What Is Obsessive-Compulsive Disorder?

Find a therapist to treat OCD

Sexual obsessions are a common, but often overlooked, form of OCD.

So-called “pure” obsessions in OCD are typically accompanied by mental compulsions.

People with sexual OCD typically wait over a decade before receiving an accurate diagnosis.

If you ask someone to describe obsessive-compulsive disorder (OCD), most would mention hand-washing, lock-checking, or arranging things perfectly. What rarely comes to mind is the version that exists entirely inside the mind, involving thoughts so disturbing that people refuse to say them out loud.

This internal, less visible form of OCD may take the shape of taboo or intrusive thoughts.8 It is sometimes referred to as “pure OCD,” the idea that a person experiences obsessions without compulsions.10 But research suggests this is a misconception. What’s interesting is that compulsions are present, but they are internal, taking the form of mental checking and reassurance-seeking, which can be just as consuming as observable behaviors.12

In many cases, those thoughts are sexual, and sexual obsessions are among the most common forms of OCD.6 They're also the least talked about, because individuals experiencing them rarely disclose them to friends, partners, or even therapists. They’re so frequently misidentified that even mental health professionals often misinterpret taboo intrusive thoughts, contributing to delays in accurate diagnosis and treatment.6

Individuals with these types of obsessive thoughts, particularly those involving sexual themes, are more likely to anticipate rejection and experience higher levels of shame, which further delays seeking care.3, 13 On average, individuals with OCD may wait 10 to 15 years before receiving an accurate diagnosis.13

What Makes a Thought an Obsession

An intrusive thought in OCD is ego-dystonic, meaning it does not align with the person’s values, identity, or desires and is experienced as unwanted and disturbing.1 These types of thoughts feel foreign and distressing, because they are.

The distinction that needs to be made is that they are the opposite of fantasy. Whereas fantasies, even when complex, are typically experienced as intentional or welcomed, obsessions are not. They appear uninvited and may cause anxiety rather than interest or pleasure.

Now imagine that these thoughts do not occur once, but repeat continuously. The brain tends to treat this repetition as meaning; if a thought keeps returning, it begins to feel important, as though it confirms something is true. This is the core trap of OCD, in which frequency is mistaken for evidence.

In reality, the repetition is the disorder itself. The more a person tries to analyze, disprove, or suppress the thought, the more persistent it becomes—a pattern consistent with what is known as ironic process theory, where attempts to suppress a thought can make it more likely to return.11 Attention reinforces the cycle, and the brain begins to interpret that attention as significance.

Sexual obsessions in OCD are typically specific and directed at what a person values most about their identity and relationships. They tend to target the exact boundary between who the person knows themselves to be and who they fear they could become.

Common examples include:

“What if I’m attracted to someone I should not be?”

“What if I’m capable of something harmful?”

“I had an intrusive sexual thought about someone close or related to me. What does that mean?”

“What if my sexual identity isn’t what I think it is?”

“What if I’m aroused right now and I don’t want to be?”

What Is Obsessive-Compulsive Disorder?

Find a therapist to treat OCD

These examples reflect thoughts that individuals internalize, spending significant time trying to disprove or neutralize them. What is often misunderstood is that in OCD, the thoughts that feel most disturbing are not evidence of intent, but a signal of conflict with one’s values. A person troubled by a thought is confronting the very thing they would never do, and the distress itself is the evidence.

What Happens Inside the Relationship

For many people with sexual OCD, the problem goes beyond intrusive thoughts to doubt about their internal experience, struggling to trust their own feelings and perceptions.2 They are not only questioning what they think, but also whether what they feel is real at all.

This is where sexual OCD begins to directly interfere with desire. If a person cannot trust their internal experience, they cannot rely on feelings like attraction, arousal, or emotional connection.

In the context of sexual OCD, this may present as:

“What if I don’t actually feel attracted to my partner?”

“What if I don’t really love my partner and everything I feel is a performance?”

“If I can’t feel it clearly right now, maybe it’s not real.”

“I should feel something. The fact that I’m not sure means something is wrong.”

Sexual OCD rarely stays contained to the individual experiencing it. Research has found that up to 80 percent of women and approximately 25 percent of men with OCD report sexual dysfunction, including impairments in desire, arousal, and engagement.5 In addition, individuals with OCD often report lower sexual satisfaction and higher levels of sexual distress, highlighting the broader impact of the disorder on intimate life.9

A partner with sexual OCD may begin to avoid physical intimacy because closeness triggers intrusive thoughts. During sex, they may withdraw as their attention shifts inward, and what appears to be disengagement is usually the result of this internal monitoring system taking over.

The relationship between OCD and sexual function is bidirectional. OCD increases anxiety and avoidance, reducing desire and arousal, resulting in sexual distress, which can further intensify OCD symptoms.4

Where to Go From Here

If your partner is living with sexual OCD, the most important thing to understand is that their withdrawal is not about you. Avoidance of intimacy, emotional distance during sex, or difficulty being present are symptoms of a threat-detection system misfiring. What looks like disinterest is often interference or misinterpretation.

