perceived need of psychological support for taboo obsessions

Perceived need of psychological support for taboo obsessions in new

parents: A cross-sectional survey

Klara Olofsdotter Lauriab, MSc, Kristina Aspvallab, PhD, Eva Serlachiuscd professor, David

Mataix-Colsd, professor, Christian Rückd, professor, Erik Anderssona, associate professor

a Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet,

Stockholm, Sweden b Stockholm Health Care Services, Region Stockholm, Stockholm, Swedenc Department of Clinical Sciences, Lunds University, Lund Swedend Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet,

and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden

Corresponding author: Klara Olofsdotter Lauri, Nobels väg 9, 171 65 Solna, Sweden,

[email protected]

Biographical note: MSc Olofsdotter Lauri is a PhD student, writing a thesis on developing

novel interventions for taboo obsessions. Dr Aspvall is a researcher with a focus on internet-

delivered interventions for children and adolescents with obsessive-compulsive and related

disorders. Professor Serlachius main research interest is internet-delivered interventions for

children and adolescents with mental health issues. Professor Mataix-Cols focus is to

understand the causes and consequences of Obsessive-Compulsive Disorder and Related

Disorders (OCD-RDs) as well as treatment innovation for these conditions. Professor

Christian Rück’s research focuses on the etiology and treatment of psychiatric disorders with

a particular focus on OCD-RDs. Dr Andersson´s main research focus is internet-delivered

treatments for anxiety-related problems as wells as OCD-RDs. He has conducted numerous

trials in this field.

Word count: 3 606

Perceived need of psychological support for taboo obsessions in new

parents: A cross-sectional survey

Previous research has shown that many new parents experience intrusive thoughts about

intentionally harming their child, also known as “taboo obsessions”. These thoughts can for

some parents lead to increased anxiety, depression and have a negative impact on parental

function and quality of life. Taboo obsessions can be stigmatizing and many parents who

could benefit from psychological support do not seek help. One way to increase access to

psychological interventions for new parents could be to deliver the treatment online. Our

research group has developed and evaluated an internet-delivered intervention targeting taboo

obsessions in individuals with a diagnosis obsessive-compulsive disorder (OCD), with

promising results. It is conceivable that the intervention could be helpful to a large proportion

of parents from the general population who struggle with taboo obsessions (i.e. not only

individuals with OCD). In the current study, 594 new parents filled out an online survey about

taboo obsessions and the perceived need for psychological support. Fifty six percent reported

currently experiencing or had previously experienced taboo obsessions. About half (54%)

responded that the taboo obsessions had a negative impact on their self-image. Additionally,

18-19% reported that the intrusive thoughts were difficult to control and/or had a negative

impact on the relationship to the child. Importantly, 51% responded that they would

absolutely or probably like to try online treatments for these intrusive thoughts. Keeping the

limitations of an online survey in mind, the results suggest that an online intervention

targeting taboo obsessions in new parents could be well received.

Keywords: Taboo obsessions, parenthood, psychological support, online intervention.

Data availability statement: The data that support the findings of this study are available upon

reasonable request from the corresponding author, KOL, given that the request comply with

Swedish and EU laws regulating protection of identifiable data.

Funding: This work was funded internally at Karolinska Insitutet.

Introduction

Obsessive-compulsive disorder (OCD) is a common condition during the postpartum period

with prevalence rates ranging from 2.4% to 9% of new parents (Fairbrother et al., 2021;

Goodman, Watson, & Stubbs, 2016; McGuinness, Blissett, & Jones, 2011; Ross & McLean,

2006; Russell, Fawcett, & Mazmanian, 2013). Additionally, up to 65% of new parents

experience subthreshold levels of OCD (Abramowitz, Schwartz, & Moore, 2003; Fairbrother

& Woody, 2008; Miller, Hoxha, Wisner, & Gossett, 2015).

Taboo obsessions are amongst the most common OCD symptoms in new parents

(Abramowitz, Nelson, Rygwall, & Khandker, 2007; Abramowitz et al., 2003; Speisman,

Storch, & Abramowitz, 2011; Starcevic, Eslick, Viswasam, & Berle, 2020; Zambaldi et al.,

2009). Taboo obsessions can be defined as distressing, ego-syntonic, sexual, religious and/or

aggressive intrusive thoughts related to intentionally harming others (e.g. thoughts about

stabbing the baby with a knife; Brakoulias et al., 2013). Taboo obsessions during the

postpartum period are associated with elevated levels of parental stress (Thiséus, Perrin, &

Cervin, 2019), increased rates of depression and anxiety (Boyd & Gannon, 2019; Miller et al.,

2015; Wisner, Peindl, Gigliotti, & Hanusa, 1999), negative impact on quality of life (Gezginç

et al., 2008), and impaired parental function (Challacombe et al., 2016). Many parents are

ashamed of their taboo obsessions and do not seek help due to fear of stigma or potentially

negative consequences, e.g., that they may be deemed unfit as parents (Bayrampour et al.,

2017).

