Therapy for Unwanted Sexual and Taboo Intrusive Thoughts

unwanted sexual & taboo thoughts

You're Not Who These Thoughts Suggest. This Form of OCD Is Treatable.

Some thoughts feel too shameful to say out loud. A sexual image that horrifies you. A doubt about your orientation that won't let go. A fear about a child, a family member, or something sacred that makes you feel sick. You've never acted on these thoughts and never would, but you can't stop asking what they mean about you. Unwanted sexual and taboo intrusive thoughts are a recognized form of OCD. They are often the most hidden and the most treatable once they're named. We offer confidential care in person in San Antonio and virtually across Texas.

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OCD often targets the things you value most.

OCD often targets your safety around children, your faith, your relationships, and your sense of who you are. Sexual obsessions are common in OCD. In one clinical sample, about 1 in 8 people with OCD had experienced Sexual Orientation OCD (SO-OCD) alone [1].

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A free 15-minute call. No forms, no commitment. Just a conversation about what you're facing.

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OCD or something else?

The key difference is how the thoughts feel.

With OCD, the thoughts are unwanted, distressing, and against your values, so you work hard to avoid, check, or neutralize them. Clinicians who don't know this form of OCD can mistake it for something else, which can make fear and shame worse [2]. A careful assessment from someone experienced matters.

How we treat it: respectful, evidence-based care at your pace.

Exposure and Response Prevention (ERP): you gradually stop checking, avoiding, and arguing with the thoughts, so they lose their urgency [3, 4]. Inference-Based CBT (I-CBT) helps you see how OCD builds a story about your identity from "what ifs" rather than from your real values and actions [5].

  • Exposures are always respectful and never involve anything harmful. They focus on facing uncertainty, not on the content itself.
  • We go at your pace. You'll never be asked to share more than you're ready to.
  • If ERP isn't the right fit, you can switch to I-CBT without leaving the practice.
Schedule a free, confidential consultation

A free 15-minute call. No forms, no commitment. Just a conversation about what you're facing.

why integratus counseling

You can say the thought out loud here.

Our team treats these themes every week, and we won't be shocked. We understand how sexual intrusive thoughts overlap with faith, including during prayer and confession, and we treat that with respect for your beliefs. Our team is trained in both ERP and I-CBT, so you're not limited to one approach. We see clients in person at 16607 Blanco Rd, Ste 1308, San Antonio, and by telehealth anywhere in Texas.

Meet our team →
Luke Mayeux, LPC, standing beneath a white garden arbor

Common themes

ThemeWhat the fear can sound likeCommon compulsions
Sexual Orientation OCD (SO-OCD)"What if I'm not really straight, or not really gay?"Checking for arousal, comparing, testing reactions
Fears about children"What if I'm a danger to kids?"Avoiding children, checking your body's responses, seeking reassurance
Family members"Why did that thought about a relative happen?"Avoiding them, mentally reviewing, confessing
Religious or sacred figuresSexual thoughts during prayer or MassRepeating prayers, avoiding church, confessing
Unwanted acts or violence"What if I would do something I find abhorrent?"Avoiding situations, analyzing past behavior

Learn more about our approaches: ERP therapy and I-CBT. Related pages: harm OCD, scrupulosity, and relationship OCD.

Related types of OCD

Harm OCD
Unwanted thoughts about causing harm
Contamination OCD
Germs, illness, and feeling "dirty"
Just Right OCD
Symmetry, order, and perfectionism
Relationship OCD
Doubts about your partner or relationship
Scrupulosity
Religious and moral fears
Perinatal & Postpartum OCD
Intrusive thoughts during pregnancy or after birth

Back to OCD therapy at Integratus.

Frequently asked questions

Will you report me or think I'm dangerous?

Unwanted intrusive thoughts are an OCD symptom, not a sign of risk, and having them is not something therapists report. We'll explain confidentiality and its limits clearly at your first session.

Do I have to tell you the details?

No, not right away. Many people start by naming the theme. Over time, saying the thoughts plainly to someone who isn't alarmed is often a big relief.

How do I know it's OCD and not what I'm afraid it means?

Doubt is the core of OCD, so you may never feel completely sure on your own. A careful assessment looks at how the thoughts feel, what you do about them, and your values. That's where we start.

How long does treatment take?

It varies with your symptoms and goals. We review your progress together regularly and adjust the plan as you go.

How much does it cost?

Individual sessions are $150 for 50 minutes. We're a private-pay practice, and clients working with Luke Mayeux, LPC, can request a superbill for possible out-of-network reimbursement.

References

  1. Williams, M. T., & Farris, S. G. (2011). Sexual orientation obsessions in obsessive-compulsive disorder: Prevalence and correlates. Psychiatry Research, 187(1–2), 156–159. https://doi.org/10.1016/j.psychres.2010.10.019
  2. Bruce, S. L., Ching, T. H. W., & Williams, M. T. (2018). Pedophilia-themed obsessive–compulsive disorder: Assessment, differential diagnosis, and treatment with exposure and response prevention. Archives of Sexual Behavior, 47(2), 389–402. https://doi.org/10.1007/s10508-017-1031-4
  3. Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder: A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156–169. https://doi.org/10.1016/j.cpr.2015.06.003
  4. Wang, Y., Miguel, C., Ciharova, M., et al. (2024). The effectiveness of psychological treatments for obsessive-compulsive disorders: A meta-analysis of randomized controlled trials published over last 30 years. Psychological Medicine. https://doi.org/10.1017/S0033291724001375
  5. Aardema, F., Bouchard, S., Koszycki, D., et al. (2022). Evaluation of inference-based cognitive-behavioral therapy for obsessive-compulsive disorder: A multicenter randomized controlled trial with three treatment modalities. Psychotherapy and Psychosomatics, 91(5), 348–359. https://doi.org/10.1159/000524425

Ready to Feel More in Control and Less Overwhelmed by OCD and Anxiety?

You don’t have to face OCD and anxiety alone. Let’s work together to help you feel more calm, confident, and in control.

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