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Guide

Unwanted Sexual Thoughts: When It's OCD, and What Helps

By , author of Sound Mind · Published · How we source

The short answer

Unwanted sexual thoughts are common, and having one isn’t proof of what you want.1 When a thought horrifies you, and you keep checking your body’s reaction, arguing with it, seeking reassurance, or avoiding people because of it, that pattern can be obsessive-compulsive disorder (OCD). The best-supported treatment is exposure and response prevention (ERP), a type of CBT.2

Being horrified by a thought is not the same as wanting it. When the horror comes with checking and reassurance, that’s the shape of OCD, and OCD is treatable.

It can strike anywhere: at a family dinner, over coffee with a friend, halfway through a prayer. A sexual thought flashes up, the last thing you’d ever want, and your stomach drops. Then the questions start. Why did I think that? What does it say about me? Did I feel something? You replay the moment, test yourself, and search at 2 a.m. for the answer that will finally settle it. Whatever you find settles it for an hour, maybe a day.

If that’s why you’re here, slow down for a minute. Clinicians know this pattern well. It has a name, and it has a treatment.

What are intrusive sexual thoughts?

They’re sexual thoughts, images, or urges that arrive uninvited and feel foreign to you. Nearly everyone gets intrusive thoughts of some kind.

Researchers interviewed 777 university students across 13 countries. More than 9 in 10 said an unwanted thought had pushed into their minds within the last three months. Sexual ones were among the rarer kinds, but they turned up too.3

In OCD, sexual obsessions tend to gather around a few themes.4 Common examples:

  • doubts about your sexual orientation
  • thoughts about children
  • thoughts about family members
  • violent or forced sexual images

What causes intrusive sexual thoughts?

The first thought is ordinary mental noise. What makes it stick is the meaning you give it, and what you do next.

A leading theory of OCD says obsessions grow out of reading normal intrusions as dangerous, or as proof of who you secretly are. They last as long as that reading lasts, and fade as it weakens.5 One man shrugs at a strange thought and forgets it by lunch. Another decides only a monster would think that, and starts guarding the door. The harder you try to keep a thought out, the more it tends to return.6

When are unwanted sexual thoughts a sign of OCD?

When they come with dread and a need to make sure. Clinicians look at how the thought feels to you and what you do about it. Treat these as a rough guide.7

The OCD pattern

  • The thought horrifies or disgusts you, and it clashes with who you are.
  • You desperately want it gone.
  • You check, argue, ask, or avoid, and any relief is brief.

A different pattern

  • You’re drawn to the thought, and you return to it on purpose.
  • It brings pleasure, and the distress comes mostly from what acting on it would cost.

Two OCD themes have names of their own. Sexual-orientation OCD centers on doubts about your orientation. In a study of 409 people with OCD, about 1 in 12 had it at the time.8 Pedophilia-themed OCD, or P-OCD, centers on the fear of being attracted to children or of harming one. The clinicians who described it call it fairly common in OCD, and often misread by professionals who don’t know it.9 In one clinic’s 293 patients with OCD, about 1 in 4 had had sexual obsessions of some kind.10

Even so, don’t diagnose yourself. Trained professionals can’t sort these patterns by distress alone.11 I’m not a therapist or a doctor, and no web page, this one included, can tell you which pattern you have. A clinician trained in OCD can.

If your thoughts pull at you rather than frighten you, how to stop thinking about sex all the time fits you better.

Why do I get sexual thoughts about family, friends, or God?

Because those thoughts feel the most important to answer, and in OCD, treating a thought as important is what keeps it around.12

A thought about a sibling, a parent, or a close friend feels like an attack on someone you love. Thoughts about family members are a recognized theme on the standard OCD symptom checklist.13

Sexual thoughts that break into prayer, or attach to God, usually bring a second fear: that thinking it was itself a sin. The International OCD Foundation (IOCDF) calls OCD with religious or moral fears scrupulosity.14 In that clinic sample of 293, people with current sexual obsessions were also more likely to have religious ones.15 If faith is part of this for you, read how to stop sexual thoughts as a Christian or how to stop sexual thoughts in Islam. Both cover scrupulosity.

What compulsions keep the thoughts going?