To our knowledge, only two randomized controlled trials (RCT) have evaluated psychological

interventions for OCD symptoms (including taboo obsessions) during the postpartum period.

Timpano, Abramowitz, Mahaffey, Mitchell, and Schmidt (2011) conducted a RCT where they

investigated the effects of a cognitive behavioral prevention program for mothers (n = 38)

compared to an active control intervention (n = 33). Fifty-nine percent of the mothers in this

clinical trial reported taboo obsessions (e.g., sexual or violent obsessions) related to the infant

at one month postpartum. Mothers randomized to the prevention program during pregnancy

had significantly lower levels of OCD symptoms compared to mothers randomized to the

control intervention at 1, 3 and 6 months postpartum. The second study (Challacombe et al.

(2017) investigated the effect of an intensive cognitive behavioral treatment (12 h sessions

over 2 weeks) for new mothers who fulfilled criteria for OCD (N = 34). Forty-one percent of

the sample participants in this trial experienced taboo obsessions associated with harming the

RUNNING HEAD: SURVEY TABOO OBSESSIONS AMONG PARENTS

infant. The treatment was highly effective in reducing OCD symptoms compared to treatment

as usual (between-group effect size: 1.32). Of note, none of the trials specifically focused on

taboo obsessions as the main outcome of interest.

Our research group has recently developed an internet-based psychological intervention

specifically tailored for OCD patients who struggle with taboo obsessions. The intervention

can be described as a therapist-guided online self-help treatment that is divided into chapters

(“modules”) accompanied by audio files and homework exercises. The intervention is

accessed through a secure online-platform where all communication is done online with a

supporting therapist, who provides only minimal guidance and support. The intervention

content is based on cognitive theory where the main focus is to change negative appraisals

related to the obsessions (e.g., “Having these thoughts is a sign that I’m an immoral person”)

to more functional and realistic beliefs (e.g., “It’s just a random thought and it doesn´t say

anything about me as a person”). This cognitive change is achieved through standard CBT

techniques such as behavioral experiments and cognitive restructuring exercises. The

intervention has so far been tested in an open pilot trial with 19 OCD patients. Results

indicated that the intervention was both feasible and acceptable, and a majority of the

participants were able to understand and apply the cognitive model to their own obsessions

(Olofsdotter Lauri et al., submitted manuscript). Additionally, 63% of the participants were

classified as treatment responders at the primary endpoint.

The majority of new parents experience taboo obsessions, which could be viewed as adaptive

and transient (Abramowitz et al., 2003). Furthermore, it is plausible to think that not all

parents whose intrusive thoughts about harming their child are disturbing or persistent may

necessarily meet diagnostic criteria for OCD. The implication is that there may be a

substantial proportion of new parents who would benefit from psychological support and who

may not seek help or even qualify to receive healthcare resources because they do not meet

formal criteria for a mental disorder. We designed an online survey to explore 1) the

frequency and impact of taboo obsessions in a sample of self-recruited parents of infants and

toddlers in Sweden, 2) whether negative appraisals – the hypothesized mechanism of change

in cognitive therapy - could be a relevant factor for intervention in this population, and 3) the

perceived need for an easily scalable self-help intervention for taboo obsessions in new

parents from the general population.

4


Materials and Methods

Recruitment

The data was collected through an anonymous online survey (software tool: KI survey;

domain: www.jobbigatankar.se). Interested individuals were presented with information about

the study and provided a digital informed consent before getting access to the online survey.

The survey was open to all adults (age 18 and above) in Sweden who self-identified

themselves as being a parent of a child between 0 – 3 years of age.

The participants were recruited through Facebook advertisements. The advertisement stated

that the online survey would inquire about intrusive and disturbing thoughts about

intentionally harming ones child, and that any parent of a child between 0 – 3 years of age

could participate, whether they had experienced these kinds of thoughts or not. It was open

between 1st of April and 17th of May 2021. After having included 300 individuals in the study

(7th of April), only 5 of the respondents were male. In order to get a more diverse sample, we

chose to adjust the Facebook recruitment algorithm to reach males only. After having

included 98 males (14th of May), we set again the algorithm to include all genders.

