Understanding Sexual Obsessions

Obsessive-compulsive disorder (OCD) has a heterogeneous presentation, and many of those afflicted experience symptoms that include sexual content. Sexual obsessions occur across ethnicity, race, and culture, although they may present as culturally bound syndromes. Common types of sexual obsessions include pedophile obsessions, sexual orientation obsessions, fears surrounding sexual/gender identity changes, religious sexual obsessions (scrupulosity), fears about committing a sexual assault, and irrational impregnating fears. This chapter reviews common concerns about the dangers posed by individuals with these forms of OCD and discusses the prognosis for those receiving proper treatment. The authors also review the four manifestations of OCD—contamination fears and cleaning rituals, doubting and compulsive checking rituals, symmetry obsessions and ordering rituals, and unacceptable/taboo thoughts and mental rituals. They describe how sexual symptoms fit into these four major dimensions.