Anything you do to check, cancel, or escape the thought. The relief is real, and it’s short. Each round tends to strengthen the obsession and set up the next round.16

The usual ones:17

  • Checking your body. Scanning for any sign of arousal, to prove the thought means nothing.
  • Seeking reassurance. Asking a partner, a friend, a pastor, or a forum, or searching online, until it feels settled.
  • Mental reviewing. Replaying the moment, hunting for an explanation, or arguing with the thought until it backs off.
  • Avoidance. Skipping family gatherings, steering clear of certain people, or dropping things you love because they might set it off.

Checking backfires in a specific way. In a lab study, 50 students repeatedly checked a real kitchen stove. Afterward they trusted their memory of it less, not more.18 That was a stove, not a thought, but it shows the trap: checking can grow the doubt it’s meant to settle.

Why reassurance, including this page, makes it worse

Reassurance works like a painkiller that wears off fast. It brings relief, the relief rewards the asking, and the doubt comes back wearing a new but what if.19

That includes reading this guide. If you’ve gone over the section above three times, hunting for the line that proves you’re safe, notice that. It’s the pattern at work, and it deserves patience. You can close the tab and go do something ordinary.

Try this now

Practice letting one thought be. It takes about three minutes, and the skill is doing less.

  1. When the thought shows up, label it once. Name the pattern, not the content: I’m having the thought again. Skip the details.
  2. Notice the pull to do something about it: check your body, look something up, ask someone, replay it. Give the pull a number from 0 to 10.
  3. Leave the thought unanswered. Don’t argue with it, don’t check, and don’t hunt for a distraction to push it out.
  4. Return to the task in front of you at the same pace, and let the thought come along if it stays.
  5. Let the number be whatever it is. It doesn’t have to drop for the practice to count.

One label is the whole dose. If you catch yourself repeating it to make the thought leave, it has turned into a ritual, and that’s worth telling a therapist. This borrows the stance ERP builds on. ERP itself is planned with a trained therapist, step by step.20

How is OCD with sexual thoughts treated?

With ERP, a form of CBT with strong evidence behind it. Medicines called SRIs are the other first-line option, and a doctor may discuss them.21

In ERP, you and a therapist build a ladder of situations that set off the fear, from mild to hard. You face each step on purpose, and you practice not doing the compulsion. The aim is to learn, through practice, that you can have the thought and leave it alone.

Across 37 randomized trials, CBT for OCD beat waiting lists by a very large margin, and did better than antidepressants in the trials that compared them.22 Sexual obsessions can take longer to treat than some other themes, but ERP remains the treatment of choice for them.23

From the other guides on this site, keep the stepping-back skill. Set aside arguing, checking, and any distraction used to push a thought out. Blocking a website is fine, but avoiding people out of fear tends to feed OCD.

How to find an ERP therapist

  1. Start with the IOCDF directory at iocdf.org/find-help, which lists therapists who treat OCD.24
  2. In the US and Canada, try ABCT’s directory, which lets you filter for exposure and response prevention.25
  3. Ask before you book: “What techniques do you use to treat OCD?” and “How much of your practice involves OCD?” The IOCDF suggests both questions, and advises looking elsewhere if a therapist is vague or never mentions CBT.26
  4. Consider video if no specialist is nearby. In trials, therapy by video did about as well as therapy in the room.27

If a therapist treats your thoughts as hidden wishes, or seems alarmed by them, find one who knows OCD.28

What if I’m drawn to the thoughts, or afraid I might act?

Then get confidential help now. You don’t need to work out the cause before you reach out.

If the thoughts involve children, contact Stop It Now. It’s free and confidential, and it’s there for people worried about their own thoughts, before anyone is harmed. Call 1-888-773-8368 in the US, or 0808 1000 900 in the UK. From Ireland, the UK line is +44 1372 847 161.29

Fear of acting on a thought about children is itself a fairly common theme in OCD, which is one more reason to talk to someone trained rather than guess.30 And if you ever feel you might act on a thought right now, put distance between yourself and the situation, and call your local emergency number.

When the checking stops

Picture a birthday dinner some months into treatment. A thought flashes up, and something in you reaches for the old questions. You leave them unasked, pass the plate, and join the conversation. Later you realize you never went back to it.

The thoughts may still visit. What changes is how much of your life they get. Your love for the people in them, your faith if you have one, and your own healthy desire are all still yours. That’s what ERP works toward, and it’s a better place to live than the constant checking.