A partner may experience distance as rejection, while the person with OCD may interpret their own uncertainty as a lack of attraction. In reality, the absence of expressed desire is not the absence of desire itself.

Reassurance often feels like the right response, but it tends to reinforce the cycle. Statements such as, “Of course you’re not a bad person,” may provide temporary relief, but they keep the loop of doubt and checking in place. Supporting a partner in seeking appropriate treatment is more helpful than trying to resolve the uncertainty for them.

If you are experiencing sexual OCD, it can help to shift the goal from finding certainty to building trust in your values. You do not need to fully understand a thought to know that it does not define you. Attempts to analyze, test, or “figure out” what the thought means tend to strengthen the cycle rather than resolve it. When these patterns become difficult to manage, seeking support can help interrupt the process.

For the relationship, exposure and response prevention (ERP) remains one of the most effective treatments for OCD.7 By reducing compulsive responses and changing the relationship to intrusive thoughts, ERP helps break the cycle of anxiety and doubt. When combined with couples and sex therapy, it can also support partners in recognizing the pattern, reducing unintentional reinforcement, and rebuilding connection.

To find a therapist, visit the Psychology Today Therapy Directory.

1. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.

2. Chiang, B., & Purdon, C. (2023). A study of doubt in obsessive-compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 80, 101753. https://doi.org/10.1016/j.jbtep.2022.101753

3. Coreil, A. J., & Wetterneck, C. T. (2013). Stigma and disclosure of intrusive thoughts about sexual themes. Journal of Obsessive-Compulsive and Related Disorders, 2(4), 439–443. https://doi.org/10.1016/j.jocrd.2013.09.001

4. de la Iglesia-Larrad, J. I., González-Bolaños, R. K., Peso Navarro, I. M., de Alarcón, R., Casado-Espada, N. M., & Montejo, Á. L. (2025). Sexuality and related disorders in OCD and their symptoms. Journal of Clinical Medicine, 14(19), 6819. https://doi.org/10.3390/jcm14196819

5. Ghassemzadeh, H., Raisi, F., Firoozikhojastefar, R., Meysamie, A., Karamghadiri, N., Nasehi, A. A., Fallah, J., Sorayani, M., & Ebrahimkhani, N. (2017). A study on sexual function in obsessive-compulsive disorder (OCD) patients with and without depressive symptoms. Perspectives in Psychiatric Care, 53(3), 208–213. https://doi.org/10.1111/ppc.12160

6. Glazier, K., Calixte, R. M., Rothschild, R., & Pinto, A. (2013). High rates of OCD symptom misidentification by mental health professionals. Annals of Clinical Psychiatry, 25(3), 201–209. https://pubmed.ncbi.nlm.nih.gov/23926575/

7. Law, C., & Boisseau, C. L. (2019). Exposure and response prevention in the treatment of obsessive-compulsive disorder: Current perspectives. Psychology Research and Behavior Management, 12, 1167–1174. https://doi.org/10.2147/PRBM.S211117

8. Moreno-Amador, B., Piqueras, J. A., Rodríguez-Jiménez, T., Martínez-González, A. E., & Cervin, M. (2023). Measuring symptoms of obsessive-compulsive and related disorders using a single dimensional self-report scale. Frontiers in Psychiatry, 14, 958015. https://doi.org/10.3389/fpsyt.2023.958015

9. Pozza, A., Veale, D., Marazziti, D., Delgadillo, J., Albert, U., Grassi, G., Prestia, D., & Dèttore, D. (2020). Sexual dysfunction and satisfaction in obsessive compulsive disorder: Protocol for a systematic review and meta-analysis. Systematic Reviews, 9(1), 8. https://doi.org/10.1186/s13643-019-1262-7

10. Proshina, E., Gaidareva, A., Beskhizhko, M., Kazaryan, G., Bainbridge, E., & Khayrullina, G. (2025). Biomarkers of obsessive-compulsive disorder subtypes: A literature review. International Journal of Molecular Sciences, 26(17), 8578. https://doi.org/10.3390/ijms26178578

11. Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101(1), 34–52. https://doi.org/10.1037/0033-295X.101.1.34

12. Williams, M. T., Farris, S. G., Turkheimer, E., Pinto, A., Ozanick, K., Franklin, M. E., Liebowitz, M. R., Simpson, H. B., & Foa, E. B. (2011). Myth of the pure obsessional type in obsessive–compulsive disorder. Depression and Anxiety, 28(6), 495–500. https://doi.org/10.1002/da.20820

13. Wongbusarakum, K., Schug, E., Visher, T. C., Sulivan-Pascual, K., Mirkis, M., Rhee, P., & Frank, A. C. (2025). Factors associated with delays in assessment and treatment of obsessive-compulsive disorder: A scoping review. Journal of Obsessive-Compulsive and Related Disorders, 47, 100982. https://doi.org/10.1016/j.jocrd.2025.100982

There was a problem adding your email address. Please try again.

By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy

© Psychology Today