Sexual Intrusive Thoughts

Sexual intrusive thoughts are characterized by extremely distressing sexual urges or visuals that the thinker may view as shameful or harmful. Sexual intrusive thoughts can be either paraphilic or non-paraphilic in nature:

• Paraphilic: May involve sexual violence, sexual activity with family, animals or children, sexual assault, or other sexual behaviors that most of these individuals do not want to be thinking about.
• Non-paraphilic: Along the lines of what’s considered socially normal, but in excess. May result in compulsions like masturbation, pornography consumption, sex with multiple partners, etc.

Obsessive compulsive disorder (OCD) is a common association with sexual intrusive thoughts. OCD consists of obsessions, which are intrusive, recurrent, and persistent, unwanted thoughts, and compulsions, which are repetitive behaviors or mental actions in response to compulsions. In sexual OCD, the obsessions are very distressing sexual intrusive thoughts, often paraphilic in nature. Compulsions may be any sort of action in response to the distress and often shame that comes with the intrusive thoughts.

Compulsive sexual behavior disorder (CBSD) also involves sexual intrusive thoughts. CSBD is similar to OCD in that individuals experience an intense and uncontrollable focus on sexual fantasies, urges, and behaviors, which can lead to distress and diminished quality of life. The most distinguishing factor is the inability to control these urges, and acting upon them, which may result in reckless sexual behavior. These behaviors tend to be non-paraphilic in nature but may be so all-consuming that they interfere with everyday life.

Sexual intrusive thoughts are not exclusive to OCD or CSBD. Anybody can experience sexual intrusive thoughts – they may just occur less often and may have different repercussions than the compulsions that accompany OCD and CSBD. Sometimes a person that – on average – does not experience sexual fantasies outside of the bedroom or in a substance-induced state, may be watching a true crime show, or sitting at work, or family dinner talking to their cousin, and have a thought pop into their head: “what if…?” And then immediately mentally facepalm, maybe get red in the face, and never speak to anyone of this moment ever. This is what it feels like almost all the time for those with sexual OCD and CSBD. Luckily, this kind of sexual intrusive thought is not too consequential and may not need any sort of treatment.

Coping Methods

If someone believes they may have sexual OCD or CSBD, it is important to speak with a sexual or mental health professional. These kinds of providers can help with coping mechanisms or tools to work through sexual urges and distressing sexual intrusive thoughts.         

One of the ways a mental health professional may try to help is through cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT), which are similar yet distinct therapies. These therapies will help to identify the unhealthy and negative thoughts or urges and combat them with healthier coping methods and thought management based on personal values.

For the effects of CSBD and sexual OCD, like depression, anxiety, or other mental health conditions, mental health professionals may prescribe medications to help lessen the impact on quality of life. Additionally, for potential health effects of compulsive sexual behavior like sexually transmitted infections (STIs), antibiotics may be prescribed by a sexual health professional.

Resources:

Antons, S., Engel, J., Briken, P., Krüger, T. H. C., Brand, M., & Stark, R. (2022). Treatments and interventions for compulsive sexual behavior disorder with a focus on problematic pornography use: A preregistered systematic review. Journal of Behavioral Addictions, 11(3), 643–666. https://doi.org/10.1556/2006.2022.00061

Chaudhary, S., Singh, A. P., & Varshney, A. (2022). Psychodynamic perspective of sexual obsessions in obsessive-compulsive disorder. Annals of Neurosciences, 29(2–3), 159–165. https://doi.org/10.1177/09727531221115305

Derbyshire, K. L., & Grant, J. E. (2015). Compulsive sexual behavior: A review of the literature. Journal of Behavioral Addictions, 4(2), 37–43. https://doi.org/10.1556/2006.4.2015.003

Lee, E., Sherwood, J. A., Crosby, J. M., & Twohig, M. P. (2018). Can distressing sexual thoughts be regulated? experiential willingness versus distraction. Journal of Cognitive Psychotherapy, 32(1), 49–66. https://doi.org/10.1891/0889-8391.32.1.49

Marchetti, I. (2023). The structure of compulsive sexual behavior: A network analysis study. Archives of Sexual Behavior, 52(3), 1271–1284. https://doi.org/10.1007/s10508-023-02549-y

U.S. Department of Health and Human Services. (2023). Obsessive-compulsive disorder: When unwanted thoughts or repetitive behaviors take over. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/obsessive-compulsive-disorder-when-unwanted-thoughts-or-repetitive-behaviors-take-over