When OCD includes thoughts of harming yourself or others
Nathan Peterson is super cool and has invested a TON into making accessible resources for folks with OCD. He tackles hard topics and does not deserve any crap from shock-jocks.
If you’ve already read my blog or know me in person, you know that I use humor A LOT to help “cut the heavy flavor” of our profession. But sometimes things get VERY unfunny in this work.
A conservative commentator/shock-jock (what do we call them these days?) went after my colleague, Nathan Peterson, for making a great video on pedophile-OCD (p-OCD), one of those types of OCD that leads sufferers to have a very high degree of self-loathing and disgust. I don’t know Nathan personally but we cross paths in professional groups. I absolutely ENVY his awesome website and videos. He makes great, evidence-based content on OCD. His website is the stuff of my dreams - LOOK AT IT if you haven’t been there. Imagine the effort he’s had to put into building that site and all of his videos and resources. So when this jerky-commentator went after him and passively threatened VIOLENCE against him, it made me really, really mad.
I’m not going to do this as eloquently as Nathan, but I think all OCD specialists need to speak up on harm-related OCDs to reduce the stigma and shine a light on a huge source of shame for a lot of our clients. Folks with harm-related OCDs are NOT more likely to hurt others. They may be more likely to harm themselves, but mostly due to the stigma around their conditions.
P-OCD: The terror of wondering if you’ll hurt someone
P-OCD is a type of mostly-obsessional OCD that a lot of sufferers don’t talk about because they’re afraid that their OCD will be misconstrued by loved ones or clinicians as actual pedophilia. Other types of OCD that I think fit the same pattern include self-harm or harm-to-others OCD (harm-OCD), and postpartum OCD (which often includes intrusive thoughts of harming your child).
How does p-OCD work?
Ultimately, the p-OCD sufferer is stuck in a loop of trying to prove the null hypothesis (that they’re safe to be around children). It’s impossible to prove the null hypothesis. You can “fail to reject” the null hypothesis but you cannot prove it (remember science 101?). No one can EVER prove that they are and will forever be “safe,” and so it’s an endless game of thinking and proving.
Here’s a common set of p-OCD thoughts:
I need to prove to myself that I am not now nor ever will be a pedophile.
I know that I have definitely NEVER harmed other people sexually. Despite that clear knowledge, my OCD brain keeps asking me, “What if my memory is wrong and I FORGOT about harming a minor?”
I know I am not attracted to minors but despite knowing that, the OCD says, “How does anyone know what they're attracted to? Maybe you’re in DENIAL.”
I know I do not WANT to be attracted to minors but then the OCD says, “what if there’s a 17 year old who looks 25 and I found them attractive - that’s proof that I am a pedophile!”
Basically any logical argument that’s thrown at the OCD, the OCD finds a way to turn it into proof that the dreaded thing is true.
OCD says to the sufferer “If you can THINK of an awful thing happening, that means it can happen.”
One of the problems with p-OCD is that it’s so shameful, sufferers are afraid of getting a misdiagnosis, and it is often invisible to others, so it grows unchecked for much longer than other types of OCD. Sufferers have the right to worry about getting the right diagnosis. MANY MANY mental health professionals have difficulty differentially diagnosing these types of harm-based OCDs from actual threats of harm to others. While my whole mission is to get general practice clinicians more facile with OCD, my strong message to any clinician struggling with making this diagnosis would be “Get consultation from an expert before you assign anyone a highly stigmatizing diagnosis.”
How’s it different from pedophilia?
Pedophiles are not unclear about their attraction to children. They may not be acting on that attraction (we hope) and they may even be working on actively suppressing it or getting therapy to keep themselves and others safe from the feelings. But they’re not UNCLEAR. They’re linear and not doing reassurance-seeking activities to avoid anxiety associated with their feelings. The attraction may be at odds with what they know are social standards of behavior but they’re not stuck in an accelerating loop of obsession and compulsive checking. Pedophilia doesn’t happen in the same pattern as p-OCD. It “moves differently".”
P-OCD behaves differently in that it often gets triggered by intrusive experiences, feels temporarily calmed through safety behaviors, and accelerates with engagement. It follows a clear OCD pattern, as does harm OCD. The fears are ego-dystonic, or against the core values of the OCD sufferer, which often makes the cycle even worse. If p-OCD sufferers find themselves in a pedophile chat room, it’s because they’re looking for reassurance that they’re not like “these people.” This is where p-OCD sufferers sometimes get into trouble. They go looking for reassurance that they’re not pedophiles, and inadvertently sometimes end up in dark places on the dark web, looking for proof that they’re NOT what they’re terrified of being.
If only we can get p-OCD sufferers into treatment earlier, we can keep them from going on a reassurance seeking quest that ends up getting them in big trouble. MOST folks with p-OCD do not end up in these places but it can happen and it does NOT make them a pedophile (but could make them a criminal which is awful.).
If you or someone you love has p-OCD or harm OCD of any type, make sure you have an OCD specialist on the team to help with differential diagnosis and a good treatment plan as soon as possible. We can educate them about the cycle and help them break it before trying to get out of it lands them in trouble. And please, support Nathan in his education efforts! He’s created so much awesome stuff and he doesn’t deserve death threats or being called a pedophile-defender.
PEOPLE WITH P-OCD ARE NOT NOT NOT PEDOPHILES.