Unwanted Sexual Thoughts and Exam Stress

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Reader’s Question

I’m a young guy, aged 20. I was a jovial person with a lot of friends, having a good life like every other young person my age but for the past two months I’ve been deeply depressed.

I used to watch porn clips — from the age of 13 — but I started getting a feeling of guilt after watching them, so eventually I stopped watching. Recently, I got stuck with a fear about whether I’ll have unwanted sexual thoughts about my mother. The fear horrified me a lot and brought a thought that I’m a worthless person. I lost interest in everything that I used to enjoy a lot. This problem started two weeks after the publication of my exam results, which I failed.

Day by day the fear of thinking that thought got worse and now I’m getting such unwanted thoughts frequently. I get really tense, anxious and sad…I cry almost every day due to this. My psychiatrist told me its a mild depression and prescribed me anti-depressants. I have been taking them for one month. Now I’m getting unwanted thoughts about the opposite sex irrespective of age and status, which is really out of my character and this is making me more depressed. I can’t concentrate on anything, and I’m having an important exam in the coming month.

My parents became tense and sad with my sudden change of behaviour. I’m a beloved son of my parents and I love them a lot too. I’m their only hope.

Will I be able to get relief from this disorder and live the peaceful life which I had before this problem occurred?

Psychologist’s Reply

First, I want to mention that my response is based on only what I have read here, which is just one snapshot of your situation. You and your psychiatrist are best positioned to work with these concerns, as you and he or she can meet regularly to follow up, discuss and respond to changes, and modify the treatment plan as necessary. It sounds as if your psychiatrist has begun by addressing depression, which includes several things you mentioned: your sad mood, with thoughts of worthlessness, lack of enjoyment of activities (anhedonia), and difficulty concentrating.

Some of the words you used, such as “stuck” and “unwanted thoughts” and “fear” point me toward the idea of obsessive-compulsive disorder (OCD), which includes unwanted thoughts that are distressing (obsessions). I am not entirely sure that this diagnosis fits for you, in part because you did not mention whether these thoughts are accompanied by ritualized behaviors aimed at reducing the distress associated with the unwanted thoughts (compulsions). However, it is worth sharing this information with your psychiatrist if you have not already done so, as he or she may have additional ideas or treatment changes to recommend regarding how you can best cope with these unwanted thoughts. Often, with cognitive behavioral treatment of OCD, the work is to come to a place of understanding that the content of the obsessions (e.g. contamination, religious obsessions, harming someone, perfectionism, unwanted sexual thoughts) is less important than learning to live your life despite the thoughts. It may sound counterintuitive, but if this is OCD, the goal is to understand that although the thoughts are scary or disgusting to you, they are just thoughts. You can then learn to identify the thoughts as symptoms and not reality.

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Speaking of symptoms, you mentioned that fears of sexual thoughts of your mother began occurring after you found out that you failed your exam. This is an excellent example of how stressors and changes in our lives can interact with and even trigger mental health symptoms. Although there is believed to be a biological basis underlying both depression and obsessive-compulsive disorder, these disorders can arise or worsen in times of stress. I imagine that finding out you failed your exam raised your anxiety about school and your future success. This may have contributed to your overall level of anxiety and indirectly, the increase of OCD symptoms (e.g., the occurrence of sexual obsessions about your mother). I know it may seem strange that school concerns could affect you in the form of unwanted sexual thoughts!

If you are feeling stressed about the upcoming exam, this may also be exacerbating anxiety or depression symptoms. I point this out because at times it is helpful to reflect on what is going on in our environment and relationships that could be stressful, so we can notice how these events are directly or indirectly impacting our mental health. Often we are not in touch with our feelings about these types of events. It may help you to look ahead to your school schedule and try to predict what times will be especially stressful, so you can ready yourself for a possible increase in depression and anxiety symptoms. In reverse, that would look something like this: You notice that you are having an increase in unwanted sexual thoughts and you take that as a signal to stop and review what in your life might need your attention or acknowledgement.

So, you asked if you will be able to get relief and live the peaceful life you had before this all happened. Of course I cannot predict the future. But I will say that I am hopeful for you, as you have demonstrated yourself to be someone who a) is aware of your thoughts and feelings and makes changes accordingly (for example, you stopped watching porn when you realized that it was causing you to feel guilty), and b) seeks treatment when needed. My suggestion is to continue to work with your psychiatrist to identify a diagnosis, medication regimen, and treatment plan that will help you understand and cope with these unwanted thoughts.

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