OCD subtypes
Sexual Orientation OCD/Homosexual Obsessive Compulsive Disorder/HOCD

Is HOCD the Same as SO-OCD? What You Need to Know

4 min read
Keara Valentine
By Keara Valentine
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
Sexual orientation obsessive-compulsive disorder and homosexual OCD are two terms used to describe a subtype of OCD that is characterized by obsessions around a person’s sexual orientation. 

You might see the terms SO-OCD and HOCD used interchangeably. SO-OCD is the term more recently used to replace HOCD in order to more fully represent the variety of experiences people with this condition can have. 

What is SO-OCD?

People with SO-OCD experience intrusive thoughts and urges around denial of or confusion about their true sexual orientation. Someone with SO-OCD will experience fears around being perceived as “gay” or “straight.” They might wonder if they actually are an orientation other than the one they thought. They may fear they are in denial of their sexual orientation. Or, they might worry that they may “turn” gay or straight, and what it will mean for their life. Will they have to leave their family? Will their relationship end when they discover they are not who they think they are?

A person with SO-OCD might analyze their own actions very diligently and be excessively concerned with whether or not their behaviors align them with a particular sexual orientation. “Why did I look at that guy at the gym? What does it mean that I think this woman is attractive? What if I’m actually straight and am not really in love with my partner?” These thoughts can take hold of a person’s mind and not let go until they’ve found sufficient proof that these fears are unfounded. However, as with all types of OCD, the relief is only temporary, and it’s only a matter of time before the cycle begins again. 

In order to ease the stress of these intrusive thoughts, someone with SO-OCD will often engage in compulsions. A common one is seeking reassurance. This will look like asking people in their life to reaffirm their sexual orientation. “Do you think I’m gay? But do you think my behaviors might mean I am? Are you sure?” No matter how many times a friend or family member reassures you, however, it’s only a matter of time before the obsessions start up again. Because sexual orientation plays such a big part of a person’s life and identity, and because OCD tends to latch on to what an individual values, it can feel like there is endless fuel for these intrusive thoughts and anxieties. 

“Do you think I’m gay? But do you think my behaviors might mean I am? Are you sure?”

These intrusive thoughts and compulsions can be extremely distressing and interfere with a person’s relationships and friendships. It’s important to note that having this condition isn’t actually about one’s sexual orientation, but the sense of doubt that’s common among all subtypes of OCD. Therapists report that patients with SO-OCD are not concerned with which orientation fits them, but just want to be 100% certain they know what their sexual orientation is. They might say, “I don’t even care if I’m gay or straight; I just want to know for sure.” For this reason, people of any sexual orientation can have SO-OCD, because it’s not about their actual identity, but rather the uncertainty that exists for everyone as part of human nature.

Treatment for SO-OCD

The best course of treatment for SO-OCD, just like all types of OCD, is exposure and response prevention (ERP) therapy. This is a type of cognitive behavioral therapy (CBT) that is targeted to help people confront their fears in order to get over them. In ERP therapy, you’ll work with a therapist to accept your intrusive thoughts so that they no longer have as strong of a grip on your mind and life.

This process works through a series of exposures that you come up with together with a therapist and work on gradually. For example, a therapist might have you observe a photo of attractive men or women, while resisting the urge to make meaning of your response to them. Instead of engaging in mental tracking about your response to the photo might mean about your sexual orientation, you’ll work with the therapist to sit with this discomfort. At first it can feel excruciating to have to sit with stressful thoughts without trying to make them go away. But with practice, the intrusive thoughts will have less and less significance. The goal is that eventually the intrusive  thoughts will fade into the background of your mind, rather than running the show and that you won’t need to rely on compulsions to temporarily alleviate discomfort or provide the illusion of certainty.

ERP therapy has been found to be 80% effective, and most people see notable results after 12 to 25 sessions. If you’re interested in learning more about how ERP therapy can help with your SO-OCD, schedule a call today with our clinical team. At NOCD, all of our therapists specialize in OCD and receive ERP-specific training.

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Keara Valentine

Keara E. Valentine, Psy.D., is a postdoctoral fellow at Stanford University School of Medicine in the OCD and Related Disorders Track, where she specializes in the assessment and treatment of OCD and related disorders. Dr. Valentine utilizes behavioral-based therapies including Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) with children, adolescents, and adults experiencing anxiety-related disorders.

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NOCD Therapists specialize in treating Sexual Orientation OCD/Homosexual Obsessive Compulsive Disorder/HOCD

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Adriana Delgado

Adriana Delgado

Licensed Therapist, LMHC

My journey as a therapist has brought me in front of more and more cases of OCD, which has led to specialization in OCD treatment. My experience working at intensive in-home services for children & families, and intensive outpatient programs, has prepared me for even the biggest challenges. During sessions, I use Exposure and Response Prevention (ERP) therapy because it’s one of the most effective treatments for OCD, and works for any OCD subtype.

Alyse Eldred

Alyse Eldred

Licensed Therapist, LMFT

I’ve been a licensed therapist since 2017, and as an OCD specialist, I only use Exposure and Response Prevention (ERP) therapy. Research shows that ERP is the most effective OCD treatment available. I truly enjoy helping people understand themselves through ERP and I’m grateful to be part of a process that helps people gain control of their lives.

Andrew Moeller

Andrew Moeller

Licensed Therapy, LMHC

I've been a licensed counselor since 2013, having run my private practice with a steady influx of OCD cases for several years. Out of all the approaches to OCD treatment that I've used, I find Exposure and Response Prevention (ERP) therapy to be the most effective. ERP goes beyond other methods and tackles the problem head-on. By using ERP in our sessions, you can look forward to better days ahead.

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