Note: This is a revised version of a post that originally discussed “Homosexual OCD (HOCD).”
Understanding Sexual Orientation OCD (SO-OCD)
Navigating one’s sexuality can be a complex journey, particularly for teens and young adults. During this time, individuals exploring their sexual orientation often face a unique set of challenges. Beyond the internal process of understanding their own sexuality, they must also contend with complex social situations and external pressures. These can include managing the opinions of parents, friends, and others who may hold differing or even conflicting views about sexuality. It’s not uncommon for anxiety, distress, and confusion to be part of this developmental stage.
It’s important to distinguish this common anxiety from a more specific and often debilitating condition. This post focuses on Sexual Orientation OCD (“SO-OCD”), an anxiety disorder that, while it can affect individuals at any age, presents a distinct set of challenges unrelated to the typical process of “coming out” or exploring one’s identity.
What is SO-OCD?
Sexual Orientation OCD (“SO-OCD”) is a specific subtype of obsessive-compulsive disorder (OCD). It’s characterized by recurrent, intrusive obsessions and persistent doubts about one’s sexual orientation. Historically, particularly when obsessions centered on a heterosexual individual’s fear of being gay, this condition was often referred to as Homosexual OCD (“HOCD”). While SO-OCD is the current and more broadly inclusive term, acknowledging its historical link to HOCD can be helpful for those familiar with the older terminology.
Individuals with SO-OCD experience obsessive fears about their sexual orientation that are incongruent with their actual desires or identity. For instance, heterosexual individuals might obsessively fear they are gay or lesbian (a common manifestation historically termed HOCD); conversely, gay or lesbian individuals might obsessively fear they are straight; and bisexual individuals might obsessively fear they are exclusively gay or straight. These obsessions typically manifest as unwanted thoughts, impulses, or vivid images that uncontrollably intrude upon their consciousness. To alleviate the intense anxiety these obsessions provoke, individuals with SO-OCD engage in various rituals. These compulsions are aimed at “proving” their true sexuality or reducing their perceived vulnerability to the feared orientation.
The sexual obsessions in SO-OCD revolve around an intense fear of being attracted to something unwanted, taboo, or “unacceptable” according to their personal worldview, coupled with intrusive doubts about their established or emerging sexual identity. The fundamental issue is the crippling obsessive doubt and the profound distress it generates, regardless of the specific content of the fear.
A hallmark of SO-OCD is the persistent worry that one might secretly be of a different sexual orientation than they identify with, or that they might become so, despite having no such obsessive doubts in the past. Prior to the onset of SO-OCD, many individuals had few, if any, significant questions about their sexual orientation and often have a history of enjoying relationships consistent with their identified orientation. The cycle typically begins when an unwanted thought “pops” into their mind, triggering excessive concern about the possibility of having a feared sexual orientation. This single intrusive thought can then lead them to question their entire sexual identity and re-evaluate past experiences through the lens of this new, distressing possibility.
Individuals with SO-OCD desperately seek certainty, wanting to know “for sure” that their feared sexual orientation is not their true one. They often go to extraordinary lengths to prove their identified sexual orientation to themselves. However, because OCD is strengthened and reinforced by such rituals, these attempts invariably backfire, often exacerbating the condition. Consequently, SO-OCD can become extremely disabling. To avoid triggering their symptoms, individuals may become depressed, drop out of school, quit their jobs, end relationships, or make other significant life-altering decisions that, paradoxically, only worsen their symptoms.
In some instances, the overwhelming doubt caused by SO-OCD can lead individuals to experiment with relationships or adopt lifestyles aligned with their feared orientation. This profound uncertainty might compel them to leave current partners, “come out” as the feared orientation, and begin dating individuals who align with that fear. However, unlike those who genuinely discover and embrace a new sexual orientation and find happiness, individuals with SO-OCD typically find these new circumstances distressing, confusing, and ultimately unfulfilling. Moreover, the underlying doubt and uncertainty about their sexuality persist.
SO-OCD Symptoms: A Closer Look
The symptoms of Sexual Orientation OCD often parallel those found in other forms of OCD, such as checking, contamination, and Pure-O OCD (Pure Obsessional OCD).
- Some individuals experience a predominantly checking-related variant. For example, when around individuals who trigger their specific fears (e.g., same-sex individuals for a heterosexual person with SO-OCD, or opposite-sex individuals for a gay person with SO-OCD), they might compulsively “check” their own bodies for any sign of sexual arousal.
- Others manifest a contamination-related variant, fearing that contact with individuals representing their feared orientation, or even items associated with them, is somehow “contagious” or could “activate” a latent feared sexuality.
- Still others grapple with fears of acting on unwanted sexual impulses. They worry that if they are around people who trigger their fears, they might lose control and act out sexually in a way that aligns with their feared orientation.
- Additionally, some individuals with SO-OCD worry excessively that others will perceive them as their feared orientation, leading them to spend excessive time and energy trying to “act” in accordance with their identified orientation. It’s common for individuals with SO-OCD to experience a combination of these symptoms.