When to get more help

See an OCD-trained therapist if any of these sound familiar:

  • The thoughts, or the checking and reviewing, take up a large part of your day.
  • You’ve started avoiding people or places you love.
  • You can’t stop asking for reassurance, or your partner or family have been pulled into giving it.
  • You feel low most days, or you drink or use drugs to get through.
  • A past therapist treated the thoughts as desires, and you came away more frightened.

Thoughts like these can bring despair. In OCD, sexual and other taboo obsessions are linked with a higher risk of suicidal thoughts.31 If you’re thinking about harming yourself, reach out now, at any hour. In the US, call or text 988. In Canada, call or text 9-8-8. In the UK and Ireland, call Samaritans on 116 123. In Australia, call Lifeline on 13 11 14. Elsewhere, findahelpline.com lists free services near you.32

Questions men ask

Do intrusive sexual thoughts mean I secretly want it?

This page can’t answer that, and the urge to get it answered is worth noticing. What the research shows is that unwanted thoughts are nearly universal,33 and that obsessions in OCD are, by definition, unwanted and disturbing to the person who has them.34 An OCD-trained clinician can help you sort out the rest.

Why does my body react when the thought comes?

Anxiety and arousal can feel alike, and one review notes that some people with OCD may mistake one for the other.35 Scanning your body for a reaction is one of the compulsions listed above, so it belongs on the list of things to work on in ERP.

Is Reddit a good place to get help with intrusive thoughts?

It can be a relief to see how many others know this. But researchers who read a day of posts on Reddit’s main OCD forum found many people asking strangers to confirm that their symptoms were OCD, which looks a lot like reassurance-seeking.36 Read for company if it helps, and save your questions for a therapist.

Can medication help?

SRIs are a first-line option for OCD, so a doctor may discuss them with you.37 In the trials that compared them head to head, CBT did better than antidepressants alone.38 Make any change to a medicine with your doctor, never alone.

Sources

  1. Radomsky AS et al. “Part 1—You can run but you can’t hide: Intrusive thoughts on six continents.” Journal of Obsessive-Compulsive and Related Disorders 2014;3(3):269–279. Interviews with 777 university students at 15 sites in 13 countries; 93.6% reported at least one unwanted intrusive thought in the previous three months. Sexual and other “repugnant” thoughts were the least common type. doi:10.1016/j.jocrd.2013.09.002↩︎

  2. American Psychiatric Association practice guideline (Koran LM, Hanna GL, Hollander E, et al. American Journal of Psychiatry 2007;164(7 Suppl):5–53) and NICE guideline CG31. Both name CBT with exposure and response prevention (ERP), and serotonin reuptake inhibitors (SRIs), as first-line treatments for OCD. The International OCD Foundation’s directory is at iocdf.org/find-help. PMID 17849776 · CG31↩︎

  3. Radomsky AS et al. “Part 1—You can run but you can’t hide: Intrusive thoughts on six continents.” Journal of Obsessive-Compulsive and Related Disorders 2014;3(3):269–279. Interviews with 777 university students at 15 sites in 13 countries; 93.6% reported at least one unwanted intrusive thought in the previous three months. Sexual and other “repugnant” thoughts were the least common type. doi:10.1016/j.jocrd.2013.09.002↩︎

  4. de la Iglesia-Larrad JI, González-Bolaños RK, Peso Navarro IM, et al. “Sexuality and related disorders in OCD and their symptoms.” Journal of Clinical Medicine 2025;14(19):6819. A narrative review of 200 studies. Sexual obsessions on the standard symptom checklist (the Y-BOCS) include aggressive sexual thoughts, obsessions about incest or child abuse, and doubts about one’s sexuality. They often come with mental rituals, checking (including somatic checking for signs of arousal), reassurance-seeking, and avoidance. Obsessions are described as unwanted and disturbing to the person, in contrast with the positive feelings often present in paraphilias. Taboo obsessions, including sexual ones, have been identified as risk factors for suicidality in OCD. The review also notes that people with OCD may confuse anxiety and arousal signals. Several authors report pharmaceutical-industry fees. PMID 41095907 · PMC12525042↩︎

  5. Rachman S. “A cognitive theory of obsessions.” Behaviour Research and Therapy 1997;35(9):793–802. A theory paper: obsessions are caused by catastrophic misinterpretations of the significance of one’s thoughts, persist as long as those misinterpretations continue, and diminish when they weaken. PMID 9299799↩︎

