POCD Explained: Intrusive Thoughts, Shame & Recovery with OCD Specialist Lukas S. Snear

In this episode of The OCD Confessional, we’re joined by Lukas S. Snear, therapist at NOCD, to discuss one of the most misunderstood and stigmatized forms of OCD: POCD (Pedophilia OCD).

POCD is not about desire or intent. It is a subtype of OCD characterized by unwanted, intrusive thoughts, fears, and doubts that can create overwhelming shame, anxiety, and isolation. Because the topic is so taboo, many people suffer in silence and are afraid to seek help.

Lukas helps us unpack:
 • What POCD actually is
 • How intrusive thoughts become obsessive fears
 • Why reassurance never solves the problem
 • The difference between OCD fears and genuine desires
 • How Exposure and Response Prevention (ERP) helps people recover
 • Why so many people with POCD feel alone — and why they aren't

This conversation is educational, compassionate, and filled with hope for anyone struggling with intrusive thoughts they don't understand.

🎧 Listen now on Spotify, Apple Podcasts, and everywhere you get your podcasts.

Transcript

SPEAKER_00 0:00

POCD is one of the most taboo themes in OCD. Many people aren't even comfortable saying the word pedophile, let alone admitting the intrusive thoughts that torment them. Today we're leaning into that discomfort. We're gonna say the words, have a conversation, and expose ourselves to the very thing OCD tells us we can't talk about. Because bringing these fears into the light is often the first step towards taking their power away.

SPEAKER_01 0:22

I'm Alicia. And I'm Liam. We both have OCD. And instead of spiraling alone, we decided to turn our symptoms into a podcast. You're welcome.

SPEAKER_00 0:31

Here we overshare real stories, laugh through the anxiety, and talk to actual experts who can explain why your brain keeps asking, What if I accidentally marry my cousin?

SPEAKER_01 0:41

Whether your thing is hand washing, mental rituals, or just silently panicking during normal conversations, congrats. You have found your people.

SPEAKER_00 0:50

This is a safe place, unless you're an interest of thought. In which case, get in line, buddy. We're booked.

SPEAKER_01 0:56

So grab a weighted blanket, cancel your plans for the fifth time, and let's dive in. This is the OCD Confessional.

SPEAKER_00 1:04

And yes, we did check this recording four times before uploading it.

SPEAKER_01 1:10

Today on the podcast, we are joined by Lucas S. Sneer, a licensed professional counselor specializing in OCD and related disorders. Lucas primarily uses exposure and response prevention, or ERP, the gold standard treatment for OCD, and works with individuals navigating anxiety, OCD, and co-occurring disorders. In today's episode, we are specifically diving into POCD, what it is, how it presents, and some of the biggest misconceptions surrounding it. We're excited to have Lucas here to share his insight and help bring more understanding and hope to a topic that is so often misunderstood. So, Lucas, thank you so much for joining us. We really appreciate it.

SPEAKER_02 1:50

Thank you for having me.

SPEAKER_00 1:51

All right, we're just going to jump in. For listeners who may not know, can you explain what POCD actually is? I know it's a very taboo and uncomfortable conversation, but we are going to expose ourselves and say the uncomfortable. So let's dive in.

SPEAKER_02 2:06

Well, POCD is pedophilia-themed OCD. And right out of the gate, the word pedophilia is kind of a bombshell to just drop on people. But I use it all the time. When we're talking about POCD, there is no sense in shying away from the idea that that is pedophilia-themed OCD. It's OCD just like any other theme that has that obsessive-compulsive cycle. This individual theme is the worry about if I may secretly be a pedophile, if I may become a pedophile, if I was a pedophile, any kind of worry about that, that's what OCD latches on to.

SPEAKER_01 2:40

How do you differentiate, right? So someone comes to a therapist or confesses to a person in their family and says, I'm having these thoughts, these fears that I might be a pedophile. What helps you as a counselor differentiate? Okay, this person might actually have some sort of pedophilia tendencies, or no, this is purely OCD and we need to work on them with that.

SPEAKER_00 3:10

Especially if OCD hasn't been brought up in their life before, and that is the first that that's tough. Yeah. Good question. Yeah.

SPEAKER_02 3:20

What a big fear right out of the gate is is this something that we need to be worried about? Is this OCD? And what I typically tell people, especially therapists that I'm talking to about this, is if somebody is bringing this up to you, good nine out of 10 times, this is gonna be OCD because true pedophilia as a paraphilic disorder is an egosyntonic thing. That that is typically a desire that a person has that is very disordered. And they're not really interested in going to a therapist or even their loved ones to talk about being worried about that. POCD, like all other forms of OCD, is ego dystonic. This person is very devastated by this worry. It's their worst case scenario that this may be true. And that right there is the biggest flag of this is OCD.

SPEAKER_00 4:09

Which is interesting because a lot of people who have those thoughts are not going to be so eager to share them. And I think that's where the trouble comes in, right?

SPEAKER_02 4:18

Even I, as a dedicated OCD specialist, with some marketed material that I even specialize in POCD, people experiencing this come to me knowing that I'm already going to know what they're talking about. It's even then still so hard for them to bring up. And it all the time I can sense it that, okay, we're talking around this thing. And usually the most comfortable way for me to bring that up is to ask somebody permission to, hey, let me guess real quick. I I think that I know and I can only imagine how hard that is to bring up. So, hey, are you worried that you may be a pedophile? And the relief that comes off of a person when they're like, okay, you already know is amazing because can you imagine being worried that somebody might judge you for that worry, that somebody might directly step on that thing that you've been so scared about, especially sitting in front of a professional that might that might go, oh God, we need to be really worried about that.

