Pedophilia OCD (POCD) refers to a common OCD theme in which one fears being sexually attracted to and/or sexually harming children.
It is distinctly different than pedophilia disorder.
OCD is egodystonic in nature.
This means that its obsessions inherently go against the sufferer’s true values or desires. In the context of pOCD, alarming, sexual, intrusive thoughts arise that are disturbing in nature, leaving the sufferer questioning why they would think these thoughts and whether they could do such acts.
We all understand what it feels like to have that instinctual feeling that something just isn’t right, it just feels a little bit ‘off’.
We can’t always explain why, but we have that overwhelming desire to go and ‘fix it’ in some way. We do this until we feel as though things are as they should be.
Everyone experiences this, but for someone with Just Right OCD that feeling is relentless and hard to shake.
Unlike most other OCD subtypes, Just Right OCD is driven by a sense of incompleteness or incorrectness.
Most OCD subtypes cause the sufferer to fixate on future-focused fears and outcomes. However, those with Real-event OCD – also known as ‘real-life’ OCD – is distinguished by obsessions and compulsions surrounding an event that has happened in the past.
In the case of real-event OCD, the sufferer finds themselves scrutinizing and ruminating over past events. Doubting the things they’ve said and done, leaving them with immense feelings of guilt and shame that they attempt to navigate through compulsive behaviors.
Someone with real-event OCD will exert a great deal of energy to try and find certainty around a past event which makes it very difficult to live and embrace the present moment.
Real-event OCD can feel as though it steals from the present moment as the sufferer remains in a rumination loop, trying to analyze and scrutinize past events that often leave them feeling like they are a bad person.
Here we will explore the ins and outs of real-event OCD.
But first, a quick recap of the OCD basics…
An Overview of OCD
There are two core components that characterize OCD and all of the OCD subtypes.
These are obsessions and compulsions.
OCD is a common mental health condition whereby the sufferer experiences obsessions in the form of thoughts, images, urges, feelings, or sensations, which trigger extreme levels of uncertainty and anxiety.
As OCD is egodystonic – meaning it goes against our values and morals – those obsessions are disturbing in nature and leave the sufferer questioning their sense of self.
Because the very nature of these thoughts has us challenging who we are, they are perceived as a cause for concern and we believe they require our attention.
In a bid to manage the uncertainty and anxiety following these obsessions, the sufferer engages in compulsive behaviors that offer temporary relief.
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These compulsions offer short-term relief but contribute to long-term struggle as they leave the sufferer trapped in the OCD cycle.
The good news is that this OCD cycle can be broken!
Effective treatment is available so you can begin managing the anxiety and uncertainty without needing to engage in compulsive behaviors.
The ins and outs of Real-Event OCD
We can all find ourselves reflecting on past events from time to time, wondering whether we should have done things a little differently.
We might berate ourselves for a moment about the things we have said or done that could have been handled more effectively.
We may even experience momentary guilt over the potential consequences of our past behaviors.
But for those without OCD, these reflections and feelings tend to fade over time. For those with real-event OCD, they find themselves over-analyzing, fixating, and ruminating on past events in a desperate plea to gain a sense of certainty.
They may be searching for definitive answers to suggest that they didn’t do anything wrong and that they aren’t a bad person.
A common compulsion within real-event OCD is mental review.
The sufferer will replay the moment over and over again.
Guilt and shame are overwhelming feelings that occur for those with real-event OCD. And these feelings brought about by such reflections are intense and painful to manage as they leave the sufferer questioning their morality and identity.
OCD takes hold of the past event and warps the sufferer’s perception, positioning them as the ‘bad guy’ or ‘villain’ of the piece, for which they can often call on self-punishment as the compulsion believing they deserve to be punished.
Examples of Real-Event OCD
Someone with real-event OCD can experience obsessions about a wide variety of past events. Anything from cheating in an exam, an argument with a partner, a job interview, or even an interaction with a stranger at the local shop.
The common thread is that obsessions are almost always driven by the fear of being a bad person.
Common Real-Event Obsessions
Did I inadvertently cause that person to feel X,Y, or Z
What would have happened if I hadn’t said or done X,Y, or Z
Was that wrong? Did I commit a crime? Am I morally corrupt?
Am I bad person for doing/saying X,Y, or Z?
It’s because I did (X) that this bad outcome occurred
I’m the reason that person I care for is suffering, because I did/said (X) when I shouldn’t have
This negative circumstance is a direct result of this thing I did/said years ago
An example of how real-event obsessions may occur could look like this…
“A friend of mine told me she kept having heart palpitations and feeling faint but I simply joked and told her she was probably just unfit. She has now been diagnosed with heart disease which they would have caught sooner if I had taken it more seriously and told her to get herself checked. If she get’s seriously ill, this will all be my fault.”