  6. Wegner DM, Schneider DJ, Carter SR, White TL. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology 1987;53(1):5–13. A meta-analysis of controlled studies found the rebound real but small to moderate: Abramowitz JS, Tolin DF, Street GP. Clinical Psychology Review 2001;21(5):683–703. PMID 3612492 · PMID 11434226↩︎

  7. Williams MT, Farris SG. Psychiatry Research 2011;187(1–2):156–159, citing the DSM: in what is often called compulsive sexual behavior, the person “derives pleasure from the activity and may wish to resist it only because of its deleterious consequences,” while OCD thoughts are experienced as distressing. The review by de la Iglesia-Larrad et al. (2025) draws the same contrast. A guide to the usual patterns, not a diagnostic test. PMID 21094531 · PMC3070770 · PMID 41095907 · PMC12525042↩︎

  8. Williams MT, Farris SG. “Sexual orientation obsessions in obsessive-compulsive disorder: prevalence and correlates.” Psychiatry Research 2011;187(1–2):156–159. 409 people with OCD from the DSM-IV field trial: 8% had current sexual-orientation obsessions and 11.9% had them at some point. The authors note that clinicians may misread such obsessions as fantasies or wishes, that people with sexual obsessions more often use mental compulsions and reassurance-seeking than visible rituals, and that although sexual obsessions may take longer to treat, exposure and ritual prevention remains the treatment of choice. PMID 21094531 · PMC3070770↩︎

  9. Bruce SL, Ching THW, Williams MT. “Pedophilia-themed obsessive-compulsive disorder: assessment, differential diagnosis, and treatment with exposure and response prevention.” Archives of Sexual Behavior 2018;47(2):389–402. A clinical review: fears of sexually harming children are “fairly common” among people with OCD, yet “largely unrecognized and frequently misdiagnosed” by mental health professionals, and misdiagnosis can increase fear, anxiety, and depression. PMID 28822003↩︎

  10. Grant JE, Pinto A, Gunnip M, et al. “Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder.” Comprehensive Psychiatry 2006;47(5):325–329. 293 consecutive adults with OCD: 24.9% reported sexual obsessions at some point, and 13.3% currently. Those with current sexual obsessions were more likely to have aggressive and religious obsessions. One clinic sample, so a link, not proof. PMID 16905392↩︎

  11. Vella-Zarb RA, Cohen JN, McCabe RE, Rowa K. “Differentiating sexual thoughts in obsessive-compulsive disorder from paraphilias and nonparaphilic sexual disorders.” Cognitive and Behavioral Practice 2017;24(3):342–352. A clinical paper. Distress alone doesn’t reliably separate OCD from other sexual thoughts, and the paper sets out the questions clinicians use to tell them apart. doi:10.1016/j.cbpra.2016.06.007↩︎

  12. Rachman S. “A cognitive theory of obsessions.” Behaviour Research and Therapy 1997;35(9):793–802. A theory paper: obsessions are caused by catastrophic misinterpretations of the significance of one’s thoughts, persist as long as those misinterpretations continue, and diminish when they weaken. PMID 9299799↩︎

  13. de la Iglesia-Larrad JI, González-Bolaños RK, Peso Navarro IM, et al. “Sexuality and related disorders in OCD and their symptoms.” Journal of Clinical Medicine 2025;14(19):6819. A narrative review of 200 studies. Sexual obsessions on the standard symptom checklist (the Y-BOCS) include aggressive sexual thoughts, obsessions about incest or child abuse, and doubts about one’s sexuality. They often come with mental rituals, checking (including somatic checking for signs of arousal), reassurance-seeking, and avoidance. Obsessions are described as unwanted and disturbing to the person, in contrast with the positive feelings often present in paraphilias. Taboo obsessions, including sexual ones, have been identified as risk factors for suicidality in OCD. The review also notes that people with OCD may confuse anxiety and arousal signals. Several authors report pharmaceutical-industry fees. PMID 41095907 · PMC12525042↩︎

  14. International OCD Foundation. “Scrupulosity” fact sheet, by C. Alec Pollard, 2010: “A form of obsessive compulsive disorder (OCD) involving religious or moral obsessions. Scrupulous individuals are overly concerned that something they thought or did might be a sin.” PDF↩︎

