POCD Versus Pedophilia - Differential Diagnosis

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Updated September 4. This is one of a number of posts I have written on mental illness. It deals with it from a diagnostic point of view that is probably most interesting to sufferers or clinicians, but may be interesting to some laypeople. I've been studying abnormal psychology for 30 years now, and experiencing it for 25 or so.

POCD is a subtype of OCD that is usually thought of as pure-O, or pure obsessional. Pure-O's do not have the usual behavioral rituals that the hand-washers, etc. have; instead, they have cognitive rituals. It is necessary that there be more documentation on this subtype of OCD because unfortunately, quite a few people are suffering from it, and clinicians barely understand it.

Due to this lack of understanding, clinicians think sufferers are psychotic or suffer from pedophilia. Many clinicians have a poor understanding of OCD as it is, and this series is intended to enlighten them about different forms that the illness can take.

I've written some stuff on POCD on this blog, and therefore, I get sufferers coming to me with the condition. As I don't have much issues with POCD these days, I'm capable of doing therapy with them online.

After talking to quite a few of them, it's clear that it's like any other type of OCD, since OCD sufferers, especially pure obsessionals, have a certain "sameness" about them such that you can nearly diagnose them on pure Gestalt alone.

I can tell pretty quickly after talking to someone whether they are suffering from OCD.

One thing to get clear on is that POCD will apparently never be acted on. I'm not aware of anyone acting on any of these obsessions.

There is another type of OCD called Harm OCD, and I have talked to a few of those folks too. Two of them were both convinced that they were serial killers. I quickly figured out that they had OCD and were completely harmless. People with harm OCD never do anything violent, and people with POCD never molest kids.

Once you know this, you can talk to them about all their scary thoughts with worries.

I might have a hard time doing therapy with an actual pedophile or a psychopath who really wanted to kill people. As a general rule though, these types do not feel there is anything wrong with them as they enjoy being this way, and they never seek help.

The usual POCD sufferer is a young man around college age or so. Females are much less common. I talked to one guy who was in his 30's. Sexual obsessions in general seem to hit young people the hardest of all for some reason. Most people with harm obsessions are also young people, mostly males, though I did talk to one 17 year old female.

OCD is a fear-based illness. It will latch onto anything in society that is frightening.

Nowadays, with Child Molester Mass Hysteria on the rampage and everyone worried about "pedos" and "predators", it's only logical that people with OCD would find this the perfect fear. What could be more terrifying than the fact that one may be a pedophile? Not much. Hence, POCD.

We have also seen a marked increase in fears of AIDS among OCD sufferers. AIDS is in our society, it's terrifying since if you get it, you're about dead, so OCD will latch onto it.

The best way we can do differential diagnosis here between POCD and pure pedophilia is to link to some websites.

First of all, a fellow I have been talking to has posted his history online here. He's given me permission to link to it. It's five pages, but if you read it, you should start to get a feel after a while about what this illness is all about.

Note the chronic doubting, the omnipresence of fear, the uncertainty about feelings and whether they are real or not, the questioning of everything from one's thoughts, feelings and history all the way to the actions and thoughts of others.

What's going on here is a hyperanalysis of the individual's history, thoughts and behaviors along with continuous checking of "scientific sources", followed by more rounds of unproductive doubting and worries. As you can see, nothing ever gets resolved here. The worries and doubts just go round and round. Once one gets settled, a new one comes up. This is truly a case of one's mind actually chasing its tail.

In this case, he is trying to prove whether or not he is a pedophile. He finds evidence, questions the evidence, checks, cross-checks and tests the evidence, then starts all over again.

There is atmosphere of wondering, uncertainty and doubting to the point where the person can start doubting his own perceptions. Thoughts and feelings can seem like they are actually occurring and the person becomes uncertain about what is really happening and what is just in their mind.

I talked to one woman who had lesbian fears during conversations with other women. I asked, "You get lesbian thoughts and this bothers you?" She said, "No, I worry that I'm going to say lesbian stuff to her. Then after the conversation is over, I wonder if I made lesbian comments to her." As we see, the person doubts their actual perceptions and wonders if things occurred that are did not even occur.

This doubting of one's own perceptions is actually quite common in this disorder and is almost diagnostic.

Unfortunately, it looks very strange, and clinicians often misdiagnose it as psychosis.

In this post, he says he can hear what people are thinking. That's a schizophrenic symptom, but when I questioned him about it, he said he just watched people very closely and thought he could figure out what they might be thinking, but he didn't really hear it with his ears. He admitted it wasn't really possible for him to know exactly what was in someone's thoughts.

When I heard that, I knew he did not have schizophrenia or a psychosis. Once again, though, we see internal thoughts and external perceptions being confused, common in OCD.

I wasn't impressed with the others in this thread, one of whom was accusing him of being a pedophile. An administrator, a clinical psychologist, finally gets it on page 4 and says he has sexual obsessions.

In this post, he says he is losing his attraction to women, and the attraction to kids seems to be increasing.