Common Real-Event Compulsions
Mental Review – repetitively playing the event over and over again in their mind to find proof that what they believe about themselves or the event is true.
Self-punishment – criticizing and berating themselves because they believe they deserve to be punished for their past behaviors.
Reassurance-seeking – Excessive reassurance-seeking from friends or family to clarify that they behaved ‘correctly’ or to confirm that they did or didn’t do anything wrong or inappropriate.
Apologizing – Someone with real-event OCD may excessively apologize to the person they believe to have wronged in the hope of gaining forgiveness.
We can use the obsession above to show an example of how the compulsion may then present.
This sufferer may replay the experience repeatedly in their mind noting what they believe they should have said or done differently. They may punish themselves by thinking, “You should have told her to see a doctor. You shouldn’t have joked about it. This is all your fault”
They may ask others whether or not they think this could have been prevented if they had told their friend to see a specialist sooner.
They may go out of their way to make up for their ‘wrong behavior’ by apologizing excessively to their friend. They may also go out of their way to do good deeds in service of the community to be forgiven for their ‘perceived error’ or ‘mistake’.
How to know if you’re experiencing Real-Event OCD?
It’s common for everyone to find themselves dwelling on past events from time to time. But here is a breakdown of symptoms to consider if you think you may have real event OCD:
Repeatedly replaying events in your mind
Over-analyzing the outcomes of your actions
Feeling excessive guilt, shame, or doubt about your actions
Apologizing excessively to those involved
Excessive reassurance-seeking to validate your experience
An intense and overwhelming feeling that you are a bad person
Someone with real event OCD can lose hours of their day ruminating and fixating on these past events.
It’s almost always impossible to gain 100% certainty, but even more so when it comes to analyzing past events that have come and gone. Because of this, those obsessions always tend to crop back up.
You can find yourself trapped in the past and unable to engage and enjoy the present moment and struggle to shake this overwhelming sense that you’re not a good person.
However, if you are able to change your relationship to those obsessions and resist the urge to do compulsions, you can find long-term relief from real-event OCD.
ERP is deemed the gold standard treatment for OCD and has been shown to be highly effective. This means that it is highly possible for you to fully recover from OCD using this treatment.
In ERP, you work with your therapist to place yourself in scenarios that gradually and intentionally trigger your obsessions. You will work together to navigate the uncertainty and anxiety and resist the urge to do compulsions.
Your brain learns that you are capable of managing anxiety and uncertainty without the use of compulsions. Each time you engage in compulsive behaviors you strengthen OCD’s hold. When you resist the urge to engage in compulsions, you can learn new ways to respond to your obsessions that will – over time – reduce the anxiety.
ERP for Real-Event OCD
Most highly trained ERP therapists will first provide thorough psychoeducation on real-event OCD and train you to engage in effective response prevention.
Response prevention is a component of ERP where we practice reducing any compulsions that the person with real-even OCD is engaging in.
Research has shown that ACT (acceptance and commitment therapy) is a highly effective modality supplement to ERP, where the person with real-event OCD practices working with value-based behaviors rather than fear-based behaviors and learns how to manage their intrusive thoughts using tools like diffusion and mindfulness skills.
In the case of real-event OCD, a common form of ERP therapy is to use an imaginal exposure script.
An imaginal script for real-event could be writing out the story as it happened, as specifically as possible, so that you can use their mindfulness, ACT, and ERP tools to resist the urge to do compulsions.
In addition, other exposures that may be helpful and beneficial are engaging back in any behaviors that you have been avoiding. You and your therapist will work together to make sure the exposures you do are exposures that you feel will be helpful and worth engaging in.
Finding a qualified therapist
Real-event OCD can sometimes be tricky to diagnose and treat. The nature of most OCD types means they are driven by the fear of what might happen in the future whereas real-event OCD is driven by the fear of what’s happened in the past.
We highly recommend you want to do your due diligence and be sure to work with an OCD specialist who is ERP trained as this is the most effective treatment for OCD and yields incredible results. It is important to work with a qualified mental health professional who can offer an accurate diagnosis and support you with the best treatment plan.
If you are based in California, our friendly team of elite OCD specialists can help you navigate your OCD and support you on your recovery journey.
Compulsive hoarding used to be considered a type of OCD.
Some have estimated that up to 1 in 4 with OCD also struggle with compulsive hoarding. And up to 1 in 5 compulsive hoarders have non-hoarding OCD symptoms.
Like many other comorbidities (such as OCD and depression, or OCD and BDD), there is a distinct overlap between the two disorders.