  15. Grant JE, Pinto A, Gunnip M, et al. “Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder.” Comprehensive Psychiatry 2006;47(5):325–329. 293 consecutive adults with OCD: 24.9% reported sexual obsessions at some point, and 13.3% currently. Those with current sexual obsessions were more likely to have aggressive and religious obsessions. One clinic sample, so a link, not proof. PMID 16905392↩︎

  16. Sun NY, Pittenger C, Ching T. “Analyzing the contents of a large, public online peer support forum for obsessive-compulsive disorder: thematic analysis.” JMIR Formative Research 2025;9:e60899. The authors coded 132 posts and 739 comments added to Reddit’s r/OCD in one 24-hour period in August 2023. Many users sought confirmation that their symptoms were OCD, which the authors read as possible reassurance-seeking. Their introduction summarizes the clinical view that reassurance brings temporary relief but reinforces obsessions and prompts more reassurance-seeking. A descriptive study of one forum. PMID 40418853 · PMC12129411↩︎

  17. de la Iglesia-Larrad JI, González-Bolaños RK, Peso Navarro IM, et al. “Sexuality and related disorders in OCD and their symptoms.” Journal of Clinical Medicine 2025;14(19):6819. A narrative review of 200 studies. Sexual obsessions on the standard symptom checklist (the Y-BOCS) include aggressive sexual thoughts, obsessions about incest or child abuse, and doubts about one’s sexuality. They often come with mental rituals, checking (including somatic checking for signs of arousal), reassurance-seeking, and avoidance. Obsessions are described as unwanted and disturbing to the person, in contrast with the positive feelings often present in paraphilias. Taboo obsessions, including sexual ones, have been identified as risk factors for suicidality in OCD. The review also notes that people with OCD may confuse anxiety and arousal signals. Several authors report pharmaceutical-industry fees. PMID 41095907 · PMC12525042↩︎

  18. Radomsky AS, Gilchrist PT, Dussault D. “Repeated checking really does cause memory distrust.” Behaviour Research and Therapy 2006;44(2):305–316. 50 undergraduates who repeatedly checked a real stove reported lower confidence in their memory of it, and less vivid, less detailed memories; checking a faucet didn’t have that effect. Earlier computer experiments found the same (van den Hout M, Kindt M. Behaviour Research and Therapy 2003;41(3):369–378). Lab studies of students, not of sexual thoughts. PMID 15890313 · PMID 12600406↩︎

  19. Sun NY, Pittenger C, Ching T. “Analyzing the contents of a large, public online peer support forum for obsessive-compulsive disorder: thematic analysis.” JMIR Formative Research 2025;9:e60899. The authors coded 132 posts and 739 comments added to Reddit’s r/OCD in one 24-hour period in August 2023. Many users sought confirmation that their symptoms were OCD, which the authors read as possible reassurance-seeking. Their introduction summarizes the clinical view that reassurance brings temporary relief but reinforces obsessions and prompts more reassurance-seeking. A descriptive study of one forum. PMID 40418853 · PMC12129411↩︎

  20. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. “Acceptance and commitment therapy: model, processes and outcomes.” Behaviour Research and Therapy 2006;44(1):1–25; the authors called the evidence promising but not yet mature. In a meta-analysis of 66 lab studies, defusion exercises had positive effects compared with inactive conditions (Levin ME, Hildebrandt MJ, Lillis J, Hayes SC. Behavior Therapy 2012;43(4):741–756). This exercise isn’t a substitute for ERP. PMID 16300724 · PMID 23046777↩︎

  21. American Psychiatric Association practice guideline (Koran LM, Hanna GL, Hollander E, et al. American Journal of Psychiatry 2007;164(7 Suppl):5–53) and NICE guideline CG31. Both name CBT with exposure and response prevention (ERP), and serotonin reuptake inhibitors (SRIs), as first-line treatments for OCD. The International OCD Foundation’s directory is at iocdf.org/find-help. PMID 17849776 · CG31↩︎

  22. Öst LG, Havnen A, Hansen B, Kvale G. “Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014.” Clinical Psychology Review 2015;40:156–169. 37 randomized trials: effect sizes against waiting lists (1.31) and placebo conditions (1.33) were very large; ERP and cognitive therapy didn’t differ significantly; CBT beat antidepressant medication (0.55), and adding medication to CBT wasn’t significantly better than CBT with placebo. The authors note methodological problems in the trials. Strong research. PMID 26117062↩︎