SPEAKER_01 5:17

My wife is a clinical psychologist and she tells this story when she was in her graduate training. So these were all people who were on the path to getting a PhD in clinical psychology. And one of her classmates brought this case before them of one of her clients had come in with this fear of being a pedophile. And the clinician quickly assessed this is OCD and POCD specifically, but brought the case to the rest of the group as part of supervision and part of their education. And my wife, Leah, said most of the people in the group were actually really concerned. No, I what if the person really is a pedophile and you're not taking the proper steps to make sure they don't have access to kids, et cetera? And Leah said it was so clear in the documentation that it was actually OCD. And even people in the field were judging this person and had real concerns that they might actually be a pedophile. How do we confront that? Because as you said, that it must be terrifying for someone with POCD to say the words out loud, knowing, boy, if this goes sideways, I could be prosecuted. I'm certainly could be shunned, I could be disowned by my family. I mean, the stakes are very, very high for someone who is experiencing this.

SPEAKER_02 6:41

As far as the answer to that, I think we're doing it right now. That's what I was just gonna say. We have to talk about it more. And I tell the story all the time. And I at this point I don't remember. I think I was at the end of my associateship. I think it was just almost fully licensed when I learned about POCD, and I learned about it on Reddit. I have been through grad school in like a year and a half of supervision at this point, and I'm still reading somebody's experience that they're posting about this great big worry that they have, and I'm kind of reading it in the same voice that in the same vein that probably a lot of your wife's classmates were of, oh my God, that's really worrying. This is a lot. And then I saw the top comment that said, Hey, everybody, pump your brakes. There's this random OCD specialist on Reddit that was saying, this is an OCD thing. And you need to go to the IOCDF, and here's all these resources and articles about what it is. And my the dichotomy of my own reaction to being so worried about it and then recognizing what that was was the first thing that really led me into having a bit of a passion for POCD because it is a thing that even I, with all of the knowledge that I thought that I had, had no idea what was going on with this person.

SPEAKER_00 7:58

And I I love that I love that you feel passionate about it. We need more people to speak up about that. And I and I imagine that like Liam and myself, people go years and years and years not knowing they even have OCD. And for that to be a recurring intrusive thought to be so debilitating is it's absolutely heartbreaking. So I think exactly what you said is just continuing to speak up about it. Why do these thoughts feel so real and convincing to the person experiencing them?

SPEAKER_02 8:25

I mean, most people aren't defused from their thoughts. And of course, OCD immediately makes you go, oh, what does that mean? What does it mean that I even had this thought? What does it mean that that crossed my mind?

SPEAKER_00 8:37

Why do some people have those thoughts and some don't that have OCD, do you think? It's just like anything it attacks what we value most. It's something that we fear.

SPEAKER_02 8:45

It attacks what we value most.

SPEAKER_00 8:47

Yeah.

SPEAKER_02 8:48

I it's interesting in the modern era, hearing more about people's recent triggers, like uh worry that I'm in the Epstein Files is a new the first emergence was that they heard heard about this thing going on and worry that I was a part of that. And of course, you hear that and go, What are you talking about? But the OCD logic of the thing, yeah, that feels like it really needs to be investigated.

SPEAKER_00 9:16

The intrusive doubt, which is what gets us into that vicious cycle, right? It's like you're questioning your own questions of the thing. Did I enjoy that? Was that a real thought that I actually enjoyed? Or am I lying to myself? And I think that's where the psychological torment comes in, is when then what lends to depression and then yeah.

SPEAKER_02 9:37

Well, it's the data gathering that keeps that cycle going so badly that yeah, the obsessional worry is there, the intrusive thought is there. And you can't actually control that. It's gonna be there. And then, like we know about the cycle of compulsion, all of the gathering data, checking myself and ways that you can never actually find 100% certainty.

SPEAKER_01 10:01

Just blow that up. Aaron Ross Powell What are the compulsions that someone with POCD is doing? I've heard stories of people with pedophilia OCD who will go on to porn websites to kind of test whether or not they're aroused. So what are some of the compulsions that they're engaging in?

SPEAKER_02 10:22

Pornography is one that is hard for people to bring up because nobody wants to talk about porn with their therapist. Uh but yeah, that's absolutely a compulsion. People will go and test themselves. And to be clear, they're watching adult regular normal porn, but testing to make sure that I'm still attracted to that. Oh also a huge amount of avoidance. They'll avoid kids, period. They'll avoid even walking by an elementary school, uh, a very common early.

SPEAKER_00 10:52

And a pedophile, I don't sorry to interrupt, but a pedophile, an actual pedophile is not going to avoid those things.

SPEAKER_02 10:58

No, not at all. Right?

SPEAKER_00 10:59

They're going they're gonna actively seek it out. So that alone is proof that you are not a pedophile.

SPEAKER_02 11:07

Yes. And to anyone listening to this, worried that you're a pedophile, notice how that reassurance doesn't last all that long. It feels great to hear that. And oh my God, thank God there's proof that I'm not a pedophile. But that's not gonna last, actually. That's not the treatment. You can't find certainty that you're definitely not.

SPEAKER_03 11:28

It is what is the treatment, Lucas? What is the treatment? Yeah.

