OCD Treatment for Sexual Symptoms
Development of a Client Workbook
Obsessive-compulsive disorder (OCD) is a disabling and distressing disorder, with a myriad of clinical presentations. According to the National Institute of Mental Health, OCD afflicts 2.2 million American adults. OCD is equally common among men and women, causing significant and pervasive impairment in multiple domains, including home life, work, and relationships. Sexually-themed symtoms can be especially distressing.
Last summer we published the first treatment manual for individuals with sexually themed OCD published by Oxford University Press. Designed for use by clinicians, we are now working on a workbook made for individuals to engage in self-directed treatment. We recognize that mental health treatment is a privilege and that a variety of barriers often makes therapy inaccessible. Even when accessible and affordable, it is rare to find a competent therapist who fully understands how to assess and treat OCD. This is especially true of S-OCD, or sexual-OCD, which is regularly misdiagnosed, and centers around obsessions and compulsions related to sexual themes. This includes ideas that one is a pedophile, does not know their true sexual orientation, beliefs that one has been unfaithful to their partner, pregnancy obsessions, and rape obsessions, just to name a few.
Because these situations are highly taboo in our society, individuals with S-OCD experience excessive shame, guilt, self-blaming, self-punishment, and distorted image of self, and often go on to suffer for many years before they seek treatment. In this workbook, we walk clients through OCD treatment by directing them in assessing their anxiety and irrational fears, teaching them about their OCD in the form of psychoeducation, and instructing them on how to develop their own exposure and prevention therapy, which is currently the gold standard of treatment.
Related Papers
Ching, T. H. W., Rouleau, T., Turner, E., & Williams, M. T. (in press). Disgust sensitivity mediates the link between homophobia and sexual orientation obsessive-compulsive symptoms. Cognitive Behaviour Therapy.
Luxon, A. M., Chasson, G. S., Williams, M. T., Skinta, M., & Galupo, M. P. (in press). Brooding over the closet: Differentiating sexual orientation rumination and sexual orientation obsessions. Journal of Cognitive Psychotherapy.
Williams, M. T., Ching, T. H. W., Tellawi, G., Siev, J., Dowell, J., Schlaudt, V., Slimowicz, J., & Wetterneck, C. T. (2018). Assessing sexual orientation symptoms in obsessive-compulsive disorder: Development and validation of the Sexual Orientation Obsessions and Reactions Test (SORT). Behavior Therapy, 49 (5), 715-729 doi: 10.1016/j.beth.2017.12.005
Ching, T. H. W. & Williams, M. T. (2018). Association Splitting of the Sexual Orientation-OCD-Relevant Semantic Network. Cognitive Behaviour Therapy, 47 (3), 229-245. doi: 10.1080/16506073.2017.1343380
Bruce, S. L., Ching, T., & Williams, M. T. (2018). Pedophilia-themed obsessive compulsive disorder: Assessment, differential diagnosis, and treatment with exposure and response prevention. Archives of Sexual Behavior, 47(2), 389-402. doi: 10.1007/s10508-017-1031-4
Williams, M. T., Wetterneck, C., Tellawi, G., & Duque, G. (2015). Domains of distress among people with sexual orientation obsessions. Archives of Sexual Behavior, 14 (3), 783-789. doi: 10.1007/s10508-014-0421-0
Williams, M. T., Davis, D. M., Tellawi, G., & Slimowicz, J. (2015). Assessment and treatment of sexual orientation obsessions in obsessive-compulsive disorder. The Australian Clinical Psychologist, 1 (1), 12-18.
Williams, M. T., Slimowicz, J., Tellawi, G., & Wetterneck, C. (2014). Sexual Orientation Symptoms in Obsessive Compulsive Disorder: Assessment and Treatment with Cognitive Behavioral Therapy. Directions in Psychiatry, 34(1), 37-50.
Williams, M. T., Crozier, M., & Powers, M. B. (2011). Treatment of Sexual Orientation Obsessions in Obsessive-Compulsive Disorder using Exposure and Ritual Prevention. Clinical Case Studies, 10, 53-66.
Williams, M. T., & Farris, S. G. (2011). Sexual Orientation Obsessions in Obsessive-Compulsive Disorder: Prevalence and Correlates. Psychiatry Research, 187, 156-159.
Williams, M. (2008). Homosexuality Anxiety: A Misunderstood Form of OCD. In L. V. Sebeki (Ed.), Leading-Edge Health Education Issues, Nova Publishers. ISBN-10: 1600218741.
Treatment Manual
Sexual Obsessions in OCD: A Step-by-Step, Definitive Guide to Understanding, Diagnosis, and Treatment
Monnica T. Williams, Ph.D., ABPP & Chad T. Wetterneck, Ph.D.
Although there have been several manuals written about how to treat obsessive-compulsive disorder (OCD) using cognitive-behavioral approaches, there has been little focus on application of CBT principles to those with sexual obsessions. Treating sexual obsessions in OCD differs from the treatment of other forms of OCD due to heightened feelings of shame surrounding symptoms, widespread misdiagnosis from professionals, and the covert nature of ritualizing behaviors.
This manual, published by Oxford University Press, provides clinicians with the tools needed to successfully help clients suffering from unwanted, intrusive thoughts of a sexual nature. It provides instructions on how to diagnose OCD in clients reporting sexual obsessions, guidance, on measures to employ during assessment, and a discussion of differential diagnoses.
