POCD Part Three: The Groin and Other Junk

If you have POCD, and you’re struggling with triggers “down below”, my recommendation is that you treat intrusive sensations the way you would treat intrusive thoughts – with mindfulness, the rejection of distorted beliefs, and the courage to face uncertainty head on.

It’s getting uncomfortable in here
So keep on all your clothes
I am
So uncomfortable
I’m gonna keep my clothes on
-not Nelly

Get ready to be uncomfortable.

Welcome to the world of POCD (pedophile-themed obsessive compulsive disorder) and bodily sensations around children. Unwanted intrusive thoughts of a sexual nature are relatively common in OCD, and the subject matter can range anywhere from sexual orientation, incest, bestiality, rape, or pedophilia to whatever you just thought of just now that you think no one has ever thought of. As discussed in Part One and Part Two of this blog series on POCD, this manifestation of the disorder is brutally painful, but no less treatable with cognitive behavioral therapy and mindfulness than any other form of OCD. Cognitive approaches look at the way thinking may be pressuring the sufferer to make compulsive and avoidant choices, Exposure with Response Prevention (ERP) looks at ways in which fear can be confronted behaviorally and systematically, and mindfulness strategies promote present-mindedness and acceptance of the presence of difficult thoughts and emotions. But one element of pedophile-themed OCD often appears to elude these offensives, breaking the rules of OCD warfare, dragging the mind and the self into chaos. Yes, it is the ISIS of your OCD, the terrorist network known in clinical circles as your genitals and in colloquial terms, as your junk.

Distorted beliefs about groinal sensations that make it easy for OCD to bully you:

  • You can control when there will be sensations and what kind of sensations there will be.
    • Nope. There are several thousand nerve endings in the genitals and they fire off pretty much no matter what is going on. They could fire off with wanted contact. They also fire off with unwanted contact. They could fire off because you saw something you liked. They could also fire off because you saw something you didn’t like. They fire off because of shifts in blood flow, which have numerous sources. And of course, they fire off in response to attention. Spend any amount of time really concentrating on your left elbow and inquiring whether or not it feels free of sensation and, guess what? Your elbow feels weird. Compulsive checking for groinal sensations causes groinal sensations, which perpetuate urges to check. Identifying the checking as the problem (not the sensations) is the only way to undo the obsessive compulsive cycle.
  • Groinal responses are indicators of sexual attraction.
    • Actually, they are indicators of activation, which is not the same thing as attraction. Activation is a body state characterized by hyper-alertness and can just as easily be caused by fear, happiness, anger, or any other intense emotion. For the POCD sufferer, the hardest truth to accept is that love, genuine non-sexual compassionate, empathic, affectionate love can also trigger sensations in the groin. That’s right. People sometimes feel sensations in their junk while thinking lovingly about their children and this has nothing to do with sex, orientation, or attraction. It has to do with love being activating and activation shifting blood flow around the body. For the POCD sufferer, this fact is so very difficult to accept. People experience joy in the body and that means that the most sensitive parts of the body are going to respond first. The POCD sufferer is likely to interpret this through one lens when in fact it requires no interpretation, no lens. The more attention you spend on groinal responses (the least meaningful of all responses because the most easily triggered of bodily responses), the more significant they will appear. It’s also worth noting that if you are used to responding to an image or thought one way, you are also going to respond to similar images or thoughts in similar ways even if that is undesirable. Consider that a person may spend a sizable amount of time associating the word “beautiful” or “handsome” with “sexually stimulating.” What might the most sensitive part of the body do in response to those words traversing the mind? How often do we look at children and think of them as beautiful or handsome? Again, it is the OCD driving an interpretation of this automatic body activation with sinister intentions.
  • Knowing exactly how to have contact with or look at your kids is important.
    • Actually, it’s impossible. At some point in their development we back away from repeatedly kissing our kids on the lips and slapping them affectionately on the behind. We just find ourselves not doing it, because at some unclear point it just feels uncomfortable. This is not OCD, but standard behavior, to suddenly start feeling icky being “too close” to a little person shaped more like an adult. This suggests that intrusive unwanted sexual thoughts about kids are actually normal events that are simply misinterpreted, over-interpreted, and over-responded to by OCD sufferers. Not only this, but being around children at various degrees of undress is inherently uncomfortable. POCD sufferers cling to a myth that the “normal” way to feel around a 12 year-old in a bikini or a 2-year old flashing his genitals at you while you try to get his jammies on is the same feeling one gets when they look at a brown paper bag or a tree. This is no less irrational than the obsessive thoughts about closet-pedophilia. The normal way to feel is weird, a bit off, and slightly avoidant. Those free of POCD will wince, grimace, and roll their eyes. POCD sufferers run, cry, self-punish, self-criticize and torture themselves for the crime of noticing.
  • Children should never come in contact with your groin.
    • Nice idea, but completely unrealistic. Your groin is a child magnet. It’s at eye level, it’s where little ones reach to grab a hand, and it’s where one sits when one sits on someone. Ask any person without POCD what it’s like to take a toddler to the movies. They want to sit on mommy or daddy’s lap. To them it’s safe. To the POCD sufferer it’s “dangerous.” It’s two hours of having a child sit, squirm, wiggle, and bounce on your groin (I warned you this would be uncomfortable). And for several years, being face-to-face you’re your child means them being foot-to-groin with you. Physical contact with one of the most sensitive parts of the human body causes nerve endings to fire. Mindfulness simply suggests you notice nerve endings have fired. OCD wants you to interpret those firings in the way that most bolsters the obsession. Nerve endings firing in your groin while having incidental contact with your children is uncomfortable. OCD wants you to interpret that discomfort as denial, romance, pedophilia, or whatever is likely to push you into compulsions. Life may be unfair for OCD sufferers, and OCD sufferers may be particularly sensitive to injustice, but at some point we have to choose our values (what kind of parent you want to be) over our fears (what kind of monster your OCD is making you out to be). This means learning how to be in the presence of the inevitably uncomfortable.