SPEAKER_02 11:34

Just like I was uh unfortunately, the hardest thing is the treatment. That's to resist the compulsion and uh resisting a lot of purely mental compulsions, thought replacement of things. Um, body checking is a very hard one. We talk a lot about what we call gronal responses, which unfortunately having sensations in your genitals is a thing that is just an anxious response. So if you're already anxious about a thing and then go checking, oh, did I experience arousal during that, there's a good chance that you're gonna have a feeling of, oh no, I did, didn't I? And then everything just keeps going and it grows and grows and grows.

SPEAKER_00 12:15

The biggest takeaway is the is the the knowledge of this and knowing that what's coming up is an interesting thought in OCD.

SPEAKER_02 12:22

That's the the biggest. Yes, and even that certainty you can't be certain of.

unknown 12:28

Yeah.

SPEAKER_02 12:28

We would go into an exposure like walk around your local mall and don't do that compulsion that you do where you only stare at the horizon and don't look at anybody. Like I need you to walk around and look at people and notice people. And if you have a thought that, wow, that girl looked really beautiful, I need you to keep walking forward. Don't overanalyze that. Don't double check it. Just keep moving forward. And that's a hard thing to do when the stakes are. Am I a pedophile?

SPEAKER_01 12:57

So the mental compulsions you mentioned, those seem particularly difficult to tackle from an exposure standpoint, right? Because avoidance of children, you can tackle that by saying, no, you're going to walk by the elementary school, you're going to go to the mall, you're going to do the thing that you're not doing in order to avoid children. But the mental checking that they're doing of thinking back through the day and, oh, I remember seeing that kid. Was I aroused by that, whatever. How do you tackle that, the exposure to that, and tell them, like, just don't do that? Because of course, that it's not that simple, right? Yeah.

SPEAKER_02 13:37

And a lot of the classic, uh, maybe, maybe not, gets really hard when we're dealing with maybe I'm a pedophile and maybe I'm not. That's a lot of anxiety to sit inside of. Yes. Uh so typically it does fall back on leaning into the uncertainty of the thing, recognizing this pattern where I'm trying to prove that I'm not, and it never works. And so I just have to remain uncertain. I can even be 99.999% sure, and I know that OCD wants 100%, and I have to deny OCD that 100%. I have to just keep moving forward.

SPEAKER_01 14:15

What's the worst case of it you've seen? Just the the most debilitating this person potentially has to be put into inpatient care as a result of it. What is the most intense case you've seen and how did that manifest for that person?

SPEAKER_02 14:32

Uh bedridden and suicidal.

SPEAKER_03 14:35

Yeah.

SPEAKER_02 14:36

And that is the thing that a large number of people that experience POCD walk around with, which is that I'm either going to figure this out or I'll kill myself before I harm a child.

SPEAKER_00 14:50

Yeah, gosh, I just got goosebumps all over my body because you know that it's so heavy and so heartbreaking.

SPEAKER_05 14:57

Yeah.

SPEAKER_00 14:58

Do these thoughts ever go away for someone?

SPEAKER_02 15:05

Yes and no. And this comes down to the ever-present argument of like, do we cure OCD or do we manage it? Is this a chronic thing? And while no, the thoughts probably don't fully go away. It's incredible meeting a person before and after ERP where they go, oh yeah, yeah, I have the thoughts, but who cares? I'm not worried about that. What ERP does is take the distress out of the thoughts. We literally retrain the amygdala to not have as robust of a response to these triggers. We've successfully taught a brain that this discomforts, because it is discomforting. It's allowed to be discomforting to worry that you're a pedophile. And that discomfort does not equal danger. You don't have to respond to it. You don't have to prove it wrong.

SPEAKER_00 15:54

You mentioned before that, you know, maybe ERP for somebody that that battles POCD would be going to the mall and having a thought like this girl looked beautiful. Is this something that you would recommend them doing on their own or should they have a partner with them? I imagine that that is not something that they're publicly going to announce that they're doing right in therapy. If they have a spouse, then maybe they've they've confided in their spouse. I would hope they would. Is that something that you would recommend they do on their own, or do they have support in those moments with somebody that they trust?

SPEAKER_02 16:31

The beauty of the post-COVID world and teletherapy is that they bring me with them on their cell phone. Oh. We can go through this together. And the primary reason for that is to help manage the compulsions that come up. Right. Uh it's a lot of response prevention work in those moments doing those exposures. And so being together, especially the first few times that we do it, uh, yeah, we're almost always together. After that, it does turn into a, okay, I was initially a much higher distress level about this. Now I can go to the mall and only be a little bit triggered. And at that point, we go, great, continue that as homework in between sessions for sure. So much of the work of ERP happens in between sessions. And yeah, once they're ready for it, they can absolutely do these on their own.

SPEAKER_01 17:20

You treat multiple subtypes of OCD, of course. Is POCD stickier? Do you find that it's a harder one to treat? Or is it like any other subtype where if you stick with the ERP or in some cases medication, the person will reliably get better?

SPEAKER_02 17:36

Aaron Ross Powell A person can reliably get better no matter the theme. I would say the one truism, the one kind of pattern is how deep into the obsessive-compulsive cycle a person gets. It doesn't really matter the theme. If it's a thing that they kind of notice and capture soon and get specialized help soon, they're very able to break out of that easier than somebody who had the unfortunately standard path of seven years of not getting the correct treatment. Managing my experience exclusively through compulsions and then trying. Yeah, that's really hard no matter the theme. And a thing that may be relevant is probably someone with PFCD is more likely to spend a long time not getting the help that they need. Yes. And so that probably does end up in presenting it as being particularly sticky. Uh yet, no, I wouldn't say that it's necessarily uniquely more difficult than any other form of OCD.

