For many parents, the first months with a newborn are among the happiest and most important periods of their lives. For Manuel*, they became a nightmare. In his mid-30s, living with his family in western Germany, he began experiencing thoughts that terrified him. While changing his newborn son’s nappy, he would suddenly imagine sexually abusing his own child.
Manuel was convinced that he would never hurt his son. Yet the thoughts returned again and again. Their persistence eventually led him to question what they meant. Could there be some hidden part of him capable of such an act? That question, he says, was the moment the obsession took hold.
The account, published by the German newspaper Die Zeit, examines a little-understood dimension of obsessive-compulsive disorder: violent and sexual intrusive thoughts that attack precisely the values people care about most. For sufferers, the central question is often not what is happening, but what could happen.
Psychologist and therapist Thomas Hillebrand, who has been on the board of the German Society for Obsessive-Compulsive Disorders for 20 years, describes this pattern in his specialist book Aggressive und sexuelle Zwangsgedanken. A person might think they could have left the cooker on, could be carrying germs, or could have run someone over. In sexual and aggressive forms of obsessive-compulsive disorder, the feared possibility can become an attack on a person’s understanding of who they are.
According to a 2014 study cited by Die Zeit, 2.3 million adults in Germany suffer from obsessive-compulsive disorders. If American estimates are applied, between 20 and 30 per cent could experience sexual and aggressive intrusive thoughts. These are sometimes described as “unacceptable” or “identity-related” obsessions because sufferers fear they might secretly be someone completely different from who they believe themselves to be.
Hillebrand stresses that such thoughts do not correspond to the person’s actual intentions. Yet the distinction can become almost impossible for sufferers to trust.
Manuel’s experience began long before he became a father. When he was in fifth grade, he suddenly imagined undressing and sexually harassing a female classmate. He remembers being shocked by the thought and asking himself: “Was war das gerade?!” From then on, the content of his intrusive thoughts changed according to what mattered most in his life.
As a schoolboy, he imagined walking through the world with a weapon and shooting people at random. When he began having sexual experiences, he developed fears that he might be HIV-positive. When he started his first job, he imagined throwing boiling tea into the face of a friendly colleague. At family gatherings, he imagined killing relatives with a champagne bottle.
For years, Manuel could dismiss these thoughts as meaningless fantasies. Fatherhood changed that.
When he was in his mid-20s and had a daughter, the thoughts increasingly attached themselves to his role as a parent. One day, while playing hopscotch with his nine-year-old daughter in the hallway, he suddenly imagined punching her hard in the face. He describes the experience as an “ice-cold shock”. He continued playing, trying to conceal from his daughter how frightened he had become.
The problem became even more severe after the birth of his son. While changing the baby’s nappy, Manuel saw his own hand and the child’s genitals and suddenly thought that he might be on the verge of committing an act he did not want to commit.
For someone already vulnerable to obsessive doubt, the difference between thought and reality can become dangerously blurred. Hillebrand refers to psychologist Stanley Rachman’s work describing how people can misinterpret the significance of their own thoughts and turn them into catastrophic conclusions.
The problem is not that intrusive thoughts exist. A 1978 study by psychologists Stanley Rachman and Padmal de Silva found that people without obsessive-compulsive disorder can also experience sudden, disturbing thoughts that contradict their intentions. Almost 80 per cent of participants reported thoughts such as harming a baby, killing a pet, saying something offensive or jumping in front of a train.
For most people, such thoughts disappear without consequence. They do not spend hours asking what the thought says about their character or whether it might eventually become reality. People with obsessive-compulsive disorder can struggle to let the thought go.
Manuel responded by fighting his thoughts. When they appeared, he imagined explosions destroying them or mentally shouted: “Go away. Nobody wants you here.” According to Hillebrand, however, trying to suppress an obsessive thought can strengthen it.
The consequences for Manuel’s family life were severe. He became tense and distracted and found it difficult to listen when his wife wanted to discuss everyday matters. He did not tell her what was happening because he feared she would judge him.
