Obsessive compulsive disorder - OCD treatment and therapy from NOCD
OCD subtypes
Sexual Orientation OCD/SO-OCD

Bisexuality & SO-OCD: The Invisible SO-OCD

6 min read
Sarah Stanton
Reviewed by April Kilduff, MA, LCPC
All types of OCD include obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, feelings, urges and doubts, while compulsions are repetitive physical or mental actions performed in an attempt to relieve distress and anxiety

This is a guest post by Sarah Stanton, autistic/ADHD/OCD advocate and co-facilitator of the NOCD Autism and OCD support group for members in NOCD Therapy.

Despite increased awareness about OCD in recent years, many OCD subtypes are still under-recognized. This means that many folks never see their particular distress in the descriptions of OCD they encounter, and thus are never able to seek help. Often, these are the more “taboo” or less well-understood subtypes—things like POCD, Suicidal OCD, or Sensorimotor OCD. And within these subtypes, there are some areas that are even further less recognized. This brings us to bisexuality and sexual orientation OCD (SO-OCD).

Outdated definitions of SO-OCD described it as fearing you might be gay when you’re not (its old name was actually Homosexuality OCD, or HOCD). Thanks to progress on queer issues, it’s now usually described as fearing you might be gay or straight when you’re not. But not everyone is gay or straight, and it’s still extremely hard to find anything on SO-OCD that discusses sexualities under the bi umbrella, such as bisexuality, pansexuality, omnisexuality, and polysexuality. And that’s a problem.

More than half of all LGBT+ people are bisexual, but due to biphobia and bi erasure both inside and outside the queer community, bi+ people often experience increased invalidation (and crucially to this topic, self-doubt) about their sexuality. This can have devastating effects on mental health: a 2017 review of 52 studies found bisexual people had higher rates of depression and anxiety than those who identified as straight or gay, and The Trevor Project found the same for feelings of hopelessness and thoughts of suicide.

This can make it really, really complicated for bi+ people with OCD. With 85% of bi+ people having experienced identity invalidation, it can be hard for us to tell the difference between SO-OCD and the very real impact of repeated biphobia and bi erasure, especially when it’s coming from within the queer community. It’s not always as clear-cut as thinking you might be gay when you’re really straight, or vice versa—of the few stories I found online on this topic, most involved bi+ people experiencing SO-OCD doubts about the legitimacy of their actual, genuine bisexuality. The extreme amount of self-doubt and imposter syndrome experienced by many bi+ people (even those without OCD) is an easy target for SO-OCD. And the lack of SO-OCD resources that cover bisexuality doesn’t help.

Effective, specialized OCD therapy is here

Learn more

In an effort to counter this, I’ve read everything I could find on the internet about bisexuality and SO-OCD, as well as interviewed other bi+ people with OCD, and I’ve assembled this list of facts and tips:

1. Biphobia actually demands certainty in a very similar way to OCD. Take the “pick a side” narrative, where bi+ people are told that if we start dating someone, we’ve “picked a side” and must really be straight or gay. We’re also often told outright to stop being bi+ and “pick a side” (none of which makes sense, because nonbinary folks exist, too). The natural fluidity of bisexuality is often perceived negatively by society, which makes it super easy for our OCD to latch onto. It’s a need for certainty double-whammy!

2. SO-OCD can hit bi+ people at all stages of exploring their sexuality. That means “out” bi+ people who were secure in their bisexuality before SO-OCD hit, people who are still in the closet or questioning if they’re bi+, and everyone in between. And of course, people with other sexualities can also develop SO-OCD about being bi+ as well.

3. For bi+ people, SO-OCD isn’t always a fear of being wrong about one’s sexuality. It can be the fear of being an imposter or not really “queer enough” to count, and it can also be the fear of losing attraction to one or more genders, even if you would still technically be bi+. This anxiety often manifests as a fear that a bi+ person is no longer attracted to the gender of the person they are currently in a relationship with. This makes sense: OCD loves higher stakes targets, and the stakes for loss of attraction to someone you’re dating or married to are much higher than the stakes for loss of attraction to people you are not dating or married to. In this way, SO-OCD for bi+ people can often overlap with Relationship OCD, with OCD latching on to dissatisfaction with a partner and turning it into doubts about sexuality.

