OCD in the bedroom: How to manage intrusive thoughts during intimacy

Intrusive obsessive thoughts can surface even during intimacy; clinical psychologist Dr. Tal Peleg explains how to manage the doubts and the impact OCD can have on both partners        

Lori Stadtmauer|
"OCD is a recognized mental disorder characterized by intrusive thoughts—when a person repeatedly thinks about something despite not wanting to think about it rationally," explains Dr. Tal Peleg, 44, a clinical psychologist and sex therapist.
"To alleviate the constant anxiety echoing inside them, they perform various rituals. For instance, a fear of contamination might lead to prolonged handwashing. Initially, this may calm the anxiety, but soon doubt resurfaces.

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"Imagine leaving the house and asking yourself, 'Did I lock the door?' A typical person moves on, but someone with OCD will return home to check. In essence, it’s a disorder of doubt. People with OCD struggle greatly with uncertainty and ambiguity in their lives."
How does OCD manifest in sexuality? "Even before addressing sexuality, there’s a concept in relationships known as ROCD, or Relationship OCD. This happens when questions about the relationship arise: Do I really love them? Is this person the one? What if I’m making a mistake? Am I even attracted to them? Almost everyone has these thoughts occasionally, but here the issue lies in the loop that forms—thinking about it over and over again and constantly searching for evidence and proof.
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"Another form of ROCD involves fixating on a flaw in your partner and obsessing over it. For example, 'His nose is too big' or 'She lacks a sense of humor,' and this preoccupation becomes obsessive. As a result, the partner feels insecure, and the relationship suffers."
In the bedroom, it's even more critical because good intimacy requires both partners to feel secure and at ease. "Exactly. During a fulfilling sexual experience, you shouldn’t be consumed by thoughts like: Am I enjoying this or not? Am I attracted to them or not? Do I feel good or bad? People with OCD are so preoccupied with these questions that they’re disconnected from the act itself."
What else do they ask themselves in bed? “For example, how do I know if I’m enjoying this or not? How do I know if his size is enough for me? How do I know if I really want this or if I’m just pleasing him?
“By the way, after October 7, we’ve seen women develop OCD around questions of sexual violence: How can I know this act isn’t being forced on me? How can I be sure he’s not exploiting me right now?”
"אנשים עם OCD עסוקים במחשבות עד שהם לא מחוברים למין עצמו".  ד"ר טל פלגDr. Tal PelegVideo: Mati Krimerman
How does this disorder affect the other partner? “It depends on how much the person chooses to share. There’s a difference between saying, ‘Listen, when you touch me like this, it’s not so pleasant; can you try something else?’ and saying, ‘I’m not sure I’m attracted to you right now’ during sex, because that can create performance anxiety for the other person.”
What can someone with OCD do during sex when doubts start creeping in? “First of all, if the thoughts are severe and intrusive to the point that you can’t focus, it might be worth considering medication. Secondly, it’s possible to delay the thoughts. I often tell patients, ‘It’s okay to think about whether you’re attracted to him or not, but is it helpful to do that during sex?’
“Sometimes I recommend setting an alarm—for instance, for 30 minutes—and deciding that for this half-hour, we’re letting go of the thoughts.
“Another helpful practice is mindfulness, learning to stay in the sensory experience. Focus on other things happening right now that can help you relax. If you have a supportive and safe partner, you can lean on them—ask them to say something nice, soothing, or arousing. Sometimes, reading something erotic or thinking of something arousing can also help, as it stimulates the body, and a sexually aroused body tends to focus less on intrusive thoughts.”
Sex tip: “Don’t fight the thoughts. Let them rest on the side.”
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