The study protocol was approved by Swedish Ethical Review Board (2020-06756; Ö8-

2021/3.1).

Online survey content

Overview

The online survey contained questions about demographic characteristics (e.g., gender, age,

number of children, highest education, occupational status), and two questionnaires to assess

obsessions, compulsions and negative appraisals (see Questionnaires below). Additionally,

the survey included four items investigating the impact of taboo obsessions on perceived

control over the obsessions, self-image, social relationships and attachment to one’s child.

The survey also contained one item asking the participants if they had told anybody about

their obsessions (yes/no), and 7 different items assessing healthcare seeking behaviors and

preferences, interest and attitudes to internet-based psychological interventions for taboo

obsessions. The survey took approximately 15 minutes to complete.

5


Questionnaires

The self-rated version of Parental Thoughts and Behaviors Checklist (PTBC; Abramowitz,

Khandker, Nelson, Deacon, & Rygwall, 2006) was used to investigate severity and impact of

taboo obsessions and related behaviors. The self-rated version of the PTBC has shown good

psychometric properties (Chronbach’s a = 0.91) and a similar factor structure as the PTBC

clinical interview (Thiséus et al., 2019). The questionnaire is divided into two parts. The first

part contains a checklist of 33 examples of intrusive thoughts related to the child and 13

additional related behaviors. In the current study, only the examples containing taboo

thoughts related to the infant and toddler were included (e.g., thoughts about intentionally

drowning the child or stabbing the child to death). The second part of the PTBC contains five

items assessing severity of the obsessions (e.g., ”How much distress do these sensless and

unwanted thougths cause you?”) and five items assessing severity of related behaviors (e.g.,

”How would you feel if prevented from preforming these behaviours/strategies? How anxious

would you become?”). Each item is rated on a 5 point scale (0-4), yielding a total score of 0 –

40 points, with higher scores indicating more severe symptoms.

As negative appraisal of the intrusive thoughts is the hypothesized mechanism of change in

cognitive interventions for taboo obsessions, we used a condensed version of the Personal

Significance Scale (PSS; Rachman, 2003) to investigate if this is a relevant construct also in

the target sample of self-recruited parents of infants and toddlers. The full PSS scale includes

23 statements rated on a 9-point scale (0 = “not at all”, 8 = “definitely”). In order to avoid

participant fatigue, only five items from the full scale PSS were included in the survey. The

items were chosen by first categorizing the full scale into cognitions related to: 1) Personal

significance 2) Fear of acting on the thoughts and 3) Fear of being judged by others.

Subsequently, we chose two items came from category 1 (“Do these thoughts reveal

something important about you?”, “Do these thoughts mean that you are a dangerous

person?”), two items from category 2 (“Do these thoughts mean that you might lose control

and do something awful?”, “Do these thoughts mean that you might go crazy one day?”) and

one item from category 3 (“Would other people condemn or criticize you if they knew about

your thoughts?”). The condensed five-item version showed a strong correlation with the full

scale (r = .86) and a good internal consistency (a = 0.88) in a sample of 19 OCD patients with

taboo obsessions (Olofsdotter Lauri et al., submitted manuscript).

6


Data analysis

All statistical analyses were conducted in STATA 16.1. Proportion, symptom severity, impact

of taboo obsessions as well as healthcare seeking behaviors and interest in treatment were

investigated using descriptive statistics. Pearson’s correlation was used to assess the

relationship between taboo obsessions and negative appraisals. Chi-square test and one-way

ANOVA were used to investigate if there were any gender differences in respect to symptom

severity of taboo obsessions.

Results

Demographics

A total of 594 new parents completed the online survey. Detailed demographic characteristics

of the participants are presented in Table 1. The majority of the sample were women in their

early thirties with a university degree. About one third of the sample were on parental leave

and one third worked full time. Almost half of the sample had one child aged between 0 – 1

years. One third of the sample reported that they had received a psychiatric diagnosis prior to

the birth of their first child. Seven individuals (1.2%) self-reported having a diagnosis of

OCD. Thirty respondents (9%) had sought treatment for their intrusive thoughts and 17 (5%)

had received treatment.