Self-compassion and POCD

If you’ve ever experienced group therapy for OCD, you’ve experienced someone saying, “Oh, I wish I had that person’s OCD instead of mine.” And then everyone silently thinks, “Yeah except POCD.” All OCD is cruel, but POCD is perhaps a special kind of cruel. It takes the most loved and makes it the most horrifying. Your body does what bodies do and your OCD says it’s doing it wrong and the self-critical voice comes diving in for the kill. You’re disgusting. You’re a monster. You’re the absolute worst. And it’s easy to forget, these are just thoughts. These are little stingers your OCD uses to get you to scratch, to irritate yourself into doing more compulsions.

Self-compassion can be understood as having three pillars: mindfulness, common humanity, and self-kindness. (Neff, 2011) Mindfulness simply means being honest about what an experience is as opposed to getting lost in interpretations over what an experience could be. Your child crawls all over you just a little too close for comfort or your child smiles at you like you’re some kind of mythical god wizard fairy, and then your junk says, “Hey, what’s goin’ on?” OCD wants you to run that data through a lens that points everything toward sexual perversion. Mindfulness asks only that you note, “I experienced a sensation.”

The concept of common humanity simply requires that you also notice you are not alone. Many traditional models of CBT and ERP emphasize the worst, shying away from anything that could be remotely self-reassuring, but I think this is being too black-and-white. The universe does provide reassurance and you are welcome to it. You just aren’t going to be helped striving for it and clinging to it. Be open to receiving it is all. 2-3% of the population has OCD and a meaningful percentage of OCD sufferers have sexual obsessions. Many people feel uncomfortable around their kids in the presence of body sensations. All people doubt their parenting worthiness.

Lastly, and the hardest to come by, is self-kindness. Clients I’ve seen with POCD have the cruelest inner dialogue taking place at all hours and for many, it’s not even an argument. The OCD says, “You’re a monster because you had this sensation around a kid.” And then the OCD sufferer says, “Oh, it’s so true, I can’t believe I’m this terrible. I’m the worst.” The key to accessing self-kindness is simply to notice (dare I say, mindfully?) the tendency to think top-down, as in, “How did I get so low?” Then, you can ask yourself what it looks like, bottom-up, as in, “How am I keeping it together despite such pain? How am I managing to cope? To deal?” Giving yourself credit for not abandoning parenthood (or any other kid-related environments) may feel a bit foolish, but again, it’s important to remember that while people without OCD certainly do feel uncomfortable (physically or otherwise) around their kids, people with OCD are carrying an unimaginable weight around. They carry with them suitcases full of guilt, self-doubt, anxiety, and false assumptions about the most terrible things conceivable. So credit for coping with this weight is well-deserved.

The lag of physical sensations

Behavioral therapy works on the premise that thoughts, feelings and sensations are often guided by behavior. The more a person goes to a rooftop and doesn’t die, the more they are going to think that rooftops are safe and ultimately begin to feel less anxiety. What is often forgotten is that physical sensations also follow this course, just at a different pace. A person can confront a fear of heights with exposure to rooftops and first they will start thinking that rooftops don’t automatically equate to falling. Some time later he will start to “feel” emotionally that rooftops are not so threatening. But a considerable time may pass before he can go on a rooftop and not have an increased heart rate. Sensations are sluggish to change course. So in doing ERP for pedophile fears and resisting compulsive behaviors, we can expect the same. You will stop buying into thoughts about being a monster, then later see the guilt and dread go down as you continue to behave like a parent who doesn’t find these obsessive concerns so important. But it will take more time and consistent effort non-responding to OCD before your junk stops tripping the alarm.

But what if…?

If you spend your days imagining how you’re going to get away with committing a pedophilic act, thinking that this would be a preferred course of action for you, and you have a history of sexual aggression and sexual impulse control problems, or you have been viewing child pornography or engaging in similar behaviors, it may be wise to seek consultation with a specialist in sexual disorders. But if you have OCD and you’re using an in-depth internal analysis of groinal sensations to get certainty about whether or not you’re a potential danger to children, it’s important to remember that this is not just bad evidence, it’s tainted evidence. The checking, the mental review, the reassurance seeking, the avoidance and all the other compulsions are mutually exclusive from getting clarity on any issue. They are actually intensifying the presence of sensations and the experience of noticing that presence.

POCD sufferers deal with a lot of shame and part of this comes from the fact that some OCD symptoms are so hard to talk about, you dare not share them even with a therapist. Social stigma around mental illness and misguided beliefs about the human body make it that much harder. But if you suffer from POCD and one of your symptoms includes over-attending to groinal sensations, try to remember that this over-attention is not about a flaw in your body or in your character. It is a symptom of OCD no different from those who over-attend to bathroom stall door handles. So if you have OCD and you’re struggling with triggers down below, my recommendation is that you treat intrusive sensations the way you would treat intrusive thoughts – with mindfulness, the rejection of distorted beliefs, and the courage to face uncertainty head on.

(cited: Neff, Kristin. 2011. Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind. HarperCollins.)

Click here for POCD Part I: What Is Pedophile-Themed Obsessive Compulsive Disorder?

Click here for POCD Part II: Treating Pedophile-Themed OCD

Jon Hershfield, MFT is a psychotherapist in private practice licensed in Maryland and California, specializing in the treatment of OCD.  Follow him on Twitter and Facebook