Sexual Orientation OCD

WHAT IS SEXUAL ORIENTATION OCD (SO-OCD)?

SO-OCD used to be called HOCD or Homosexual OCD. This heteronormative title became more inclusive to account for anxiety and extreme doubt about sexuality for people who are gay, straight, bisexual, pansexual, etc. Many with SO-OCD do fear they are gay and in denial. However, this is merely a reflection of the central fear common to those with SO-OCD: that they are being disingenuous about their identity. It is worth noting that most people with this form of OCD do not believe there is anything wrong with being gay, lesbian, bisexual, etc.⁠ Sexual Orientation OCD has nothing to do with homophobia or bigotry.

SEXUAL ORIENTATION OCD (SO-OCD) SYMPTOMS

How do you know if you have OCD? Only a licensed practitioner can perform an official assessment and provide a diagnosis. That said, the symptoms of OCD include the presence of obsessions and compulsions that take up a significant amount of time, cause distress and impair social, occupational and other important areas of functioning.

OBSESSIONS

Obsessions are intrusive, upsetting, repetitive, distressing thoughts, images and urges. In SO-OCD, obsessions can include thoughts like:

• What if I’m secretly straight/gay/bi and just can’t admit it to myself? What if I’m in denial?
• If I don’t figure this out, I could I live an inauthentic life! I could be living a lie!
• What if I hurt future partners and children when I realize I’m identified with the wrong orientation?

You can learn more about obsessions and OCD in general here.

COMPULSIONS

Compulsions are behaviors that individuals do in order to get rid of the anxiety, doubt, distress, disgust and discomfort that often result from obsessions. A person might do any number of things compulsively. They might wash, check, avoid, seek reassurance, analyze thoughts and more. In SO-OCD, compulsions can look like:

• Checking and ruminating about physical sensations – like feelings in the groinal region
• Avoiding contact with a gender that you’re concerned you might be secretly attracted to
• Confessing thoughts to a partner so that you are not fearful of lying to them about the fact that you could realize that you are attracted to a different gender at some point

You can learn more about compulsions here.

TREATMENT FOR SEXUAL ORIENTATION OCD (SO-OCD)

EXPOSURE AND RESPONSE PREVENTION (ERP)

We approach the treatment of every subtype of OCD in the same way, with Exposure and Response Prevention (ERP). This involves facing the things that trigger thoughts and feelings without capitulating to compulsions. For instance, someone who identifies as straight who is afraid they might know they’re gay “deep down,” could put up rainbow flags as an exposure. In response to this, the goal would be to drop compulsions, that is to notice and disengage from rumination, checking arousal, reassurance seeking, avoidance, etc.

The ultimate goals of ERP for SO-OCD are to:

• allow for the presence of doubt thoughts about one’s sexuality
• make space for distress
• accept that one cannot know their sexual orientation with absolute certainty

We want to be careful not to focus too much on the content of OCD as the thoughts themselves are unimportant. Still, there are some common challenges and roadblocks that people with this subtype face. ⁠If you’re interested in support for this subtype, our Therapists have extensive experience supporting those with SO-OCD. You can learn more about the treatment and services we provide here, or email us here to find out more.

ACCEPTANCE AND COMMITMENT THERAPY (ACT) & MINDFULNESS

While ERP is considered the gold-standard treatment for OCD, Acceptance and Commitment Therapy (ACT) is also an evidence-based treatment for OCD that can be used in conjunction with ERP. ACT draws upon mindfulness principles in order to support people in non-judgmentally witnessing and accepting their thoughts and feelings. By supporting this objective view of these internal experiences, ACT helps people to accept thoughts and feelings while they take actions based on what matters most to them. You can learn more about ACT here.

General Mindfulness as well as Meditation are also helpful approaches that support recovery from SO-OCD. Given that SO-OCD is a type of Pure Obsessional OCD, learning how to deal with mental compulsions is key to treatment. Meditation can support people in disengaging from mental compulsions. Mindfulness can support individuals to peacefully coexist with thoughts and feelings.