  23. Williams MT, Farris SG. “Sexual orientation obsessions in obsessive-compulsive disorder: prevalence and correlates.” Psychiatry Research 2011;187(1–2):156–159. 409 people with OCD from the DSM-IV field trial: 8% had current sexual-orientation obsessions and 11.9% had them at some point. The authors note that clinicians may misread such obsessions as fantasies or wishes, that people with sexual obsessions more often use mental compulsions and reassurance-seeking than visible rituals, and that although sexual obsessions may take longer to treat, exposure and ritual prevention remains the treatment of choice. PMID 21094531 · PMC3070770↩︎

  24. American Psychiatric Association practice guideline (Koran LM, Hanna GL, Hollander E, et al. American Journal of Psychiatry 2007;164(7 Suppl):5–53) and NICE guideline CG31. Both name CBT with exposure and response prevention (ERP), and serotonin reuptake inhibitors (SRIs), as first-line treatments for OCD. The International OCD Foundation’s directory is at iocdf.org/find-help. PMID 17849776 · CG31↩︎

  25. ABCT’s Find a CBT Therapist, checked October 16, 2026: licensed members, searchable by US zip code and by US state or Canadian province, with “Therapy Offered” filters that include Exposure and Response Prevention, and OCD among the specialties. Top listings pay to appear there. Find a CBT Therapist · Find a therapist · babcp.com · Referral Directory · AASECT Certified Sex Therapist · Top FAQs · Find a Therapist · Relate↩︎

  26. International OCD Foundation, “How to Find the Right Therapist.” Suggested questions include “What techniques do you use to treat OCD?” and “How much of your practice currently involves OCD?” It cautions against a therapist who “is vague or does not mention cognitive behavior therapy (CBT).” Directory listings are self-reported. How to Find the Right Therapist↩︎

  27. Fernandez E et al. “Live psychotherapy by video versus in-person.” Clinical Psychology & Psychotherapy 2021;28(6):1535–1549. Across 47 studies comparing groups, results by video differed negligibly from in-person therapy. Most studies treated anxiety, depression, or PTSD. PMID 33826190↩︎

  28. Bruce SL, Ching THW, Williams MT. “Pedophilia-themed obsessive-compulsive disorder: assessment, differential diagnosis, and treatment with exposure and response prevention.” Archives of Sexual Behavior 2018;47(2):389–402. A clinical review: fears of sexually harming children are “fairly common” among people with OCD, yet “largely unrecognized and frequently misdiagnosed” by mental health professionals, and misdiagnosis can increase fear, anxiety, and depression. PMID 28822003↩︎

  29. Stop It Now (US), stopitnow.org: a “confidential, toll-free Helpline at 1.888.PREVENT (1.888.773.8368)” for anyone concerned about their own sexual thoughts or behaviors toward children, with chat and email. Stop It Now UK and Ireland (Lucy Faithfull Foundation), stopitnow.org.uk: free, confidential, and anonymous, on 0808 1000 900, or +44 1372 847 161 from Ireland. Checked October 16, 2026; hours change. Get immediate help · How can I find confidential help? · Worried about your own thoughts, feelings and behaviors · Helpline↩︎

  30. Bruce SL, Ching THW, Williams MT. “Pedophilia-themed obsessive-compulsive disorder: assessment, differential diagnosis, and treatment with exposure and response prevention.” Archives of Sexual Behavior 2018;47(2):389–402. A clinical review: fears of sexually harming children are “fairly common” among people with OCD, yet “largely unrecognized and frequently misdiagnosed” by mental health professionals, and misdiagnosis can increase fear, anxiety, and depression. PMID 28822003↩︎

  31. de la Iglesia-Larrad JI, González-Bolaños RK, Peso Navarro IM, et al. “Sexuality and related disorders in OCD and their symptoms.” Journal of Clinical Medicine 2025;14(19):6819. A narrative review of 200 studies. Sexual obsessions on the standard symptom checklist (the Y-BOCS) include aggressive sexual thoughts, obsessions about incest or child abuse, and doubts about one’s sexuality. They often come with mental rituals, checking (including somatic checking for signs of arousal), reassurance-seeking, and avoidance. Obsessions are described as unwanted and disturbing to the person, in contrast with the positive feelings often present in paraphilias. Taboo obsessions, including sexual ones, have been identified as risk factors for suicidality in OCD. The review also notes that people with OCD may confuse anxiety and arousal signals. Several authors report pharmaceutical-industry fees. PMID 41095907 · PMC12525042↩︎