INSERT TABLE 1

Frequency and impact of taboo obsessions

Of the 594 participants, 334 (56%) reported previously having and/or currently experiencing

taboo obsessions related to intentionally harming their child, and 321 (54%) reported

previously having and/or currently engaging in neutralizing behaviors in response to these

intrusions. There were no significant gender differences in experiencing intrusions (X2 (1) =

0.45; p = .504). Participants who had stated gender as other were excluded from analysis due

to the small sample size (n = 6). Half of the sample (n = 167, 50 %) who responded “yes” on

currently/previous taboo obsessions reported they had revealed the content of their intrusive

thoughts to someone.

As shown in Figure 1, the majority of the participants (n = 182, 57%) reported a score of 7 or

lower on the PTBC, 108 (33%) reported a score between 8 – 15 points, and 31 (10%) reported

7


a score of ≥16 points. There were no gender differences in symptom levels (F(1) = 0.15, p

= .67). Participants who had stated gender as other (n = 4) were excluded from the latter

analysis.

INSERT FIGURE 1

A total of 61 (18%) participants responded that the intrusive thoughts were difficult to control

(PTBC thoughts subscale: M = 6.62, SD = 2.81, median 6, IQR = 5 – 8 vs. individuals who

responded “no” M = 4.12, SD = 2.40, median 4, IQR = 3 – 5). A total of 180 participants

(54%) responded that the taboo thoughts had a negative impact on self-image (PTBC thoughts

subscale: M = 5.51, SD = 2.67, median = 5, IQR = 4 – 7 vs. individuals who responded “no”

M = 3.49, SD = 2.20, median = 3, IQR = 2 – 5). Sixty-four participants (19%) reported that

the intrusive thoughts have had a negative impact on the relationship/attachment to the child

(PTBC thoughts subscale: M = 6.86, SD = 2.53, median = 7, IQR = 5 – 9 vs. individuals who

responded “no” M = 4.03, SD = 2.39, median = 4, IQR = 2 – 5). Finally, 41 participants

(12%) reported a negative impact on the relationship to partner, parents and/or friends (PTBC

thoughts subscale: M = 7.15 (SD = 2.06, median = 7, IQR = 5 – 8 vs. individuals who

responded “no” M = 4.22, SD = 2.54, median = 4, IQR = 3 – 6). Detailed information about

the distribution of scores on the PTBC thoughts subscale is shown in Figure 2.

INSERT FIGURE 2

Association between negative appraisals and severity of taboo obsessions

As shown in Figure 3, there was a moderate to strong correlation between scores on the PSS

(negative appraisals) and severity of taboo obsessions assessed with the PTBC (r(320) = .53).

INSERT FIGURE 3

Acceptability of internet-based treatment for taboo obsessions

As shown in Table 2, 420 (71%) participants responded that they would be interested in

receiving psychological support if they would experience taboo obsessions related to their

child. Of these 420 individuals who were positive to psychological treatment, 307 (73%)

responded that would absolutely or probably like to try internet-based psychological treatment

for taboo obsessions. Among individuals who reported a score of ≥16 points on the PTBC (n

8


= 31) did 26 (84%) respond that they would be interested in psychological support, and 20 of

these individuals (77%) stated that they would absolutely or probably like to try internet-

based psychological treatment. Of the individuals who reported a score of <16 points on the

PTBC (n = 290) did 199 (69%) respond that they would be interested in receiving

psychological support, and of these 199 individuals did 152 (76%) respond that they were

positive towards an internet-based psychological treatment. There were no significant gender

differences in attitude towards psychological treatment (X2 (1) = 0.11, p = 0.746), or in

attitude towards internet-based psychological treatment (X2 (1) = 2.28, p = 0.089).

INSERT TABLE 2

Discussion

The results of this cross-sectional survey showed that the majority of the respondents (56%)

were currently experiencing or had previously experienced taboo obsessions related to their

own child. About one fifth reported difficulties controlling their obsessions and/or that the

obsessions have had a negative impact on the relationship/attachment to their child. As many

as 54% of the respondents experienced the obsessions as having a negative impact on their

self-image. In line with the cognitive model of obsessions, there was a strong association

between severity of taboo obsessions and degree of negative appraisals. An important finding

was that the majority of the sample (71%) reported interest in receiving psychological

treatment for taboo obsessions and 74% of these individuals would definitely or possibly like

to try internet-based psychological treatment.

