ERP Therapy Stories: Pedophilia OCD (POCD)
I created this “ERP Therapy Stories” series to share a glimpse of how the application of ERP therapy could look within the context of different OCD subtypes. I hope to provide some examples of ERP therapy while channeling my creative and imaginative side. The stories and characters that I write about are fictional, but the ERP strategies depicted are ones that I teach and use in treatment with my clients. This particular post focuses on illustrating symptoms of POCD, including common POCD obsessions and POCD compulsions. As an OCD therapist who enjoys storytelling, I hope these vignettes can help you feel less alone and see hope in ERP therapy.
Luis is a 21-year-old college student attending the University of Southern California in Los Angeles. He is getting ready to enter his senior year of college and feeling nervous about returning to campus.
Luis experienced symptoms of Pedophilia OCD (POCD) at the end of his junior year.
At the time, he didn’t know what was wrong. He was plagued with unwanted thoughts about the possibility of becoming a pedophile or being a pedophile in denial. The thoughts were so scary and they brought on so much anxiety and shame. He started to believe that he was a bad person, a monster. Walking outside and seeing children and prepubescent girls in summer clothes was something he dreaded.
Luis spent part of his summer break isolated from friends and not wanting to go out. His parents saw how distraught and depressed their son had become and expressed their concern. He eventually got the courage to share his symptoms with them. With their help, Luis was diagnosed with OCD.
He started ERP therapy with an OCD therapist in Los Angeles.
One of the first things he learned in OCD treatment was that his thoughts were ego-dystonic. This was one of the telling signs that this was OCD. Luis’ POCD obsessions were not in line with who he is as a person and they caused him significant distress. A pedophile would derive pleasure from sexual thoughts with children, purposely fantasize, and seek opportunities to get closer to children. They would not be avoidant, distressed, ashamed, or fearful like Luis. That initial pre-treatment education was very validating for Luis. But it was the only time his therapist would provide this information, to prevent it from turning into reassurance-seeking compulsions.
Luis meets with his OCD therapist twice weekly to make some headway in treatment before the start of school. One of his therapy goals is to start going on outings with friends again. He always enjoyed these outings.
Until POCD showed up and caused him to question his own identity.
Being around children, in particular, tween girls in swimsuits is a big trigger and something that he wants to tackle in ERP therapy. He and his OCD therapist started looking at Google images of children and girls in casual clothing, followed by swimsuits. Then they moved to watching videos of middle schoolers in gymnastics and swim team practice. Eventually, Luis moved on to in vivo exposures (facing his fears in real life). He gradually went from spectating outside the Santa Monica public pool entrance to going in and spending a couple of hours there with his family. All this was done with Luis resisting his identified compulsions. He and his therapist decide that he is ready to move down to weekly sessions by the time school starts and Luis plans to continue with OCD therapy for as long as needed into his senior year.
The first week of school is over and the weekend has arrived. Luis and his friends have planned to spend their first Saturday back at USC in Venice Beach. Luis is feeling anxious but determined. Luis and his friends arrive at the beach and get lucky finding a parking spot right on Pacific Avenue. Luis feels the anxiety rising. ERP therapy has increased his self-awareness and he notices the sensations in his body. He slowly unclenches his jaw, relaxes his shoulders, and allows the anxious feelings to be present without treating them as a threat. He refocuses his attention and joins the casual talk that his friends are making, trying his best to stay connected. As they enter the beach, he remembers how much he’s missed the warm sand under his feet and the Los Angeles coastal breeze.
Soon enough, a group of young-looking girls in swimsuits cross his path and settle on a spot near him and his friends. Luis did his due diligence in anticipating how he might handle a triggering situation like this one. “They look like they’re in middle school. How do you know you’re not attracted to them?” says his mind. Luis starts to feel a pit in his stomach and a lump in his throat. “Why are you even having these thoughts again? Only sick predators have thoughts like these.” That all too familiar feeling of shame is surfacing, the thoughts are making him doubt who he is as a person. Could he be as monstrous as his thoughts make him believe? He has the urge to do all the compulsions that he has relied on in the past. He wants to scan his body and check for signs of arousal. He wants to mentally review all the reasons why he wouldn’t abuse young girls. He wants to say “not interested” repeatedly and express vehement disapproval. He wants to turn away and distract himself.
But today, Luis was ready for this. He knew the obsessions would be coming strong at the beach. This was once a high-ranking item on his exposure hierarchy, a 10 on a scale of 0-10.
ERP therapy taught him to plan for these situations preemptively.
By doing so, he could catch himself in the OCD cycle early on and interrupt it. He’s having a bit of a tough time and remembers to respond to himself with some self-compassion. “You’re having some frightening thoughts right now. They’re loud, but you don’t need to engage with them.” Just as he had been practicing in ERP therapy sessions, he worked hard on letting the thoughts be present without getting sucked into what they were saying.
Luis didn’t try to push the thoughts away and he also didn’t give them his attention. He knew that his response to his obsessions was important and that he couldn’t cave into the compulsions, no matter how fearful he was. “Aren’t you worried that you might be a pedophile?” his thoughts kept going. “If you don’t do anything about it, then maybe you really are one!” Luis threw in a little sarcasm, “OK, whatever you say” before treating the thoughts like buzzing in the background. The thoughts got louder before they finally dimmed down.
It was tough, but Luis felt accomplished by the end of his beach day. The beach was a big exposure- he got triggered many times. But it got easier as the day went by and he succeeded in resisting most compulsions. Luis took an opportunity to reflect and write down what he learned and how he felt after this mega exposure. He didn’t leave early like he thought he would, and he had a better time than expected. Luis and his friends ended up staying at the beach till sunset and it was the most fun he’s had in a while. He would’ve missed out on this experience if he had not chosen to confront his fears. This gave him the motivation and confidence boost to continue participating in these kinds of outings.
Luis learned that he could handle it.
OCD took away a chunk of his summer and he is refusing to let it continue. Spending time with friends and socializing during his last year of college is not something he is willing to give up.