4. Even without the impact of biphobia, the fluid nature of bisexuality can be an easy target for SO-OCD. The bi+ community often talks about something called the “bi-cycle”, which is a natural and very common shift of preferences within bisexuality over time. SO-OCD can latch onto this shifting of preferences (say, being more attracted to women for a while) and try and convince you it’s big, scary, and permanent. And because your preferences are indeed in flux, it can find lots of evidence to back that up. That does not mean it is right.

5. Being bi+ can make it feel like none of the resources on SO-OCD are relevant to you. When everything you read is focused on monosexuals, it’s easy for OCD to convince you that your situation is different. SO-OCD about bisexuality can also be missed in clinical screening, where the questions tend to be gay/straight focused. And even when SO-OCD resources do acknowledge bisexuality, they often focus on being scared that you might be something you’re not, when SO-OCD (for everyone, but especially bi+ people) can also often look like “I don’t care what my sexuality is, I just need to know for sure.”

6. Despite all that, it’s really important to remember that the approach remains the same. It can be easy for OCD to tell you that because the resources don’t perfectly describe your situation, the advice doesn’t apply to you. But it does. No matter how you identify, your goal in ERP for SO-OCD is always to sit with the uncertainty that you don’t know what your sexuality is right now, and resist the urge to figure it out.

7. A therapist can help you build tailored ERP exercises based on your unique experiences, feared outcomes, triggers, obsessions, and compulsions. ERP exercises  for people whose SO-OCD revolves around bisexuality (whether they fear they might be bi+, or they might not be bi+) might involve scenarios like: 

  • Looking at photographs of people you fear you may/may not be attracted to while resisting urges to make meaning out of your physical responses
  • Purposefully being friendlier than usual with friends of a certain gender while resisting fears that you may be “hitting” on them. 
  • ERP exercises that address rumination around one’s sexuality

The deeper target of these exposures is not necessarily the possibility of having any particular sexual orientation. Rather, it is the possibility of not knowing one’s sexual identity—of not knowing one’s self—which is most often at the core of one’s fears. In general, every subtype of OCD boils down to the two hallmarks of OCD: refusal to allow any discomfort, and refusal to allow any uncertainty.

If you’re bi+, odds are high you’ve already struggled as a result of your sexuality in one way or another (due to internalized/externalized biphobia, bi erasure, adverse health outcomes due to discrimination, etc.) Having SO-OCD on top of all that can feel like adding insult to injury. But even though it can seem really different, challenging this form of OCD is exactly the same as challenging any other form of OCD. 

Find a therapist who can help you manage your OCD

Find therapist

Allow yourself to sit in the uncertainty of your sexuality, and resist that sense of urgency to “figure it all out.” Finding a bi+ positive therapist can make a big difference, and bi+ positive OCD support groups can make a big difference too. If the people who are meant to be helping you with this are biphobic, you have the right to find better people, and keep fighting. At the end of the day, the beauty of bisexuality—and all non-monosexual sexualities—is its expansiveness and fluidity. OCD could stand to learn a thing or two from that!

Sarah Stanton

Sarah Stanton is a disabled writer, autistic/ADHD/OCD advocate, and deeply interested person. She co-facilitates the NOCD Autism and OCD support group for members in NOCD Therapy. Find more of her advocacy work on Instagram at @autisticompulsive.

April Kilduff, MA, LCPC

April Kilduff is a NOCD therapist who has exclusively treated OCD and anxiety disorders, as well as their intersection with the Autism spectrum, for over a decade. Her path to this career started with her own journey dealing with panic attacks, perfectionism and a couple phobias. When not working on exposures with members, you can find her at home reading books and hanging out with her two cats or out taking pictures and traveling the world.

NOCD Therapists specialize in treating Sexual Orientation OCD/SO-OCD

View all therapists
Taylor Newendorp

Taylor Newendorp

Licensed Therapist, MA

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Madina Alam

Madina Alam

Licensed Therapist, LCMHC

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

Tamara Harrison

Tamara Harrison

Licensed Therapist, MA

I have personally struggled with OCD and know what it's like to feel controlled by intrusive thoughts and compulsions, and to also overcome it using the proper therapy. I’ve been a licensed therapist since 2017. I have an M.A. in Clinical Mental Health Counseling, and practice Exposure and Response Prevention (ERP) therapy. I know by experience how effective ERP is in treating OCD symptoms.

Want to work with one of our therapists?
Schedule a free call to learn more.