M. Williams, PhD, brainphysics.com says: “Sexual compulsions and paraphilia related disorders (PRDs) are complex psychiatric disorders; therefore, exact causes are not known, although there are many theories. Whether they represent an addiction, obsessive-compulsive disorder, impulse control disorder, or a pattern of hypersexualism is still a matter of controversy. Some have argued that since these disorders represent an ongoing pattern of uncontrolled sexual behaviour, they should be viewed as an addiction because like substance abuse, these consist of a pathological relationship with a mood-altering experience. Others have argued against this idea, instead describing paraphilias and PDRs as symptoms of an underlying obsessive-compulsive disorder (OCD).” 

My thoughts are that while I agree sexual compulsions and PRDs are complex psychiatric disorders and that exact causes are not fully understood, I do believe that sexual obsessions are just that – that is, that these are biologically driven intrusive thoughts that are clearly unwanted. Results show that obsessions are involuntary, that they alarm the person who gets them, and that they do not represent harm to a child, adult, parent, sibling, or other.  Yet, a person who suffers sexually intrusive thoughts feels threatened by them and lives in fear that they could be a paedophile, could be incestuous, a rapist, or other and will go to lengths to “prevent” their perceived fear. When someone has a true sexual thoughts or impulses towards others however, this does represent potential harm because there is an underlying threat there.  For example, a person who has a true sexual desire for children, incestuous thoughts about a family member, or other sexual preference has the capacity to follow through with that desire. Through study, ongoing research, and personal struggles, I have written 3 short accounts that back up my thoughts on sexual addictions, paedophilia and sexual obsessions.  My main concern with this article is to clarify that OCD has many variations including sexual obsessions and is classed as an anxiety-related disorder (DSM-5), and therefore not valid in content; whereas sexual compulsions (true impulses) and PRDs are conditions that are valid and thus are able to be discussed with logic or justification – which often include a person’s conforming to the law or certain rules.

Sexual Addictions

People who have addictions, also called “appetitive compulsions”, or “extreme appetitive urges” are compelled to satisfy a “need” – these refer to gambling, food, alcohol and drug addiction and some forms of sexual activity – e.g., addiction to porn. However, while appetitive-compulsives tend to be lured to the things they crave, they also want to stop.

A person who has a sexual addiction notices his or her behaviour is destructive, yet cannot control the urges regardless of painful loss and emotional consequences. Whilst the person experiences gratification in the activity itself it’s important to note that distress, shame and guilt follow this type of momentary pleasure. A person’s addiction whether sexual or other is often to escape emotional pain, maybe about loss, abuse, recent traumatic event; or something else.

Treatments of choice: The 12-Step ProgrammesAddiction Counselling

The 12-step programmes attempt to support people who wish to discuss their personal addiction and behavioural concerns. Developed in 1935 by Bill Wilson and Dr Bob Smith, the programme was originally intended for those who were experiencing alcohol addiction; and it now addresses and treats other addictions, including smoking, drug addiction, compulsive gambling, plus sex and porn addiction.

Addiction counsellors are active listeners who help the person identify the behaviours associated with this condition and addresses emotional needs and how these are affected, which can lead to full recovery.

Paedophilia

This is not a paedophile obsession (POCD) or an addiction. However, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is a mental condition termed “paedophilic disorder”. Literally, paedophilia means an attraction for children (Arthur S. Reber). Yet, the term needs to be dealt with carefully, as paedophilia differs from actual child abuse. As noted, a paedophilic disorder is a psychiatric condition; therefore, as the term is used, “that attraction is always sexual in its connotations and the meaning of the term is restricted to the sexual feelings of an adult for a child. It only becomes a paraphilia when it results in actual sexual activity and the child is pre-pubic.” (Reber) 

Treatments of choice: The Dunkelfeld Project

The Dunkelfeld Project allows people access to professional mental health treatment and attempts to prevent or change deviant behaviour.

Sexual Obsessions

Sexual obsessions are biologically driven into a person’s mind without their will. What usually follows are corresponding compulsions to counter the obsession. For example, a person who has a paedophile obsession generally has a strong urge to check for signs that will prove or disprove whether they are capable of molesting a child; or they will suffer doubts and will ruminate about whether they have already “committed the act”. 

Yet, they desperately want to stop doing rituals because they know how this can strengthen the obsession. They understand that not checking (or not doing other compulsions) reduces obsessional symptoms. However, while most people who experience sexual obsessions have insight into their symptoms and understand how the disorder works, it is due to the relentless doubts that go with this condition that the person finds resisting compulsions difficult. People who have sexual obsessions fear an underlying threat – that is, that they mistakenly believe their obsession marks their true values or morals, hence going with the anxiety relieving behaviours and to settle briefly the obsessional torment.

Unlike a person who gains some form of satisfaction through giving into addictive behaviours, and this being a consequence of acute anxiety or stress-related issues (“I do it because of my anxiety”) the difference for a person who has OCD is that the only goal from doing compulsions is momentary anxiety relief (“I do it to relieve my anxiety”).

Treatments of choice: In-person or online cognitive behavioural therapy programmes with exposure response prevention, SSRI medication, mindfulness, or inpatient treatment.

Cognitive Behavioural Therapy (CBT) with exposure response prevention (ERP) is the combined gold standard treatment for obsessive compulsive disorder. Cognitive therapy acts as the foundation for facing obsessions and the exposure therapy focuses on strategies designed to help a person resist compulsions and reach recovery, or at least reduced symptoms. A selective serotonin reuptake inhibitor (SSRI) is often also prescribed for people who have moderate-severe symptoms. In extreme cases, a patient would be admitted for inpatient treatment at a specialised hospital that treats OCD.

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