SPEAKER_00 18:45

Right. Because I imagine if somebody went years and years and years with this secret, um, and they're living with these thoughts, that they've they've created this identity, a false identity around who they are. So you have to work through those layers, right? You have to like, yeah, there's a lot of layers there. This is so good. I'm so excited we're doing this. I hope we can save life. I hope we can save somebody out there who is living with these thoughts. Quick break. We'll be right back. But first, a word from our sponsor.

SPEAKER_01 19:14

The same distressing, unwanted thoughts keep playing over and over in your mind. The same rituals keep eating up your time, holding you back from enjoying your life. You've tried talk therapy before and spent session after session diving into those thoughts, trying to understand them, trying to fix them, but somehow they just get worse. And the shame piles on because you think, why isn't this working? What's wrong with me? If this sounds familiar, here's what you need to know. You are not the problem. You're experiencing something that a lot of people with OCD experience. Getting your life back is possible because OCD is highly treatable. It just requires a completely different approach than other mental health conditions. In fact, standard talk therapy often makes OCD worse because it encourages you to analyze those intrusive thoughts or try to replace them with positive ones. But with OCD, the more attention you give the thoughts, the stickier they become. That's where No C D comes in. No CD provides virtual therapy designed specifically for OCD. Every single one of their therapists is extensively trained in a type of therapy called ERP, or exposure and response prevention, which is the most effective treatment available for OCD. And they get their training from world-renowned OCD experts so they truly understand what you're dealing with, even this stuff that feels impossible to say out loud. In live, face-to-face virtual sessions, your No CD therapist will teach you how to take the power away from intrusive thoughts so you can live the life you want to live. In between sessions, you'll be able to message your therapist anytime, join dozens of live support groups, and continue your progress with other expert-developed therapy tools. NoCD is also covered by insurance for over 138 million Americans, and their team makes it really simple to get started. Visit nocd.com and book a free 15-minute call. That's nocd.com to learn more and talk to someone who can help because you deserve treatment that actually works for OCD. And now, back to our show. With a lot of OCD subtypes, Lucas, and this has been true for Alicia and me for most of our experience with it, is that often you do have some level of insight that this fear is illogical. I know that for some people that insight is lower than for others, but often there's some voice in there going, all right, I know it's not true, but I'm gonna perform the compulsion to give myself the comfort anyway. With POCD, do most of the patients you see know I don't think deep down I actually am a pedophile, but this fear of it is just consuming me. And so I'm gonna perform that compulsion to Get the relief? Or have you found people who are truly lost in it and have no insight into the fact that they're really not a pedophile?

SPEAKER_02 22:09

I think the worry about being a pedophile, and similarly to all kinds of sexual or sexuality-based compulsions, there is a genuine level of complete unknown that you really can't have a confidence in I'm definitely not. Be uh partially because of that checking groanal response kind of thing, where my anxiety kind of produces the symptoms that I'm looking for, anyways.

SPEAKER_01 22:41

Yes. Can we dive in a bit on the groinal response? Which, you know, for for someone listening, I I would imagine that that's some sort of tingling or right that you experience with one of these sexually taboo OCD subtypes, and it then confirms your fear. But you're saying that that response often is just a function of anxiety more than anything else. So just I not getting too much into the mechanics of it or whatever, but but can you just explain a groinal response for someone who might be listening going, oh my God, I've had that?

SPEAKER_02 23:19

Yeah, absolutely. The sympathetic nervous system is the thing that amps us up. And the sympathetic nervous system is uh not all of that complicated. It's the thing we tend to talk about as the fight or flight response. Um there is another F in that triangle, uh, and we can call that fornicating. That's a form of arousal. That is still your uh sympathetic nervous system becoming aroused. So your body is not very good at knowing when this is a fear response or an anger response or a sexual response. So even though it's an anxiety response, the sympathetic nervous system is doing what the sympathetic nervous system does. Your pupils dilate, your heart rate increases, there's increased blood flow everywhere in your body. If you're a man, including to your penis. If you're a woman, including to your vagina. And so you have this experience and you don't know what that means.

SPEAKER_00 24:18

Yeah, it's a body response. It's not a statement of desire.

SPEAKER_02 24:24

Absolutely.

SPEAKER_01 24:25

That is so awful. Like I can't even Isn't that we talked about it Yeah, we talked about that with Chrissy Hodges, and she's had the groinal response and she's had taboo OCD stuff. Unfortunately, she talks very openly about it. But my God, when you have a subtype, any subtype, relationship OCD, health OCD, P O C D, you are constantly looking for evidence that it's real, right? You know, because your OCD is trying to latch on to stuff. And so for that detective element of your OCD to be able to latch on to that, like it's an actual physical response, like what a confirmation of my fear. That is, and so how do you talk to a patient about that, right? Because as you say, reassurance can only take you so far. So you can sit with them in the session and say, well, when you have that groinal response, it's actually your sympathetic nervous system, and you can just explain it to them the way you just explained it to us, which was really helpful. But that reassurance will only last for so long, where they're gonna go, you know, the OCD is gonna go, no, no, no, it's the other part of the triangle that you're actually experiencing. And how do you help them with that when that groinal response shows up? How do you expose your way out of that one?