You can be diagnosed with hoarding disorder without an OCD diagnosis. A hoarding disorder with an OCD diagnosis is known as hoarding OCD.
Like many OCD subtypes (and mental health disorders in general) hoarding and hoarding OCD are greatly misunderstood. Both hoarding and hoarding OCD are great sources of pain and stress; they are not enjoyable and they do not bring pleasure to one’s life.
It can have a huge impact on quality of life which, to those who do not understand the disorder, can appear as a way of living that the sufferer may even enjoy.
This is simply not true.
Let’s look at OCD and hoarding separately and together to understand the differences between the two.
OCD: A Recap
Photo Credit: Marina Vitale
People with OCD will suffer from obsessions in the form of thoughts, images, feelings, urges, or sensations. Intrusive thoughts will pop into their head, causing an immense amount of stress and discomfort.
These unwanted and intrusive thoughts are disturbing or fearful in nature and conjure tortuous feelings of uncertainty and distress.
These intrusive thoughts are constant, persistent, and all-consuming and the sufferer will try desperately to alleviate their distress.
This distress leads to a physical or mental compulsion; a ritualistic behavior aimed at soothing the anxiety and uncertainty brought on by distressing thoughts.
Anxiety felt around any uncertainty and thoughts of “what if?” brings with it cravings and urges for certainty.
We do compulsions to try to solve that uncertainty and mitigate any potential consequences of not addressing the obsessions.
In doing this, our brain learns that the physical or mental ritual is needed in order to navigate the uncertainty and anxiety. We learn that we cannot tolerate those feelings without doing compulsive behaviors.
But, the relief this offers is only fleeting and allows OCD to thrive. This is known as the OCD cycle and it acts to perpetuate long-term feelings of distress.
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What is hoarding
Photo Credit: Dim Hou
Hoarding is characterized by the persistent gathering and saving of an excessive number of objects. The ‘excessive’ part comes into play as the sheer volume is unmanageable, storage is chaotic and the behavior has a detrimental effect on everyday life.
The items will likely have no monetary value and will create clutter to the point that access to a person’s home is compromised.
People who experience hoarding feel greatly distressed at the thought of discarding the items they have hoarded.
When is hoarding considered a problem?
Hoarding is considered a problem when:
It starts to affect someone’s ability to look after themselves or their family. For example, if access to the kitchen or cooker is blocked, individuals with hoarding disorder will stop feeding themselves or their families properly, choosing to work around the clutter by skipping meals or eating out, despite sometimes not having the financial resources to do so.
The idea of parting ways with the clutter brings on significant distress. They can become upset if someone tries to tidy up or remove items and this can have an adverse effect on relationships.
People who struggle with hoarding can also find themselves isolated from friends or family, and be unwilling to have anyone else enter their homes.
In extreme cases of hoarding, an individual’s safety is at risk as fire and tripping hazards are littered about their home.
They believe these items will be needed at some point in the future
They have ‘a great find’ believing the item to be unique and interesting
The items have significant sentimental value, representing a lost loved one or a previous time in their life that brought great joy
The things that they save bring reassurance or comfort
The thought of missing out on the opportunity to benefit from the items is distressing
Often, someone with hoarding OCD has a fear of contamination.
Contamination fears are not the only type of obsession in hoarding OCD, but it is very common.
The difference between hoarding and collecting
Photo Credit: Karen Vardazaryan
Collectors will typically take great joy in organizing or filing their collection for admiration.
The presentation will be neat – think stamps in a scrapbook – and the collection will be carefully considered and follow a theme. Collections can be large but they are not disorderly and their existence does cause a detrimental effect on lives.
Hoarding is impulsive and follows no discernible theme. Presentation, in order to admire, isn’t considered and the clutter can often be a source of embarrassment or shame.
A collector will have the presence of mind to budget money and space for their items, whereas the impulsivity of individuals with hoarding disorder means that their items can cause financial strain or debt.
Signs of hoarding disorder
Here are some key signs to look out for when identifying hoarding disorder:
An individual’s home, car, or office space is so cluttered that it is difficult to navigate
Storage units are rented to accommodate the sheer volume of possessions
The individual flat-out refuses or has difficulty discardingpossessions
Discussing the removal of cluttered items is met with dismissive or aggressive behavior due to anxiety
The individual struggles with the organization and order of their possessions
Showing signs of shame over the amount of clutter in their home
Overly possessive feelings towards their possessions, i.e. an individual won’t allow others to touch their things
Signs of obsessive thoughts and behavior towards items such as looking through trash or showing distress when they believe something has been disposed of.
