how can ocd show up in our sex lives?
CW: Sex Therapy discussed below
Although many of us understand OCD (obsessive-compulsive disorder) as an experience focused primarily around handwashing and aversion to germs, this Hollywood version of the OCD spectrum is not an inclusive representation of the unique ways that these thought patterns can look. The spectrum of OCD thought patterns are marked by an anxiety-producing thought (obsession), and a resulting thought or behavior (compulsion) to try to help soothe that anxiety. Unfortunately, these thoughts or behaviors are not effective in soothing these anxious thoughts in the long term, creating a difficult cycle.
An aspect of OCD that is not as frequently discussed is the way these thoughts can impact sexuality. Studies show a high correlation between what would be categorized as sexual dysfunction and OCD thought patterns, with some research showing rates of dysfunction as high as 54-73% in folks diagnosed with OCD.1
The importance of talking about these statistics is not to pathologize any of these experiences, but to normalize how common this can be, and to talk about ways to better understand and support folks coping with some of these frustrating and upsetting dynamics.
For many people who have experiences that exist in the OCD spectrum, thought-based compulsions can be common occurrences. These are sometimes referred to as mental rituals. This could look a lot of different ways, including a repetitive "checking" thought - scanning the body, looking outside around oneself, going over moments or conversations in one's mind.
Sexual obsessions are actually one of the more common types of OCD thought patterns, but much less frequently discussed. These types of thoughts can happen at any point, but can often occur for people during sexual moments. These thoughts are often described as unwanted, very upsetting, anxiety-provoking, and unsettling. They are opposite to what folks actually desire, and can lead to avoidance of sexual connection, fear around sexual connection, and anxiety about sexual connection.
Here are some common examples of how this might be expressed:
An intrusive thought around sexual orientation and the resulting checking behaviors - constantly looking at the people around oneself and "checking" if there is attraction, when in a sexual moment with oneself or others "checking" if there is arousal or desire, seeking media to "check" to see what one's response might be. These thought patterns can happen for people of all different sexual orientations.
These thoughts can be quite disconnected from a person's thoughts and feelings about sexual orientation in general. Very specifically, this does not mean a person is homophobic.
This is so common it has been categorized as "Sexual Orientation OCD", or SOOCD.
Upsetting intrusive thoughts around sexual acts that might include content very undesirable and deeply upsetting for folks, including violent acts, sex with family members, sex with animals, and sex with children (another subset so common it is called "Pedophilia OCD", or POCD)
Intrusive thoughts around relationships, including sexual connection. In this instance, folks find themselves questioning and experiencing worry around their connections and the quality of their romantic and sexual relationships, leading to anxiety and discomfort, and subsequent checking behaviors.
Another subset of OCD so common that it is called "Relationship OCD", or ROCD.
It is easy to imagine how these thought experiences might result in distancing from sexuality in many different forms, and difficulty when in sexual moments. With compassion and understanding, there are a lot of ways to work with these types of thought patterns and physical experiences to find some relief. If any of this resonates with you, there is nothing wrong with you! You are amazing, and there are options.
Some helpful interventions include Exposure and Response Prevention Therapy, Mindfulness, Dialectical Behavioral Therapy, medication, microdosing, and trauma-informed psychotherapy.
If you're looking for more information, feel free to message me, or check out Made of Millions for some wonderful resources around sexuality and OCD.
Thinking of all of you!
Agarwal, S., Das Koolwal, G., Gupta, A., Koolwal, A., Manohar, S. Obsessive-Compulsive Disorder and Sexuality: A Narrative Review. Journal of Psychosocial Health; 2020.
First Published April 2, 2020 Research Article
https://doi.org/10.1177/2631831819896171