SPEAKER_02 25:46

There's many, many themes of OCD that as an ERP specialist, I will let you know out of the gate, you're getting zero reassurance from me. OCD is one that oftentimes I don't do that with. And I'll give them my little shtick, kind of like I did a minute ago of, hey, I want you to notice how this doesn't actually help long term, but I do want you to know that this is what that is. And now, moving forward, we need to accept that you can't actually know that. So now when you're triggered and you notice that you walked by the elementary school and then you had an erection, and does that mean something? Well, I don't think there's any way to know for sure. It could be this sympathetic nervous system thing. It could be because you're a pedophile. And ooh, that's yucky to hold on to that, isn't it? Yeah, it is. And let's hold that, don't make it go away. Sit with that feeling for long enough until you notice it slowly come down. When you habituate that worry over and over again, you can eventually have the experience, which again is a bizarre experience to talk about, to walk by an elementary school, get an erection, and go, hmm, I don't know what that means. And it's not so loud anymore.

SPEAKER_00 27:04

Oh, yeah, I cannot sit with that. No chance.

SPEAKER_02 27:08

No chance.

SPEAKER_00 27:09

I I have a big issue with that of going, yeah, maybe I am, maybe I'm not. And every subtype, every part of OCD is crazy to me. I I feel like if you're in therapy and we've already established that it's egogystonic, and then they're doing exposure and response prevention, and you're having them walk by and still still tell themselves that maybe they are, maybe they're not.

SPEAKER_02 27:35

There's no way to know. You can't be a hundred percent certain.

SPEAKER_03 27:43

In this particular topic, we should be.

SPEAKER_01 27:48

You can. Yeah, yeah. That Alicia does not like she does not like the maybe maybe not uh thing.

SPEAKER_00 27:56

Um and well, I think okay, for example, I've had I've had intrusive thoughts of the FBI is gonna knock on my door and tell me I committed some act. I I can't even kill an ant. I I know rationally that that's unlikely. So you want me to say that maybe I did actually commit a murder in my sleep? No, I know I didn't. I know I didn't, but that thought still comes up, and I've done enough work on myself to know that that is an irrational thought. So I guess it's hard for me to wrap my head around somebody in therapy knowing that they are not a pet, they yeah, that that is weird to me. Sorry, I don't understand that one.

SPEAKER_02 28:41

No, that's weird to a lot of people. And in the majority of cases, like worry that the FBI is gonna come and get you. You can find functioning in that worry and then just move on with your life. You you can achieve a level of functioning there. But if you would like freedom from that worry, you do have to begin to practice sitting with. Let me imagine the FBI is on their way right now. And maybe I have some rare amnesiac disorder where I don't remember.

SPEAKER_03 29:11

Oh, I've done that.

SPEAKER_02 29:12

So if that gets you, oh, that's yucky. I don't like that. I feel very accused by that. I really make that go away. And then if you refuse and you hang on to that thought, now the anxiety associated with that is gonna feel like it's gonna go up forever until you die.

unknown 29:31

Yeah.

SPEAKER_02 29:32

It will peak and it will slowly come down. Okay, so eventually you will look back and go, hey, watch, I can trigger myself. Go, the FBI is coming to get me. Huh. Remember when that used to really worry me? Okay.

SPEAKER_03 29:47

Okay, fine. Like that.

SPEAKER_02 29:50

You really don't need to do. You don't need to, unless you want to. If you want to not have to experience that distress anymore, you can go for this freedom over functioning kind of ideal. With something like POCD, people don't want to have this thought anymore. They do not want to worry about it. It's very hard to achieve a level of functioning in saying that maybe, maybe not. And so we have to really power through that and accept that you cannot have the certainty. A lot of times that looks like the uncertainty of what if I one day become a pedophile? And well, how would you ever disprove that?

SPEAKER_01 30:34

Right. You have to accept the uncertainty in that scenario. You can't know. I have gotten a lot from that kind of school of thought of like maybe, maybe not. I apply it daily, regularly to some of the intrusive thoughts that come up for me a lot. Um, how have you seen POCD affect people's romantic relationships? I have to imagine that is an especially complex one. I mean, maybe in some ways, even more complex than relationship OCD, which it's right in the name there. But you can work on that with your partner and try to get your partner to understand. But POCD is just so taboo, so unspoken, so shameful, which it it shouldn't be, but it is, uh, that I have to imagine it makes it very hard to form intimate relationships with another adult.

SPEAKER_02 31:26

A lot of people are surprisingly successful at suppressing this worry so that they can still have a relationship with another adult. Uh and ideally, yes, this is a thing that you should be able to tell your spouse or significant other and uh help them walk alongside you. But I can't tell you the number of sessions that I've done with, hey, I need my partner to come in here and we need to tell them together because Lord knows I cannot do it on my own. And I say, all right, bring them in, let's do it together. And then I'm gonna spend a lot of time probably reassuring your partner and educating them about exactly what this is and how you don't need to be worried. And also you plug your ears, don't listen to any of this reassurance that I'm giving your partner because this will help them. It's not gonna help you. Uh and one of the biggest ways that I do see it affect relationships is when the POCD is centered around my own kids. That is Oh. Oh yeah. Oh, wow. Because how do you parent when you're dealing with that? And especially if you're dealing with that and your partner doesn't know that you're dealing with that.

SPEAKER_01 32:38

That's heavy. Oh my gosh. What does a compulsion with that look like? Is it them just avoiding parenting, avoiding bath time, I imagine? How is it showing up?

SPEAKER_02 32:49

Bath time, diapers, any possible trigger you can think of, uh, even holding my child, if they're going to be straddling me, nope, can't do that. I need to hold them this away. When I put them in the car seat, I have to do it so so. A thousand ways to manage my own triggers that all are just a version of compulsive avoidance that keeps this problem around.

