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The Rucklab researchers also work as clinicians within regular psychiatric care. We have met some OCD patients who have reported unwanted erection or lubrication in direct response to violent or sexual obsessions (interpreted as extremely ego dystonic). We wanted to know more about this phenomena, searched the pubmed and came across this interesting article from 1990.

Warwick, H. M., & Salkovskis, P. M. (1990). Unwanted erections in obsessive-compulsive disorder. The British Journal of Psychiatry, 157(6), 919–921.

The first case was a 43 year old man who reported frequent erections in relation to obsession of becoming a pedophile. These thoughts were clearly ego dystonic and he had at no time had, and had no desire to have, sexual contact with the child. Assessment revealed that he believed that he should always be able to control and prevent unwanted erections. His failure to do so made him think that he might be a pervert. The patient was treated with CBT and resumed normal contact with his child without ritualizing and remained symptom free.

The second case was a 38 year old student who 
had an erection on at least two separate occasions when he had intrusive thoughts of violence to children. He then felt he was on the verge of losing control and attacking
 the children he was near. He reported that this fear was
based on the thought “I have already kind of lost control; 
my body is out of control!” He found the
 erections extremely repugnant

How is this relevant to clinicians?

The authors discuss some experimental studies (e.g. Barlow 1983, 1986) that suggest that anxiety and threat stimuli can actually increase erection and sexual arousal. They finally explain their treatment model: “Patients have found the following explanation particularly helpful and easy to understand: “Erections is a reflexive response involving changes in blood flow, and can be regarded as similar to excessive blushing in social situations. As often happens with blushing, the more anxious one becomes about the response itself, the more likely it is to happen, because the reflex can be paradoxically set off by anxiety.”. Careful explanation about the nature of unwanted erections is crucial – without this appropriate behavioural treatment may be unacceptable to these patients”.

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