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.

Recently, autobiographical memory theorists proposed that intrusive imagery contains important information about goals. This study examined thematic links between approach and avoidance goals in two groups: a clinical group (n = 22) and a non-clinical group (n = 24). Participants completed the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), Goals Task and an imagery interview. In the total sample, almost 90% of reported imagery matched at least one goal. Eighty-five percent of clinical participants reported imagery that matched avoidance goals, whereas only half of non-clinical participants' imagery matched an avoidance goal. The majority of imagery was found to be associated with a particular memory or a collection of memories for similar events. These findings support proposals that intrusive imagery contains important information about goals, and in particular states of the world to be avoided. Clinical implications and directions for future research are discussed.

This study uses semi-structured interviews with obsessionals and nonclinical controls to investigate the frequency with which these individuals experience intrusions about possible harm and the frequency with which they then act to prevent that possible harm. The findings suggest that obsessionals do not generally experience more frequent intrusions about possible harm than do nonobsessionals, but that obsessionals more frequently experience intrusions in specific situations: obsession-relevant situations and situations they find most problematic. There was found to be a generalized difference between obsessionals and nonobsessionals in terms of frequency of actions taken to prevent potential harm following intrusions in situations that are obsession-relevant and obsession-irrelevant. The findings suggest that the occurrence of intrusions is just one factor influencing obsessional behaviour.