SPEAKER_01 33:11

And can you imagine if you're the spouse and your partner's like, I can't do the diapers? You know, and you're like, Well, why why I have to do every diaper?

SPEAKER_00 33:21

Like, if you've never done a bath tonight.

SPEAKER_02 33:25

It's at minimum, I need you right here over my shoulder while I'm doing bath time.

SPEAKER_00 33:29

Yeah, I need proof that I didn't do anything.

SPEAKER_02 33:32

Absolutely. Oh man, that is tough.

SPEAKER_00 33:36

Yeah.

SPEAKER_02 33:37

Can POCD show up for somebody and there not be any other It can be the emergent theme for sure. Sometimes that's the first time OCD ever shows up.

SPEAKER_00 33:49

So POCD can be the emergent theme, which is the very first one that shows up for somebody and the only one ever.

SPEAKER_02 33:58

Um, it's rare that somebody has OCD that never jumps stain.

SPEAKER_00 34:03

Okay. But that can be the first one for somebody, which is why it becomes so debilitating and debilitating no matter when it shows up.

SPEAKER_02 34:12

There are kids and teenagers that I have worked with that are themselves minors worried that they are a pedophile. And how do you work through that? That, hey, you're 15, your attraction to 15-year-olds is normal. But no, what if that means that I'm a pedophile? What if I'm always attracted to 15-year-olds, even when I'm 40? Wow. Yeah, that's a thing you can't have certainty about. Wow.

SPEAKER_01 34:39

Yeah, because it for one.

SPEAKER_00 34:41

That statement alone is OCD. If you're sitting with a therapist, they're like, okay, this is what that is. But how does that person know to express that to somebody before they know it's OCD? Nobody is going to express that to a 15-year-old is not going to know to share that. They're going to have to almost have other OCD themes in order for that to come up for them to feel comfortable enough. And I think that's the biggest issue, right? Well, with people that have POCD.

SPEAKER_02 35:11

I think that they would probably have to stumble upon a very beautifully produced podcast to learn a lot about experience. Truly. That's the answer is getting it out there, letting people know that this is a thing. And that's a hard thing to do with this particular theme because it is so societally abhorrent.

SPEAKER_00 35:36

Yeah. And do you think that is because people think, okay, you can have someone who's like, okay, I understand what OCD is. I get it. I understand the intrusive thoughts. I understand that someone with POCD is not a pedophile. But that doesn't take away the fact that I know that person still had those thoughts. That's probably where the shame comes in for a lot of people is like, I can talk about it openly. I mean, I personally do not struggle with that one. And I thank God because I know that OCD alone is horrific, let alone that thing. However, I imagine that people that do struggle with that, the shame is so intense, whether people understand it or not, that they will they will die with that secret. They will die with that secret.

SPEAKER_02 36:25

Here's a huge barrier to that. And a uh trigger that comes up surprisingly often is that at a lot of malls, and I don't know, it's probably at a Spencer's in a mall somewhere, there are t-shirts on display that say kill all pedophiles. Can you think of one single other class of humans that you could put under kill all? And we as a society would go, yeah, that's great, put on a t-shirt, we'll buy it. Right. No, it's so abhorrent, not just to the individual, but to society. And so, yeah, absolutely. People and other practitioners that I have talked to about this will hear that somebody had those thoughts and go, full stop, mandated reporting, keep this person away from kids, all of this stuff. And I really emphatically stop them and say, absolutely not. No. Any one of my people that I have worked with that struggle with POCD, I would trust with my own children because they're worried about it.

SPEAKER_00 37:31

Do you think that therapists struggle with giving that diagnosis? Because there is a lot of responsibility on that, on them for that, right?

SPEAKER_02 37:39

And a very salient point is that there are only three reasons to break confidentiality in therapy. Harm to myself, harm to others, and harm to kids. And even though somebody coming and reporting POCD is not even remotely a reportable thing, people know about this, and that keeps people from bringing it up with their therapists. Absolutely. And then hearing that how does somebody, especially a young therapist, somebody who doesn't know that POCD even exists, like I did, sub-learning about it on Reddit?

SPEAKER_03 38:11

Right.

SPEAKER_01 38:13

How would that person respond? If someone's in their car right now and they're listening to this episode and they're going check, check, check, and it really resonates with them, what should they do? Because again, this one is slightly different from other OCD subtypes, where there is some risk that you're going to be misunderstood when you show up to the therapist's office. I mean, we've we've given a few examples here of times when it's gone sideways for people. So what should they do? What steps should they take to ensure that when they do finally take this weight off their chest and open up to a therapist, that they are not going to be reprimanded in some way. Find a specialist immediately.

SPEAKER_02 39:01

There are very good resources. The International OCD Foundation, of course, IOCDF.com, has a directory that only includes people that have been through their behavior therapy training institute. Uh anybody at nocd.com has all been through No CD Academy. They are all educated on this. We know all about it and probably could pick up on it without you even having to take us there a whole lot. And that is a specialty that is quite rare. And you have to be kind of careful with that one because there are a huge majority of people, a huge majority of therapists that put together a psych today profile and just tick OCD, because they go, Yeah, that's OC, that's anxiety with extra steps. I can help out with that without actually having any real specialization in it.

SPEAKER_01 39:51

I'm curious, as someone who specializes in POCD, if you have taken criticism yourself from people in the public or people who might somehow be aware of your specialty and what it is you do. I follow Allegra Castins, I'm sure you're familiar with her. And she's very outspoken about her own battle with POCD. And she now thankfully is in a place where she has kids and she's doing much better. But I look at the comments under her posts, and a lot of them are filled with hate and questioning of, you know, whether, you know, basically calling her a pedophile.

