Current Update: Assessment and Treatment of Sexual Obsessions in Children and Adolescents

To review and summarize the current literature on the assessment and treatment of sexual obsessions in children and adolescents. Sexual obsessions are a subgroup of obsessive-compulsive disorder (OCD), characterized by intrusive, ego-dystonic and embarrassing thoughts and fears of engaging in inappropriate sexual behavior. A rapid review of papers published during the last 10 years reporting any aspect of sexual obsessions in pediatric OCD in four databases revealed only five papers, three of which were case reports. We present data on prevalence and phenomenology of the sexual obsession subtype of OCD in children and adolescents and review clinical recommendations for assessment and treatment, including obstacles for accurate identification of symptoms. Sexual obsessions in children and adolescents are under-studied, often under-diagnosed, and likely under-treated. They are reported in roughly 20% of children and adolescents with OCD and are associated with substantial distress. Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) is recommended as first line treatment. When addressed and treated appropriately, outcomes appear comparable to other OCD subtypes, but the evidence base is limited.