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Sexual obsessions are common in adolescents with obsessive compulsive disorder (OCD), but how to address these obsessions in a developmentally sensitive manner remains under-explored. This report presents the case of an adolescent who experienced unwanted sexual imagery, undergoing conventional exposure and response prevention, which was subsequently augmented with imagery-based techniques. This approach was associated with remission in symptoms of OCD and marked improvements in symptoms of anxiety and depression. The imagery-based approach was well received and valued as key to treatment success by the adolescent. This raises the tantalising possibility that working directly with images can fuel treatment innovation in tackling sexual (and non-sexual) obsessions in youth OCD. Key learning aims (1) Sexual obsessions are common in adolescent obsessive compulsive disorder (OCD). (2) Little guidance is available on how to conduct exposure and response prevention sensitively for sexual obsessions in adolescent OCD. (3) Imagery-based techniques can be used effectively for reducing sexual obsessions. (4) Imagery-based techniques delivered by videoconferencing can be acceptable for young people.

Original publication




Journal article


Cognitive Behaviour Therapist

Publication Date