OCD with sexual intrusive thoughts: what they are and how they are treated in the UK

The NHS defines an obsession as an unwanted and unpleasant thought, image or urge that repeatedly enters your mind, causing feelings of anxiety, disgust or unease. A compulsion is a repetitive behaviour or mental act that you feel you need to do to temporarily relieve those feelings. OCD can affect men, women and children, and the NHS says symptoms may start from as early as 6 years old but often begin around puberty and early adulthood.

OCD-UK explains that OCD often fixes on the subjects that matter most to a person. For sexual intrusive thoughts this can include fearing being sexually attracted to children or to family members, fearing being attracted to people of the same or opposite sex to the one you expect, intrusive sexual thoughts about religious figures, or constantly questioning your own sexuality. It describes the constant analysing of these thoughts as among the most disturbing aspects of OCD.

The defining feature is that the thoughts are unwanted and clash with the person's values. A person who is horrified by a thought is typically the person least likely to act on it. The charity makes the point that people frequently check their body for signs of arousal while trying not to feel it, and that the body can respond simply because attention is focused there, so the checking becomes part of the problem.

The Royal College of Psychiatrists describes OCD as having three parts: obsessions (the thoughts that make you anxious), emotions (the anxiety, guilt, disgust or depression you feel) and compulsions (what you do to reduce anxiety). In sexual obsessions the compulsions are often less visible, because many of them happen in the mind.

• Repeated unwanted sexual thoughts, images or urges that feel out of character.

• Checking your own reactions, or checking your body for arousal.

• Mentally reviewing the past or analysing a thought to decide what it means.

• Seeking reassurance from others, or searching online repeatedly.

• Avoiding people, places or situations, such as spending time with children, which OCD-UK says can lead to emotional distress for parent and child.

• Neutralising a thought with a counter-thought, prayer or counting, as the Royal College describes.

This is the question that people with sexual obsessions most fear asking. The Royal College of Psychiatrists is clear: people with obsessions do not act on these thoughts, even though they fear they will, and a person with OCD is at no greater risk of causing harm than any other member of the public. It also says people with OCD do not lose control, even though they often worry about it, and that loss of control is extremely rare.

The college adds that nearly all of us have odd or distressing thoughts at times, and that most people quickly dismiss them. If you have particularly high standards of morality and responsibility, you may feel it is terrible to have the thought at all, so you watch out for it, which makes it more likely to return. Having a thought is not the same as wanting it or acting on it, and the college encourages people to remember this.

If you are troubled by thoughts and are also feeling an urge to act or are worried about your safety or someone else's, speak to a GP or use NHS 111. If someone is in immediate danger, call 999.

The NHS says it is not clear what causes OCD. Family history, differences in the brain, life events such as bullying, abuse, childbirth or bereavement, and personality traits such as a strong sense of responsibility may play a part. The Royal College of Psychiatrists adds that stressful life events bring it on in about one or two out of every three cases and that times of increased responsibility, such as puberty, a new baby or a new job, can be triggers.

OCD does not reflect a person's character. The NHS stresses that having OCD does not mean you are mad and that it is not your fault.

The NHS says there are two main ways to get help: refer yourself directly to an NHS talking therapies service, or see a GP, who will ask about your symptoms and can refer you to a local talking therapies service. If you are under 18, the NHS points to mental health support for children and young people. It says it is unlikely OCD will get better without proper treatment and support.

Because the thoughts can be very hard to say out loud, it may help to write down what you want to say, or to tell the clinician that you are experiencing unwanted intrusive thoughts and that you think they might be OCD. The Royal College says that clinicians with specialist OCD experience are best placed to help, and OCD-UK notes that fear of being labelled keeps many people away.

The NHS says the main treatments are talking therapy, usually CBT, which helps you face your fears and obsessive thoughts without putting them right through compulsions, and medicine, usually a type of antidepressant called an SSRI. CBT will usually have an effect quite quickly, and it can take up to 12 weeks before you notice the effects of an SSRI. If these do not help, you may be offered an alternative SSRI, a combination, or clomipramine, and some people are referred to a specialist service.

The Royal College of Psychiatrists describes two types of CBT used for OCD: exposure and response prevention (ERP), in which you gradually face the feared situation or thought while resisting the compulsion, and cognitive therapy, which helps you change your reaction to thoughts rather than trying to get rid of them. It says about 3 in 4 people who complete ERP are helped a lot, that SSRIs help about 6 in 10 people and reduce symptoms by about a third on average, and that medicine is best continued for at least 12 months if it is helping.

The Royal College of Psychiatrists suggests remembering that it is not your fault and you are not going mad, resisting the compulsive behaviour rather than the thought, not using alcohol or street drugs to control anxiety, and trying self-help books or support groups. It warns that trying to push thoughts out, correcting them with safe thoughts, rituals, checking, avoiding and seeking reassurance all reduce anxiety for a short time but strengthen the belief that they prevent bad things.

Support is available from OCD Action, OCD-UK and TOP UK, which the NHS lists, and which can also tell you about local support groups. Family members can help by not joining in rituals or providing repeated reassurance, and by learning about OCD.

The Royal College says OCD symptoms may improve or go away for a time but often return, that treatment will usually help, and that anti-obsessional medicine helps prevent OCD returning for as long as it is taken. It also notes that of those who get better with ERP, about 1 in 5 will develop symptoms again and need extra treatment. Many people go on to live full lives with OCD well controlled.