Studies are needed to determine if treatments for obsessive-compulsive disorder should be directed toward specific types of unwanted thoughts that patients experience.

Although many individuals with obsessive-compulsive disorder (OCD) appear to be preoccupied with contamination from dirt, some are afflicted with unwanted sexual thoughts. What percentage of persons with OCD suffer from sexual obsessions, however, has been unknown because little research has been conducted on the subject.

To get some answers, Jon Grant, M.D., an associate professor of psychiatry at the University of Minnesota, and coworkers studied almost 300 subjects with a primary lifetime diagnosis of OCD. They indicated that “to our knowledge, this is the largest and broadest sample of individuals with primary OCD that has been studied.”

About one-fourth of these subjects suffered from sexual obsessions at one time or another, and 13 percent were currently experiencing such obsessions, the researchers found. Typical unwanted thoughts consisted of having sex with friends, family, children, or even animals, or of engaging in violent sexual behavior.

Thus, “sexual obsessions are fairly common among individuals with OCD,” the scientists concluded. Their findings appeared in the September Comprehensive Psychiatry.

Their inquiry also compared subjects with sexual obsessions with those plagued by other kinds of obsessions. Severity of OCD, comorbidity, insight, depressive symptoms, quality of life, and social functioning did not differentiate the two groups. Also, the study debunked some older myths about OCD sexual obsessions—that they are more common in men, that people with these obsessions have a poorer response to treatment, and that these individuals have poorer sexual functioning or satisfaction.

However, several factors did separate the sexually preoccupied from those with other types of obsessions. Those who experienced unwanted sexual thoughts also often incurred unwanted aggressive and religious thoughts as well. Moreover, subjects burdened by intrusive sexual, aggressive, and religious thoughts started to experience them at a significantly earlier age—on average at 15 years—than did OCD subjects afflicted with other kinds of thoughts.

Grant and his group speculated on some reasons for these two findings in their report. “Social understanding and comprehension emerge during puberty, and the taboo content of these pubertal obsessions may reflect the anxiety associated with social concerns commonly seen in this age group. The maturational and psychological changes associated with puberty may also be involved in the pathogenesis of these obsessions.”

The results have implications for clinical psychiatrists, Grant told Psychiatric News. For one thing, intrusive sexual thoughts are fairly common in OCD patients. Therefore clinicians need to inquire about them, especially in young patients who may be too ashamed to bring up the subject themselves.

Studies are greatly needed to find out whether treatments for OCD patients with sexual, aggressive, or religious obsessions should be specifically tailored for them, Grant and his team pointed out in their report.

The investigation was funded by the National Institute of Mental Health.

An abstract of “Sexual Obsessions and Clinical Correlates in Adults With Obsessive-Compulsive Disorder” can be accessed at<www.sciencedirect.com> by clicking on “Browse A-Z of journals,” then “C,” then “Comprehensive Psychiatry.” ▪