In the current study, 9% of the participants had sought treatment for their intrusive obsessions

and 5% had actually received any treatment. Previous research have suggested that women

who suffer from psychiatric symptoms during the postpartum period have difficulties to seek,

receive or complete evidence-based treatments (Goodman & Tyer-Viola, 2010; Smith et al.,

2009). Possible barriers to treatment-seeking among new parents could be shame/stigma,

limited time to spend on therapy, not perceiving one’s problems as sufficiently severe, and

financial barriers (Bayrampour et al., 2017; Maloni, Przeworski, & Damato, 2013;

Woolhouse, Brown, Krastev, Perlen, & Gunn, 2009). There is also evidence suggesting that

individuals with stigmatized conditions are more likely to utilize online resources to receive

help than non-stigmatized conditions (Berger, Wagner, & Baker, 2005), highlighting the

possible benefits of developing and testing a digital solution that can reach the larger

9


population of parents who struggle with taboo obsessions and who do not necessarily meet

diagnostic criteria for OCD. In our sample, only 7 individuals (1.2%) self-reported having

OCD. An internet-based intervention has the potential to reach individuals who do not have

access to evidence based treatments, for example due to economic limitations and/or long

travel distances to a mental health clinic (Muñoz, 2010; Titov et al., 2020).

Slightly more than half of the total sample reported that they probably or definitely would like

to try an online psychological intervention for taboo obsessions. These results are in line with

a previous survey study investigating the acceptability of online treatments in individuals who

suffer from OCD (Wootton, Titov, Dear, Spence, & Kemp, 2011). Previous trials have found

positive results of internet-based treatments for women experiencing stress, depression and

anxiety in the postpartum period (Lau, Htun, Wong, Tam, & Klainin-Yobas, 2017; Loughnan

et al., 2019; Mu et al., 2021; O'mahen et al., 2014). The results of this survey suggest that it

could be feasible to develop self-guided internet-based psychological interventions for new

parents who experience disturbing and impairing taboo obsessions about harming their

children. A possible risk in developing treatment for, at least partly, a non-diagnostic group is

that it would signal that taboo thoughts are pathological and thereby unintentional

contributing to stigma and over-medicalization. The intervention to be developed in this

project, intends to normalize the taboo obsessions by addressing the negative appraisal and

therefore should be well positioned to mitigate such risks.

The vast majority of research studies on parental taboo obsessions have been conducted on

mothers only. This stands in contrast to previous research showing comparable prevalence

rates of obsessions in fathers (Abramowitz et al., 2007; Abramowitz et al., 2003). The current

study did not find any gender differences in terms of symptom severity, impairment, or

treatment preferences. However, it was generally more difficult to recruit fathers; 84% of the

advertisement budget was spent on reaching men despite only constituting one fifth of the

sample. This overrepresentation of women is line with previous research (Whitaker,

Stevelink, & Fear, 2017); females are generally more favorable attitude towards mental

health treatment, treatment seeking behaviors as well as less perceived stigma towards mental

illness (Eisenberg, Downs, Golberstein, & Zivin, 2009; Mojtabai, 2007). Females sign up for

internet-based psychological assessment and treatment to a larger extent than males (Titov et

al., 2020), and are generally overrepresented in trials investigating internet-based treatments

10


for depression and anxiety (Etzelmueller et al., 2020). Future clinical trials should investigate

optimal ways to reach and include fathers in such interventions.

The interpretation of the findings from this study are affected by several important limitations.

Firstly, this study is based on a convenience sample recruited via Facebook advertisements.

The majority of participants were highly educated women. Thus, the sample is likely to be

unrepresentative of the full population of new parents in Sweden. For example it is possible

that Facebook users have a more positive attitude towards internet-based treatments than the

population at large. However, the aim in this study was to reach a similar population that may

be interested in participating in a clinical trial of unguided online self-help for taboo

obsessions, i.e., self-referred new parents who are motivated to receive psychological support

for their intrusions. Secondly, all data from this study was based on self-report. It is therefore

possible that some individuals may have undiagnosed OCD or other mental disorders. Future

studies should validate the self-report version of the PTBC against the clinician-rated version.

In conclusion, a majority of a sample of parents, recruited through Facebook advertisements,

experienced taboo obsessions related to harming their child but a very small minority have

sought and/or received treatment. Most participants were positive to the idea of an internet-

based intervention targeting taboo obsessions.

Acknowledgment

We want to express or gratitude to Johan Åhlén for valuable input about the content and

administration of the online survey and David Brandell for support in writing the ethical

application.

