychiatry and Related Sciences. 45 (3): 177–182. PMID   19398821.
  6. ↑ Williams MT, Wetterneck C, Tellawi G, Duque G (April 2015). "Domains of distress among people with sexual orientation obsessions". Archives of Sexual Behavior. 44 (3): 783–789. doi:10.1007/s10508-014-0421-0. PMID   25339522. S2CID   4712902.
  7. ↑ Williams MT, Farris SG (May 2011). "Sexual orientation obsessions in obsessive-compulsive disorder: prevalence and correlates". Psychiatry Research. 187 (1–2): 156–159. doi:10.1016/j.psychres.2010.10.019. PMC   3070770 . PMID   21094531.
  8. ↑ Bhatia MS, Kaur J (January 2015). "Homosexual Obsessive Compulsive Disorder (HOCD): A Rare Case Report". Journal of Clinical and Diagnostic Research. 9 (1): VD01–VD02. doi:10.7860/JCDR/2015/10773.5377. PMC   4347158 . PMID   25738067.
  9. ↑ Safer DL, Bullock KD, Safer JD (June 2016). "Obsessive-Compulsive Disorder Presenting as Gender Dysphoria/Gender Incongruence: A Case Report and Literature Review". AACE Clinical Case Reports. 2 (3): e268–e271. doi: 10.4158/EP161223.CR . ISSN   2376-0605.
  10. 1 2 3 Gordon WM (2002). "Sexual obsessions and OCD". Sexual and Relationship Therapy. 17 (4): 343–354. CiteSeerX   10.1.1.604.8231 . doi:10.1080/1468199021000017191. S2CID   40820512.
  11. 1 2 Williams MT (2008). "Homosexuality Anxiety: A Misunderstood Form of OCD". In Sebek LV (ed.). Leading-Edge Health Education Issues. Nova. ISBN   978-1600218743.
  12. ↑ Kamath P, Reddy YC, Kandavel T (November 2007). "Suicidal behavior in obsessive-compulsive disorder". The Journal of Clinical Psychiatry. 68 (11): 1741–50. doi:10.4088/jcp.v68n1114. PMID   18052568.
  13. 1 2 Aardema F, O'Connor K (2007). "The menace within: obsessions and the self". Journal of Cognitive Psychotherapy. 21 (3): 182–197. doi:10.1891/088983907781494573. S2CID   143731458.
  14. 1 2 Osgood-Hynes D (November 2011). "Thinking Bad Thoughts" (PDF). Belmont MA: MGH McLean Institute. Archived from the original (PDF) on 15 November 2011.
  15. ↑ Doron G, Derby DS, Szepsenwol O, Talmor D (2012). "Tainted Love: exploring relationship-centered obsessive compulsive symptoms in two non-clinical cohorts". Journal of Obsessive-Compulsive and Related Disorders. 1: 16–24. doi:10.1016/j.jocrd.2011.11.002.
  16. ↑ Doron G, Derby DS, Szepsenwol O, Talmor D (2012). "Flaws and All: Exploring Partner-Focused Obsessive-Compulsive Symptoms". Journal of Obsessive-Compulsive and Related Disorders. 1 (4): 234–243. doi:10.1016/j.jocrd.2012.05.004.
  17. ↑ Williams MT, Wetterneck CT (2019). Sexual Obsessions in Obsessive-Compulsive Disorder: A Step-by-Step, Definitive Guide to Understanding, Diagnosis, and Treatment. Oxford University Press. ISBN   9780190624798.
  18. ↑ Aardema F, O'Connor K (2003). "Seeing white bears that are not there: Inference processes in obsessions". Journal of Cognitive Psychotherapy . 17: 23–37. doi:10.1891/jcop.17.1.23.58270. S2CID   143040967.
  19. ↑ "How Do I Know I'm Not Really Gay?". International OCD Foundation. Retrieved 24 December 2015.
  20. 1 2 Williams MT, Davis DM, Powers M, Weissflog LO (2014). "Current Trends in Prescribing Medications for Obsessive-Compulsive Disorder: Best Practices and New Research". Directions in Psychiatry. 34 (247–261): 247–261.
  21. ↑ Bystritsky A (2004). "Current Pharmacological Treatments for Obsessive-Compulsive Disorder". Essential Psychopharmacology. 5: 4. CiteSeerX   10.1.1.456.2873 .

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