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04.16.2025
Three Taboo OCD Themes that are Often Misunderstood
Patrick McGrath, PhD
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April 16, 2025
Three Taboo OCD Themes that are Often Misunderstood
Authored by: Patrick McGrath, PhD
When it comes to obsessive-compulsive disorder (OCD), nothing is off the table. People with the condition experience obsessions—intrusive thoughts, sensations, images, feelings, or urges that cause anxiety or distress—which can attach onto anything from fears about germs to extremely taboo thoughts that can feel disturbing and grotesque.
Although these thoughts are ego-dystonic—meaning they don’t align with a person’s true values or intentions—it can be hard to remember that in the moment. This is because OCD causes thought-action fusion: the fear that thinking something is equivalent to doing it.
People with OCD often struggle to find adequate care due to stigmas, shame, and a lack of clinical education on the condition, but those with more taboo thoughts face even bigger barriers. They may fear discussing their obsessions, and some providers may not even be aware that OCD can present this way. But, contrary to popular belief, OCD is about more than just germs or organization; taboo themes come up often. Let's explore some of the most common ones:
1. Scrupulosity or Religious OCD is a subtype characterized by fears about violating religious or moral codes. Concerns may sound like:
- “What if I’ve sinned and didn’t realize it?”
- “Did I do something that angered a higher power?”
- “Will I spend eternity somewhere I don’t want to if I laughed during faith services?”
Someone with scrupulosity OCD will respond to these obsessions with compulsions—the other defining symptom of OCD—which are repetitive behaviors or mental acts aimed to alleviate distress. You may have seen media portrayals of OCD compulsions as excessive washing and cleaning behaviors. But, compulsions can take a wide range of forms. With scrupulosity, common compulsions include repetitive religious rituals, constantly seeking reassurance from faith leaders, and excessive prayer and confession.
Living with this subtype can be especially hard as every decision becomes heavy with spiritual consequences, making even small everyday choices difficult.
2. Harm OCD involves intrusive and unwanted violent thoughts, images, and urges about harming others or oneself. It’s critical to note that intrusive thoughts about homicide or suicide are different from homicidal or suicidal ideation. With OCD, there is no intent to harm, just thoughts that may sound like:
- “What if I stabbed myself with this knife?”
- “Do I want to drop my baby? What if I actually did?”
- “What if I snap and shoot up a school?”
Dealing with these intense themes can be frightening, especially if you’re unaware you have OCD and don’t understand that thinking about these things does not mean that you will do these things. You may perform compulsions like hiding all sharp objects, avoiding triggering media, or ruminating on why you’re experiencing these thoughts.
3. Pedophilic OCD (POCD) is a debilitating fear of being a pedophile, even when there is no genuine attraction to minors. Unlike with pedophilia, someone with POCD does not want to have sex with children or teens; their OCD causes these thoughts precisely because it’s the worst thing they can imagine. They may wonder:
- “What if I harmed a child in the past and don’t remember?”
- “Did I click on child pornography by accident?”
- “Will I become a pedophile in the future?”
These thoughts can lead to physical and mental compulsions, which can be an attempt to try and “protect” minors, like avoiding children at all costs, or checking how you act around kids.
How ERP therapy can help you overcome taboo OCD themes
Despite how distressing these themes can be, exposure and response prevention (ERP) therapy has been shown to be effective at treating even the most taboo OCD obsessions. ERP therapy is a form of cognitive behavioral therapy designed for OCD that works by gradually exposing you to situations that trigger your intrusive thoughts, while teaching you response prevention techniques for resisting compulsions. Basically, ERP helps people break the OCD symptom cycle, by teaching you to sit with uncertainty that comes alongside intrusive thoughts instead of immediately reacting.
ERP therapy can save lives. Healthcare professionals who aren’t knowledgeable about taboo themes of OCD may hear these thoughts and escalate cases to law enforcement, unnecessarily traumatizing patients, whereas an ERP specialist is trained to detect OCD and treat it accordingly. For people with taboo OCD, this individualized therapeutic approach is crucial. It can allow someone who’s been avoiding all social situations out of fear of causing harm to safely reintegrate into their family and society.
There are many taboo themes of OCD—I’ve heard every intrusive thought you can imagine from “what if the earth stops spinning?” to “what if I ran someone over with my car and now they’re trapped under it?” No matter what your OCD is sticking on to, an ERP therapist can get you back to living a life free from paralyzing obsessions and compulsions.
Information Resources provided by NOCD:
OCD: https://www.treatmyocd.com/what-is-ocd
ERP therapy: https://www.treatmyocd.com/what-is-ocd/what-is-erp
Obsessions: https://www.treatmyocd.com/blog/ocd-obsessions
Compulsions: https://www.treatmyocd.com/blog/what-is-a-compulsion-ocd-erp
Patrick McGrath, PhD
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