Feeling overwhelmed at the amount of clutter and feelings of deep shame
In extreme cases, a hoarding disorder will inhibit someone’s ability to work, take pride in their appearance, and have financial stability and it will affect relationships with friends and family.
Wanting to save items for fear of needing them at a later date but then, when the time comes that they need the item they can’t even find it.
Difference between hoarding disorder and hoarding OCD
The best way to differentiate between hoarding OCD and hoarding disorder comes down to the reason why the sufferer is hoarding.
For a long time, hoarding disorder was considered to be a part of OCD. In recent years, hoarding disorder has been given its own diagnosis and what separates the two is mainly down to the reasons for the compulsive behavior.
Individuals with hoarding disorder accumulate items because they perceive them to be valuable, and unique or believe that one day they will have a use for them.
Distress is experienced when faced with the prospect of throwing possessions away because of this perceived value.
Whereas hoarding OCD is an unwanted behavior done in response to an obsessive thought.
For those with hoarding OCD, the accumulation and retention of objects are often very stressful as they find themselves ruminating on the potential consequences of what might happen if they were to get rid of said items.
A helpful distinction between hoarding OCD and hoarding disorder is that those with hoarding disorder hang on to items they feel are valuable and feel distressed at the idea of getting rid of them. Whereas hoarding OCD, people are holding onto items because they fear what will happen if they don’t.
Example of hoarding OCD obsessions
Hoarding OCD obsessions could sound like:
I need to buy six of these cans of soup as the labels match up with those I already have at home and these six cans will fit perfectly in the cupboard
I don’t need this sweater anymore and should donate it to a thrift shop, but they might be contaminated and I don’t want to make anyone ill
I should throw out these plates but what if they break in the bin and someone cuts themselves on the sharp edges?
The trash has been sitting by the door for ages now but I don’t want to touch the outside garbage bin in case I catch anything that could make me ill
These wedding favors were left by the guests after our wedding. I’ll hold onto them in case throwing them away is a bad omen
I need to keep this because it feels wrong to get rid of it/this item feels right to keep.
I see other people are throwing this out and doing so damages the environment so I have to keep this to save the planet.
Examples of hoarding OCD compulsions
Hoarding compulsions might look like:
Waiting until the same register clerk is available to scan your groceries
Purchasing items in specific sets, i.e. only ever three bananas, only ever six cans at a time, two cartons of milk even though there is only the need for one
Purchasing items that have been touched, even if you don’t want/need them
Storing dirty items in a specific drawer or cabinet for fear of contamination
Keeping hold of items that could be considered ‘trash’
ERP therapy for Hoarding OCD
Photo Credit: Angel Balashev
Cognitive behavioral therapy (CBT) with exposure response prevention (ERP), is the gold-standard treatment for OCD disorders, including hoarding OCD.
Through repeated exposure to obsessive thoughts, wilfully tolerating the anxiety and uncertainty, and resisting the urge to do compulsions (hoarding in this instance) we teach our brain that we are capable of navigating the uncertainty without those safety behaviors.
Falling into an OCD cycle is all too easy but by changing our response to those obsessions we provide our brains with new tools that can be used to soothe our anxieties, away from the detrimental and compulsive behavior we may have exhibited in the past.
ERP exposures for hoarding OCD
ERP works by gradually exposing yourself to your obsessions and taking small steps toward changing how you think and behave toward them.
With hoarding OCD in mind, you will work closely with your therapist to break away from your compulsions, for example, going to a grocery store and only buying one item instead of multiples.
With your therapist, you’ll first come up with a hierarchy of exposures you are willing to do and be given education on how to reduce compulsions such as mental compulsions, avoidance compulsions, reassurance compulsions, and hoarding compulsions.
You will also discuss your feared outcome and address ways in which you can expose yourself to those fears.
Along with exposure to only accumulating one item at a time, the therapist and client will also work at exposing the client to getting rid of the hoarded items in the house. This is done in a step-by-step manner where the client themselves get to choose what they are willing to get rid of.
When the degree of clutter is so much, the client and therapist may consider the option of hiring cleaners to discard the items to help the client maintain a degree of safety in their home, if they are unable to do it at a pace that reduces the safety risk.
The aim is to become more comfortable with obsessive thoughts, to identify them, and break away from the compulsive, ritualistic behavior that follows.
If we familiarize ourselves with uncertainty and discomfort, we’re far less likely to fear it. And if we no longer feel apprehensive in the face of the unknown, we’re far more likely to live full and satisfying lives.
People with checking OCD tend to fear that something terrible may happen to themselves or others if they don’t check. These fears (obsessions) trigger an intense feeling of anxiety and uncertainty that can be incredibly distressing.