There is another sexual obsession called HOCD (homosexual OCD) that works much the same way. The person goes into horrible worries, thinking in a similar manner as this guy, that they may be gay or bisexual. In severe cases, they think that they are losing their attraction to the opposite sex and getting a new attraction to same sex. HOCD is very common; much more common than POCD.

As it's not possible to turn gay, bi or pedo against one's will, this is the common denominator in all sexual obsessions and is pathognomic.

Gay, bisexual and pedophilic persons do not feel as if alien forces are turning them into something they do not wish to be. They are what they are. The attraction, wanted or not, feels normal, natural, right, correct, real. They may worry about the way society will treat them, but it isn't a question of being transformed into something you are not.

He is also masturbating to pedophilic fantasies, but I'm not worried about that. He's doing this as some sort of checking behavior to "see if he's really a pedophile" or to "get it out of his system".

People with HOCD often do the same thing. They search out gay porn on the Internet and masturbate to it to "test their reaction". Then they go find some straight porn and masturbate to that to "test their reaction" to that. Then they endlessly compare reactions to try to figure out if they are gay or not. Typically, the testing never reveals any significant answers, so it just goes on and on.

This is called checking and it's also pathognomic of OCD.

The truth is that in males, sexuality is fixed by age 15. That means straight, gay, bi or whatever, can't change after that. What turns you on, turns you on. Behavior can change afterward, but not attraction. In females, it's different, but no female turns gay or bi against her will.

In one post, he tries to argue with the OCD by saying "I'm not a pedophile" (thought compulsion). His mind argues back, of course, by saying the opposite and telling him he is one. This is also pathognomic of OCD. OCD acts like a gremlin in your mind. It contradicts you and tells 4you stuff you don't even believe in and makes you confused.

The truth is, that's not really an internal dialogue, it's just OCD talking back and being contradictory. The result can be endless wars in the mind whereby one uses thought compulsions to try to contradict obsessions. For some strange reason, these don't seem to work very well, and the OCD often just fights back even harder with more intense contradictory statements.

Although masturbating to pedo fantasies may seem disturbing, I'm not worried about it in this case. Humans, especially young males, are polymorphously perverse, and can get turned on by just about anything.

A pedophile in general has a true preference for kids and does not have much interest in adults. They have been this way since early adolescence. It doesn't probably doesn't come on after age 15 or so, and neither do most other paraphilias. The root of all paraphilias, like the root of all sexual orientation, seems to be in the birthing storms of the teenage years.

My take is that OCD is lying to this guy. As you can see, he also has HOCD. He's suddenly developed gay fantasies. How? By looking at some gay porn on the Net. In his case, both pedo and gay fantasies were fantasy-supercharged due to their forbidden and taboo nature, not due to any real attraction.

OCD is lying to him, telling him he's gay and pedo and he's losing his attraction to women. HOCD sufferers also feel that they are losing their attraction to the opposite sex and gaining a new one to the same sex, but this is just an illusion. How this strange illness does this I'm not sure, but I think it has to do with the way anxiety and fear work on the brain.

HOCD sufferers are also typically young people and most are males, but there are quite a few young females too. They usually are shy introverts, like most OCD sufferers, and often have little sexual experience. The extroverted obsessional exists, but is quite rare. People seem to grow out of this gay OCD thing with age, or at least move onto other obsessions.

Since homosexuality is in our society and a popular meme in our culture and yet is not quite accepted, it's a logical fear for OCD to latch onto. For many young people, homosexuality is just wrong enough and taboo enough the fact that the thought that one might be gay or bi is quite terrifying.

If at some point, homosexuality and bisexuality become more accepted, OCD sufferers may stop worrying about being gay and start worrying about something else.

The nature of the OCD fears is not important. Depending on the era and society, OCD will latch onto whatever fears seem most terrifying for the time and place. The illness is mobile and once one fear is conquered, a new one can be acquired.

HOCD is a particularly horrible type of OCD. I've been to boards on the Net full of sufferers and many are seriously miserable, deeply depressed and contemplating suicide. For some reason, obsessionals, while often complaining of being suicidal, rarely seem to commit suicide. I think the fact that they are so fearful and inhibited keeps them from taking this final step.

For a glimpse of how real pedophiles think, and to tell the difference between POCD and pedophilia, check out this Wikisposure page that gives bios of numerous actual pedophiles that they are tracking. After you read through a number of the bios, you will get a common feel for what these guys are all about.

This, like all paraphilias, is not an anxiety disorder. The dominant emotion is not fear and doubt as in OCD. These guys aren't going round and round about whether or not they are pedophiles. That they are is clear as air to them.

Pedophilia, like all paraphilias, is an illness of desire, of appetite. It's like an addiction. They love it. This is what gets them off. They don't want to change, they don't want to get better, and the truth is they probably can't anyway.

I assume that true pedophilia, once fixed in adolescence and cemented in adulthood, is incurable. What gets you off, gets you off. It's not going to change. They can't help it, but at the same time, society needs to be protected.

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