Fighting the 'inner demon'

I am a 32-year-old man with issues I feel shy to share with anyone, hence writing anonymously. For the past 10 years, I have struggled with a secret. I keep getting sexual images in my head about loved ones. Sometimes they are performing sexual acts. Please don't judge me. I do not choose to think of these; they don't make me happy. In fact, I feel ashamed because some of these are about my near and dear ones. I see blasphemous images of even deities and gods having intercourse, whenever I cross any temple. This distress has caused me to not be a good student and now an employee and I have difficulty focusing on things.

I am getting married soon and am very concerned that this will hamper my married life. Please help me get out of this hell in my mind.

Hi, anonymous. I am sorry you are struggling with this inner demon. It has a name: OCD. It is an abbreviation for obsessive-compulsive disorder. The most common understanding of the term OCD is with being excessively knit picky, obsessed with cleanliness, washing hands, or having things a certain way. But sexual OCD is a real subtype, and rather less spoken about, because it's attached to a lot of stigma, shame, and guilt.

Obsessions are:

OCD obsessions are repeated, persistent and unwanted thoughts urges or images that are intrusive and cause distress, unease or anxiety to the individual.

Compulsions are:

Compulsions or compulsive acts can be defined as repetitive, purposeful physical or mental actions that the individual feels compelled to engage in according to their own strict rules, or in a stereotyped manner.

Disorder

It is considered a disorder when it affects your day-to-day life, and interferes with work, personal life, and other spheres of well-being.

How common is it?

The prevalence of sexual OCD is considered to be between 6 per cent and 24 per cent of people with OCD. However, in reality, this number may be skewed. Many folks experience some form of sexual obsession but do not report it due to the stigma.

Who can have this subtype of OCD?

Literally any age group, any gender.

Causes of any type of OCD

A. Biological: Neurobiochemical, genetic, drugs, hormones

⁕ Neurobiochemical changes are involved in the serotonergic, dopaminergic and adrenaline system

⁕ Genetic: higher chances of OCD are seen if one or more parents, grandparents, siblings, or relatives have this condition. However, there is no hard and fast rule that one will have the condition if their loved one has it.

⁕ Drugs: Drug abuse can disturb the neurochemical equilibrium in the brain.

⁕ Hormones: OCD can result from a strong interplay between the hormones of the body and the chemicals of the brain.

B. Psychological

⁕ Personality: Certain personality types are more prone to OCD. Another distinct personality style is OCPD which means Obsessive Compulsive personality disorder. This personality style may or may not have OCD but are considered annoying perfectionists by others.

⁕ Coping: Our coping strategies differ from person to person.

⁕ Trauma / abuse: Higher chances of mental health disorders are found in those who may have faced abuse or trauma

C. Social: Stressors, societal norms, loss of a loved one, negative events, and even the pandemic, can all precipitate OCD.

Sexual OCD

Many believe that sexual OCD is a choice, and one is choosing to think of these sexual thoughts, images, or impulses. The reality is that these are not pleasurable. They are ego-dystonic and cause distress to the individual.

Talking to your partner and approaching professional help with their support may be a good place to begin. The core of a relationship is trust and transparency. This condition can be treated with the right intervention and management.

Treatment and management

Since the aetiology is multifaceted, the treatment also needs to be multipronged. Psychiatrist, psychologist, family support and your own efforts need to all sync.

⁕ Medication: Antidepressants like SSRIs, SNRIs, TCAs, along with add-on medications like low-dose antipsychotics, and NMDA receptor antagonists can help.

⁕ ERP: Exposure response prevention therapy (ERP)

⁕ CBT: Cognitive behavioural therapy is the gold standard and shows good results

⁕ ACT: Acceptance and commitment therapy is widely accepted

⁕ Art-based and dance movement-based therapy: Certain individuals find solace in expressing themselves via art or dance as a medium

⁕ Exercise: It is a natural way to titrate the body and mind.

⁕ Meditation: Helpful in cases where mindfulness may help them cope with the now, rather than the thoughts

⁕ NIBS: Noninvasive brain stimulation methods like rTMS are excellent for helping with OCD, especially in drug-resistant cases.

⁕ Exploratory research: Currently, advances in the fields of researching psilocybin (magic mushrooms) for low dose for the management of OCD is being studied.

Send your questions to help@dreradutta.com