  32. Checked on each service’s official site on October 16, 2026: 988 Suicide & Crisis Lifeline (988lifeline.org); 9-8-8 Suicide Crisis Helpline (988.ca); Samaritans (samaritans.org), for the UK and Ireland; Lifeline Australia (lifeline.org.au); Find A Helpline (findahelpline.com), which lists helplines in over 175 countries. 988 Suicide & Crisis Lifeline · 9-8-8 Suicide Crisis Helpline · about 9-8-8 · Samaritans · Samaritans Ireland · Lifeline Australia · Find A Helpline↩︎

  33. Radomsky AS et al. “Part 1—You can run but you can’t hide: Intrusive thoughts on six continents.” Journal of Obsessive-Compulsive and Related Disorders 2014;3(3):269–279. Interviews with 777 university students at 15 sites in 13 countries; 93.6% reported at least one unwanted intrusive thought in the previous three months. Sexual and other “repugnant” thoughts were the least common type. doi:10.1016/j.jocrd.2013.09.002↩︎

  34. de la Iglesia-Larrad JI, González-Bolaños RK, Peso Navarro IM, et al. “Sexuality and related disorders in OCD and their symptoms.” Journal of Clinical Medicine 2025;14(19):6819. A narrative review of 200 studies. Sexual obsessions on the standard symptom checklist (the Y-BOCS) include aggressive sexual thoughts, obsessions about incest or child abuse, and doubts about one’s sexuality. They often come with mental rituals, checking (including somatic checking for signs of arousal), reassurance-seeking, and avoidance. Obsessions are described as unwanted and disturbing to the person, in contrast with the positive feelings often present in paraphilias. Taboo obsessions, including sexual ones, have been identified as risk factors for suicidality in OCD. The review also notes that people with OCD may confuse anxiety and arousal signals. Several authors report pharmaceutical-industry fees. PMID 41095907 · PMC12525042↩︎

  35. de la Iglesia-Larrad JI, González-Bolaños RK, Peso Navarro IM, et al. “Sexuality and related disorders in OCD and their symptoms.” Journal of Clinical Medicine 2025;14(19):6819. A narrative review of 200 studies. Sexual obsessions on the standard symptom checklist (the Y-BOCS) include aggressive sexual thoughts, obsessions about incest or child abuse, and doubts about one’s sexuality. They often come with mental rituals, checking (including somatic checking for signs of arousal), reassurance-seeking, and avoidance. Obsessions are described as unwanted and disturbing to the person, in contrast with the positive feelings often present in paraphilias. Taboo obsessions, including sexual ones, have been identified as risk factors for suicidality in OCD. The review also notes that people with OCD may confuse anxiety and arousal signals. Several authors report pharmaceutical-industry fees. PMID 41095907 · PMC12525042↩︎

  36. Sun NY, Pittenger C, Ching T. “Analyzing the contents of a large, public online peer support forum for obsessive-compulsive disorder: thematic analysis.” JMIR Formative Research 2025;9:e60899. The authors coded 132 posts and 739 comments added to Reddit’s r/OCD in one 24-hour period in August 2023. Many users sought confirmation that their symptoms were OCD, which the authors read as possible reassurance-seeking. Their introduction summarizes the clinical view that reassurance brings temporary relief but reinforces obsessions and prompts more reassurance-seeking. A descriptive study of one forum. PMID 40418853 · PMC12129411↩︎

  37. American Psychiatric Association practice guideline (Koran LM, Hanna GL, Hollander E, et al. American Journal of Psychiatry 2007;164(7 Suppl):5–53) and NICE guideline CG31. Both name CBT with exposure and response prevention (ERP), and serotonin reuptake inhibitors (SRIs), as first-line treatments for OCD. The International OCD Foundation’s directory is at iocdf.org/find-help. PMID 17849776 · CG31↩︎

  38. Öst LG, Havnen A, Hansen B, Kvale G. “Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014.” Clinical Psychology Review 2015;40:156–169. 37 randomized trials: effect sizes against waiting lists (1.31) and placebo conditions (1.33) were very large; ERP and cognitive therapy didn’t differ significantly; CBT beat antidepressant medication (0.55), and adding medication to CBT wasn’t significantly better than CBT with placebo. The authors note methodological problems in the trials. Strong research. PMID 26117062↩︎

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