SPEAKER_00 40:30

I mean, that ships proof that she's that far along and confident with who she is and what's going on. Good for her. Like to be able to do that, that just shows that there's proof. That is proof for people with POCD that you can get to the other side and with and and you know, take the the criticism at some point. I'm sure it it doesn't feel good, but she knows in her heart the truth. So what do you can do?

SPEAKER_01 40:53

But I'm curious if if you've taken criticism like that and how you deal with it. Absolutely.

SPEAKER_02 40:59

Uh and I don't uh have an experience of POCD. I don't have a particularly wide internet following or anything like that. But I do uh die on that hill every single time I'm able to when I'm having a conversation with another professional. And they do have those kind of probing questions. And I will stop my whole day and we will talk about this until you understand that this is POCD. This uh this population are not pedophiles, and I need you, as a professional, at minimum, to refer that person to a specialist when you meet them and do not judge them because otherwise, how many years will it be before they walk back into another therapist's office?

SPEAKER_01 41:44

Aaron Powell For a family member who's listening, they have someone in the family who's struggling with POCD, and thankfully that person has felt free enough to confide in them. What would you tell them about offering support without feeding the OCD and the POCD specifically?

SPEAKER_02 42:05

The same as any other theme of OCD. Reassurance is not support. It feels like it is. It even feels particularly cool not to reassure my loved one about this thing that I can see so clearly. Hey, the germs aren't gonna kill you. Hey, I'm not gonna die because you left the stove on. Hey, you're not a pedophile for all of these reasons. Feels like a very logical thing to do, but it doesn't help them. It does actively make OCD worse. And you can support them and help them manage the way that they're feeling without reassurance and absolutely encourage them to seek out treatment with a specialist.

SPEAKER_00 42:42

Would you recommend that they sit in on some of the sessions with them so that you can help educate and how to respond and how not to respond?

SPEAKER_02 42:51

In my work, that's completely up to my members. Okay. If they want that, absolutely.

SPEAKER_01 43:03

What do you wish more people understood about intrusive thoughts generally? You know, we've talked, obviously, we're diving deep this episode on POCD, but intrusive thoughts generally, what do you wish people understood more about them as they relate to OCD?

SPEAKER_02 43:19

Everybody has them. And you will never be free of them. And that second one sounds kind of intense. Uh and that is to say, you're never not gonna have intrusive thoughts. Even if you are fully maintaining freedom from your OCD, the thought's gonna come up. What's going to change is the amount of distress that you experience around that thought. The thought will be there in the future, for sure. But you'll know exactly how to respond to it. Yeah. Then you won't give it the power that the obsessive compulsive cycle gives it.

SPEAKER_00 43:56

And the intrusive thought does not reveal anything about your character.

SPEAKER_02 44:00

You can't be sure though.

SPEAKER_03 44:09

I just got a sick feeling in my stomach.

SPEAKER_00 44:17

Alicia's face. No, I'm back to being a horrible person. I'm a terrible person.

SPEAKER_02 44:27

That our ERP therapists are uniquely broken individuals. That's an insane thing for me to say. Like we all get a little weird and engage in life where there is no certainty about anything. There's no way to know. And for the vast majority of human beings, our experience of that is minimal. It's very unconscious that we engage with the uncertainty of the world where you could die in a car wreck today. But you didn't think about that when you started up your car today.

SPEAKER_00 45:04

Oh, I do every time.

SPEAKER_02 45:05

A million maybe you do. People with harm OCD definitely think about it. Every day. And yet there's a million other uncertainties that are just below the level of our consciousness, really.

SPEAKER_03 45:18

Yeah.

SPEAKER_02 45:19

And then something slips through that filter, hits you right in the amygdala, and all of a sudden, that is a great big threat that I need to protect against. Especially because if I don't protect against that, that would mean something about me. That would be my fault for not taking care of that. And then we compulse. And then the thought gets louder and compulsions get less effective. And so the thought gets louder and then the compulsions grow. And before I know it, I can't manage this anymore.

SPEAKER_00 45:47

I think I'm very much still in the function, not freedom stage of my uh OCD for sure.

SPEAKER_02 45:54

That's okay.

SPEAKER_00 45:56

If that's crazy, if your life is okay.

SPEAKER_02 45:59

Yeah, absolutely.

SPEAKER_00 46:01

I I mean I my life is my life is great. And I make conscious decisions every day to tell myself it is. However, I do still battle intrusive thoughts regularly, hourly. I I think I need to just get back into ERP like yesterday.

SPEAKER_02 46:19

You can. It's available. You don't have to. You certainly do not have to. I am in a camp of uh people that will encourage freedom over functioning. Yeah. Because it's available. Just like I'm I'm a person that would encourage anybody with OCD to try some meds. Get on an SSRI because it works. You're gonna be able to do that.

SPEAKER_00 46:45

You have to believe it's available, right? You have to first choose to believe that freedom does exist. And I think our OCD keeps us from believing that it even exists. I know I have spent my entire life um with this brain. And I think there is fear around who am I without the way that I think. Because in my mind, I'm protecting myself, you know, with the way that I am and who I am. And there are so many habitual thoughts that happen that I think are protecting me. The the layers and and depth of my OCD are so deep.

