Abstract
Despite the prevalence of atypical sexual thoughts in OCD presentations, research suggests that treatment providers often misclassify OCD with pedophilic obsessions (P-OCD) as pedophilic disorder. Such misdiagnoses can have adverse effects including inappropriate treatment, worsening of symptoms, and potential legal complications. Given these iatrogenic effects, clinicians must be competent in differentiating between these two conditions. To clarify the difficult differential between P-OCD and pedophilic disorder, the current paper provides readers with two vignettes that illustrate the differential process. These vignettes highlight important distinctions in symptom presentations and common pitfalls when assessing for P-OCD and pedophilic disorder. The first vignette describes a 32-year-old married woman who experienced pedophilic-themed intrusive thoughts, leading her to avoid children and certain interactions with her daughter. The second vignette describes a 42-year-old married man who experienced ego-dystonic attraction toward minors, particularly 8–10-year-old girls. Following these vignettes, treatment implications and forensic implications are discussed. Finally, recommendations for future clinical and empirical work are made.
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The authors would like to thank Dr. Elizabeth Jeglic who provided consultation during the completion of this project.
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The original idea for this article came from Dylan Abrams. The primary literature search was performed by Dylan Abrams, with secondary searches performed by Alexandra Bonagura and Jonathan Teller. The original draft for this article was written by Alexandra Bonagura, which all authors then edited and revised. All authors read and approved the final manuscript.
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Bonagura, A., Abrams, D. & Teller, J. Diagnostic Differential Between Pedophilic-OCD and Pedophilic Disorder: An Illustration with Two Vignettes. Arch Sex Behav 51, 2359–2368 (2022). https://doi.org/10.1007/s10508-021-02273-5
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DOI: https://doi.org/10.1007/s10508-021-02273-5