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Table 1. Demographic characteristics of the sample (N = 594)

Variable

Gender, n (%)

Female 490 (82%)

Male 98 (17%)

Other 6 (1%)

Age

Mean (SD) 33.90 (4.67)

Min-Max 21 - 57

Age, youngest child

Mean (SD) 1.10 (0.84)

Min-Max 0 - 3

Number of children, n (%)

1 277 (47%)

2 236 (40%)

3 62 (10%)

4 11 (2%)

5 or more 8 (1%)

Occupational status, n (%)

Parental leave 208 (35%)

Full-time work 221 (37%)

Part-time work 96 (16%)

Full-time sick leave 7 (1.5%)

Student 50 (8%)

Unemployed 5 (1%)

Other 7 (1.5%)

Highest education, n (%)

Primary school 7 (1%)

High school 48 (8%)

Higher education, not university 36 (6%)

University < 3 years 38 (7%)

University > 3 years 435 (73%)

Postgraduate education 30 (5%)

Psychiatric diagnosis prior to the first child? n (%)

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Yes 177 (30%)

No 417 (70%)

Number of psychiatric diagnoses (self-report) n (%)

No diagnosis 417 (70.2%)

One diagnosis 108 (18.2%)

Two diagnoses 41 (6.9%)

Three or more diagnoses 21 (3.5%)

Not specified 7 (1.2%)

Self-reported psychiatric diagnosis n (%)

Depression 116 (19.5%)

Anxiety UNS 24 (4.0%)

GAD 23 (3.9%)

PD 18 (3.0%)

ADHD/ADD 16 (2.7%)

Fatigue syndrome 16 (2.7%)

PTSD 14 (2.4%)

Eating disorders 11 (1.9%)

OCD 7 (1.2%)

SAD 5 (0.8%)

Autism 5 (0.8%)

Bipolar disorder 2 (0.3%)

Psychosis 1 (0.2%)

Emetophobia 1 (0.2%)

PMDD 1 (0.2%)

EUPD 1 (0.2%)

Adaptive disorder 1 (0.2%) Note: GAD = Generalized anxiety disorder; PD = Panic disorder; ADHD/ADD = Attention deficit hyperactivity disorder/Attention deficit disorder; PTSD = Post traumatic stress disorder; OCD = Obsessive-compulsive disorder; SAD= Social anxiety disorder; PMDD; Premenstrual dysphoric disorder; EUPD; Emotionally unstable personality disorder.

Table 2. Attitudes towards treatment

Questionnaire n (%)

Healthcare seeking behavior among participants experiencing intrusive thoughts (n = 334)

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Have you sought help for your intrusive and unwanted thoughts about your children?

Yes 30 (9%)

No 304 (91%)

If yes, where did you seek help? (n = 30)

Maternity care/midwife 13 (43%)

Primary care 5 (17%)

Psychiatric clinic 8 (27%)

Other 4 (13%)

Have you ever or are you currently undergoing treatment for these intrusive and unwanted thoughts? (n = 30)Yes 17 (57%)

No 13 (43%)

If yes, what type of treatment have you received / are you undergoing? (n = 17)Psychological treatment 10 (59%)

Pharmacological treatment 4 (24%)

Other 3 (18%)

Interest in treatment in total sample (N = 594)

If you have or had intrusive and unwanted thoughts about your child, would you be interested in receiving psychological treatment for these distressing thoughts?Yes 420 (71%)

No 174 (29%)

If you wanted to get treatment for your unwanted thoughts, would you consider trying psychological treatment via the internet?Absolutely, I would definitely like to try it 189 (45%)

I would probably like to test it 118 (28%)

I might want to try it 91 (22%

Absolutely not, there is a 0% probability that I would try it 22 (5%)

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Figure 1. Distribution of individual total scores on the Parental Thoughts and Behaviors

Checklist (PTBC) for all respondents reporting taboo obsessions and related behaviors (n =

321).

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Figure 2. Difference in distribution of level of obsessions measured with the Parental

Thoughts and Behaviors Checklist (PTBC) obsession subscale for individuals who replied

“yes” (blue line) vs “no” (red dashed line) to four items inquiring: A) perceived control over

the thoughts, B) negative impact on self-image, C) negative impact on social relationships and

D) negative impact on the relationship/attachment to one’s child.

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Figure 3. Scatterplot showing a relation between the level of taboo obsessions measured with

the Parental Thoughts and Behaviors Checklist (PTBC) thoughts subscale and negative

appraisals measured with Personal Significance Scale (PSS).

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perceived need of psychological support for taboo obsessions

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