SPEAKER_02 47:34

There's a second answer to your question, Liam, about what more people can know about intrusive thoughts. And that is that the really the way that the mental health industry is set up is not ready for OCD. Because the primary modality of therapy generally is CBT or talk therapy. Right. And what CBT or talk therapy would teach us to do with our intrusive thoughts is to gather evidence, challenge those thoughts, uh, look to your values, really try to understand something about the situation, and all of those responses is helping a person get better at compulsing.

SPEAKER_05 48:18

Right.

SPEAKER_02 48:19

And so a lot of people that have OCD have an experience of going to talk therapy. I feel better for the 53 minute hour. And then I walk out of there, and even as I'm driving home, I go, oh, but what if she didn't know about this thing? What if I didn't articulate that just right? What if, what if, what if and then we're not even back to square one. We're set back even farther.

SPEAKER_01 48:39

My experience with talk therapy. When I first got into therapy, I didn't know I had OCD. It's a very common experience for people with OCD. And so I was in talk therapy at first. And there were ways in which that therapy helped me. The primary, primary one being that she is the one who persuaded me to get on an SSRI, but she did not clock it as OCD and treated it the way you would any other issue. And it made things worse. It it, you know, I was doing a lot of exactly as you say, kind of looking at my thoughts and the thought process and you know, balancing against my values and then trying to do meditation and put myself into a safe place during meditation and all this stuff. And and I just after a few months, I remember saying to my wife, like, I think I'm actually worse. You know, and that I don't I don't think that's what should be happening. And so finally, you know, we came around and and determined that it was OCD, but um you're exactly right, that that so many people can get into that, you know, cycle of the current system where they finally, and that's what's so cruel about it, is they finally open up. Like, I'm gonna finally go get help, I'm gonna do it. And then they navigate the labyrinth that is our mental health system and insurance system in this country. And and they finally find a therapist, they take all the steps, and then it's they're worse. And they're like, well, all right, I'm I'm that's not an option for me anymore. I mean, and what a disservice that is to people who are already struggling so much.

SPEAKER_02 50:22

And then I always talk about the second minotaur in that dungeon is okay, you finally figure all that out. You go to find a specialist, and then there's three people in your entire Metroplex. They're giving only 250 bucks an hour and booked out for three months. None of them take insurance. Now what?

SPEAKER_00 50:44

They call no cd. No seeding.com.

SPEAKER_01 50:52

That's right.

SPEAKER_00 50:53

Lucas, thank you so much for joining us and helping shine a light on one of the most misunderstood and stigmatized forms of OCD.

SPEAKER_02 51:01

It has been a pleasure, and I'll pay for your future therapy. Sorry for traumatizing you.

SPEAKER_01 51:10

Thank you, Lucas.

SPEAKER_02 51:11

Absolutely thank you all for having me.

SPEAKER_00 51:15

Okay, so I so I have a confession. I realize one of my OCD um compulsions this morning that I've been doing is that when I go to take my meds, I have to say it out loud three times because I've told myself that if I do, I'll remember that I took them. Um, and it has to be three. Four feels uncomfortable. So I was like, okay, I take my meds, I take my meds, I took my meds. And then I went into the bathroom to do my hair and I was like, Spencer, do you realize I do that? He's like, uh, I guess I I do. I'm like, do you think that's OCD? He's like, yeah, 100%. I go, you don't do that? You don't have to tell yourself you took your meds. He goes, No, I go, how do you know for sure you don't double up on them? I'm afraid I'm gonna take like 10 pills.

SPEAKER_01 52:05

Wait, so why the number three? Why three?

SPEAKER_00 52:09

I don't know, it feels good. It feels good.

SPEAKER_01 52:11

It just feels right. So you say it out loud. You go, I took my meds, I took my meds, I took my meds.

SPEAKER_00 52:16

I took my meds, I took my meds, I took my meds, yeah.

SPEAKER_01 52:18

And your fear if you don't do this.

SPEAKER_00 52:21

Four makes me go, and two is not enough. Yeah, so it's interesting though, because I don't know that I've ever counted out loud like that. I don't know if or maybe I have, and it just wasn't as apparent or evident to me since I didn't know I had OCD. I don't know. But I thought, oh, I gotta share that today.

SPEAKER_01 52:43

Yeah, you might start finding other patterns too. I what my thing with the pills is yes, I do sometimes worry about whether or not I've taken them, but I think that's kind of normal. But but um but what I do is when I when I take the pills and you know, drinking the water, I have to take 10 sips of water. So I like am counting as I gulp. So um now I now I don't. And so sometimes I'll I'll like count it out and be like 11 to do one more than 10.

SPEAKER_00 53:14

And other times I'll try to like confuse my brain about how many I've Yeah, but Liam, I think that if you do 11, that's just a new compulsion in disguise.

SPEAKER_01 53:24

Well, it's to challenge not doing the 10, right?

SPEAKER_00 53:26

The 10 was the I know it is, but you've just created a new compulsion, challenging the 10. You're not supposed to count at all.

SPEAKER_01 53:36

Yeah, so now, but that the the counting is just so habit-forming. Like I'll just be drinking the water and be like, oh wow, I'm counting right now. So then what I'll do is try to confuse my own brain about how many I've done, and I'll be like, eight, one, hundred, eleven.

SPEAKER_03 53:52

Like it's so that I don't know how many I've got you, brain.

SPEAKER_01 54:01

Fuck you, brain. You don't know where you are.

SPEAKER_05 54:06

Oh yeah? Let's see if we can count.

SPEAKER_01 54:14

Thanks for listening to another episode of the OCD Confessional. Be sure to follow the show so you get new episodes. You can subscribe to us on YouTube or find us on Instagram and TikTok at the OCD Confessional.