For more than 20 years, he had kept his sexual and aggressive intrusive thoughts secret. Hillebrand says this is not unusual. The disorder begins, on average, at around 15, yet many sufferers remain silent for years, carrying fear, shame and guilt alone.
After his son’s birth, Manuel entered a deep crisis. He feared that he was a monster and might harm the people he loved most. At his lowest point, he wanted to be locked away or even “run over”. He says he sometimes wished to sleep forever because, while he was asleep, his children were safe.
Eventually, after five months, he told his therapist, whom he was seeing at the time for depression. He expected to be regarded as a danger to others. In fact, he wanted that intervention because, in his words, his priority at that moment was protecting his family.
Such moments can be decisive. Hillebrand says people with these obsessions may disclose them during a crisis to doctors, psychiatric services, crisis centres, support programmes for people with paedophilic concerns and sometimes even the police. The response they receive matters greatly.
A 2013 US study presented different case examples to 360 psychotherapists. In cases involving paedophilic intrusive thoughts, therapists made an incorrect assessment in 43 per cent of cases, compared with around 15 per cent for contamination obsessions. An Irish study in 2022 reached similar conclusions.
The distinction between a paedophilic tendency and a paedophilic obsessive thought is therefore critical. Psychotherapist Anna Konrad, who works with the Berlin Charité’s “Kein Täter werden” support programme, says people with obsessive-compulsive disorder regularly approach the service. Among those who are not accepted because they are not paedophilic, they form the largest group.
According to Konrad, people with obsessive-compulsive disorder generally describe doubts and fears rather than concrete incidents. Contact with children can itself be stressful and anxiety-inducing, and sufferers often avoid it altogether.
For Manuel, treatment involved behavioural therapy and exposure exercises. He was encouraged to care for his baby, bathe him, apply sun cream and put him to sleep while allowing intrusive thoughts to arise without engaging with them or introducing unnecessary safety measures.
Exposure therapy has shown evidence of effectiveness in treating obsessive-compulsive disorder. Hillebrand cites, among other research, a 2018 US study in which 25 patients with predominantly paedophilic intrusive thoughts showed substantial improvement.
For Manuel, however, the treatment did not have the hoped-for effect. The sense that his thoughts were merely thoughts never fully arrived. He eventually burned the written story he had created as part of therapy because he feared someone might discover it.
He later decided to tell his wife. He had spent days fearing that she would condemn him, divorce him or believe he was a monster. Instead, she was relieved. She had already noticed that he was distant and had wondered whether he was having an affair.
Manuel also joined a self-help group. He had expected to encounter people defined by the thoughts that horrified him. Instead, he found ordinary people — pensioners and students, professionally successful people and those with varied hobbies. When one man finally said, “I have a great fear of being paedophilic,” Manuel experienced what he describes as a moment of relief. For the first time, he understood that the illness really existed.
A decade after his crisis, the thoughts have not disappeared. Manuel describes them as “like a television in my head that is constantly running”. Medication has made them less frightening, but the obsessive doubt remains capable of changing form.
His children are now seven, ten and 20. He believes he has maintained a good relationship with them, despite the private struggle he has tried to keep hidden.
When his son once said that he sometimes had “strange pictures” in his head, Manuel briefly found himself in a different position. He told him that he would always listen and that people can have thoughts that mean nothing more than thoughts.
The University of Marburg is currently examining different aspects of obsessive-compulsive disorder and parenthood through three studies, including whether affected parents want support in discussing the illness with their children and what child-friendly information about obsessive-compulsive disorder might look like. Initial results are expected by the end of 2026.
For Manuel, the illness remains a private burden. Apart from therapy and his self-help group, he has told only his wife and a now-deceased friend. Perhaps, he says, he may one day tell a close friend or family member. That, he believes, would be meaningful because the thoughts would no longer feel like a secret that has to be hidden.