What fuels these intrusive obsessions about sexual orientation? As with any form of OCD, SO-OCD symptoms are maintained by a vicious cycle of faulty beliefs, compulsive rituals, and avoidance behaviors. Misguided beliefs about sexuality and sexual orientation perpetuate the fear regarding the potential consequences of resisting OCD-related compulsions. This is detrimental because every time an unwanted thought is avoided or neutralized through a ritual, the thought is inadvertently reinforced, making it more likely to recur. Thus, avoidance and rituals prevent new, healthier learning from taking place (e.g., learning that unwanted thoughts can be treated as random mental “noise,” or learning to allow these thoughts to pass without responding to them). In this manner, attempts to control thoughts ironically result in a greater loss of control.
SO-OCD: Common Checking Rituals
To decrease their anxiety and reassure themselves about their sexual orientation, individuals with SO-OCD engage in various mental and behavioral checking rituals. These often include:
- Mentally asking oneself, “Am I aroused right now?”
- Mentally reviewing past interactions to ascertain if one has “ever been aroused” by stimuli related to the feared orientation.
- Mentally checking for any physical sensations (e.g., in the groin) when around people who trigger fears or when viewing triggering content (e.g., media depicting the feared orientation).
- Mentally visualizing scenes or individuals related to the feared orientation and checking for arousal.
- Mentally attempting to “conjure” feelings of arousal for stimuli consistent with one’s identified sexual orientation.
- Mentally comparing perceived levels of attraction to people consistent with one’s identified orientation versus the feared orientation.
- Spending excessive time reading or searching online for information about sexual orientation, OCD, HOCD, or supposed signs of being gay, straight, bisexual, etc.
- Constantly reassuring oneself of consistency with one’s identified sexual orientation (e.g., “I’ve always liked people of the opposite sex, so I must be straight.”)
- Investing excessive time and effort in trying to present an appearance aligned with one’s identified sexual orientation (e.g., dressing in a hyper-masculine or hyper-feminine way if one’s fear is related to same-sex attraction and one is heterosexual, or vice-versa).
- Repeatedly asking others if they think one is of the feared sexual orientation or if one appears to be.
- Checking to see if one is staring at individuals who align with the feared sexual orientation.
- Experimenting sexually with individuals aligned with the feared orientation to “test” for arousal.
SO-OCD: Common Avoidance Behaviors
In addition to rituals, individuals with SO-OCD frequently engage in avoidance behaviors to prevent triggering their obsessions and the subsequent anxiety. Common examples are:
- Avoiding physical contact with people who trigger the feared sexual orientation.
- Avoiding individuals perceived to be of the feared sexual orientation or places where such encounters might occur.
- Avoiding movies, TV shows, or books featuring characters or themes related to the feared sexual orientation.
- Avoiding situations where one might be perceived as the feared sexual orientation (e.g., specific social gatherings, types of clothing).
- Avoiding news stories or discussions related to sexual orientation.
SO-OCD: Underlying Maladaptive Beliefs
Fueling both checking rituals and avoidance behaviors are various maladaptive beliefs about sexual orientation, arousal, and thought processes. Some of the most common include:
- “If I have a thought about being [feared orientation], it means I actually am or want to be.”
- “If I feel aroused by someone of my [feared orientation], it means I am [feared orientation].”
- “If I don’t feel aroused by someone of my [identified orientation], it means I’m not really [identified orientation].”
- “Sexual orientation can be changed or ‘caught’ like a disease.”
- “Being [feared orientation] would be the worst thing that could happen to me.”
- “I must be 100% certain about my sexual orientation.”
- “My thoughts can make things happen or reveal hidden truths.”
- “It’s not okay to have doubts or uncertainty about my sexuality.”
Effective Treatment for SO-OCD
The most effective path to treating SO-OCD, much like any other variant of OCD, involves therapy with a psychologist specializing in this condition. Ideally, the therapist should be an expert in cognitive-behavioral therapy (CBT) and, more specifically, exposure and response prevention (ERP). (Specialists may sometimes still be found under searches for “HOCD specialists” due to the older terminology.) ERP is a targeted approach that focuses on helping individuals gradually confront the situations, thoughts, and feelings they have been avoiding, while simultaneously resisting the urge to perform compulsive rituals.
It is crucial to understand that the goal of SO-OCD treatment is not to “prove” one’s sexuality one way or the other. Instead, the primary aim is to help individuals learn to live with doubt and uncertainty about their sexual orientation and to stop battling their unwanted thoughts. Recovery from SO-OCD occurs when individuals learn to allow their intrusive thoughts to come and go without reacting to them. This involves learning to accept the possibility that their worst fears might be true, without needing absolute certainty. While this is undoubtedly a challenging process, it is an achievable goal. Through consistent practice with ERP, individuals can learn to accept uncertainty, thereby diminishing the power that these obsessions hold over their lives.
Questions? Comments? Experiencing an obsession related to sexual orientation? Sound off below.
