Assessing Clients with Sexual Obsessions

This chapter reviews the most important considerations when assessing a client with sexual obsessions within OCD (S-OCD). Clients typically experience increased shame surrounding symptoms and obsess about the cause and meaning of obsessions, and this chapter provides guidance for therapists during the initial consultation. Also reviewed are recommended assessment strategies and helpful clinical tools, with a table of measures. Differential diagnosis for S-OCD versus pedophilic disorder and sexual identity confusion are contrasted. Also provided are examples of OCD surrounding transgender fears, bestiality fears, and S-OCD with psychosis. Clients with OCD are often undermedicated by their physicians, and so included is a review of medication options for OCD and common side effects, written to be accessible to therapist nonprescribers. The chapter ends with a discussion of how to communicate with other mental healthcare providers, including physicians and other prescribers, therapists, social workers, clergy, and traditional healers.