OCD is a disorder of irrational doubt. We commonly hear about people with OCD doubting whether the door that they’ve just locked is actually locked and checking repeatedly, but OCD can cast doubt on anything. This includes a person’s sexual orientation.
Sexual Orientation OCD (SO-OCD) is a manifestation of OCD that involves pathological, irrational doubt about a person’s sexuality. Common obsessions include:
- What if I’m not gay and I’m lying to everyone?
- What if I’m gay?
- What if I’m not bisexual?
- What if I’m only saying that I’m asexual for attention?
- And more!
As a therapist specializing in the treatment of OCD, this manifestation of OCD shows up frequently in my office. I’ve collected some of the most commonly asked questions about this subtype and answered them below.
How can I tell if it’s SO-OCD or just me questioning my sexuality?
As with all OCD obsessions, sexual orientation obsessions are egodystonic—meaning the person with SO-OCD does not desire their obsessions, nor do they desire acting on them, and the doubt OCD casts about their sexual orientation is obsessional: irrational and not rooted in reality. The obsessions oppose reality, which is what makes them so distressing to the person. This could look like a lesbian with OCD experiencing relentless intrusive images of sexual acts with cisgender men. She knows that she’s not attracted to men, but doubts what she knows because of how pervasive, graphic, and visceral the intrusions are. “What if I’m not a lesbian and I’ve been lying to my wife?” becomes an obsession. It’s not a question rooted in desire or curiosity. It’s a question rooted in irrational doubt.
When someone is truly questioning their sexuality, reality tends to reflect that. The doubt is reasonable, meaning there is reason in the here-and-now to question their sexuality: They’re noticing attraction to different genders and sexes that they want to explore, they’re curious about exploring their sexuality, they’ve gained new information that helps them better understand themselves (i.e., the difference between sexual and romantic attraction).
With OCD, there is a distrust of reality (i.e., I know that I’m not gay, and that I don’t desire having sex with cisgender men, but am doubting that knowledge because of intrusions). True questioning tends to stem from what is happening in reality: what a person desires.
What are some signs that what I’m experiencing is SO-OCD?
- You’re plagued with irrational doubt about your sexual orientation that you know doesn’t make sense, but you feel like you can’t stop engaging with it.
- You’re experiencing relentless intrusive thoughts and images that are totally opposite to what you desire sexually and romantically.
- You carry out excessive and time-consuming behaviors (mental or physical) to try and quell this irrational doubt.
What do compulsions look like with SO-OCD?
Common compulsions people with SO-OCD carry out (include, but are not limited to):
- Checking on your emotions and bodily sensations after experiencing an unwanted thought or image (i.e., checking your genital area for arousal)
- Rumination about the obsessions; trying to resolve the irrational “what if” through thought
- Physically checking (i.e., looking at porn or kissing someone to reassure yourself that the obsession is not true)
- Reassurance-seeking (i.e., asking other people about their sexuality, scouring the internet for answers, reading “coming out” stories to make sure you don’t relate to them)
- Thought neutralization: replacing an unwanted thought with a more desirable one
- Avoiding media out of fear that the obsession will arise (i.e., a straight woman avoiding shows with lesbian characters)
- Avoiding looking at other people (i.e., because you’re afraid you’ll experience a thought)
- Staring at other people to check for attraction or arousal
- Avoiding sex, dating, intimacy
- Mentally reviewing the past for “signs” that might confirm that obsessions are true
Can you have SO-OCD about being straight if you’re gay?
YES! Sexual orientation OCD can impact people of any sexual orientation: heterosexual, bisexual, gay, lesbian, asexual, etc.
How can a lack of visibility for asexuality/other lesser-known orientations increase doubt?
A lack of visibility and accurate information about sexual orientations can lead people to doubt themselves more. For example, some people wrongly assert that bisexuality doesn’t exist and that people who say they’re bisexual need to pick a lane. This rhetoric can contribute to someone with the obsession “what if I’m not actually bisexual?” doubting themselves even more. Similarly, people sometimes invalidate asexuality by saying things like, “You would be interested in sex if you just met the right person!” This can exacerbate obsessional doubt for people with “what if I’m not actually asexual?” obsessions.
Why do I feel something in my genital area when I do not enjoy the intrusive thoughts and images?
A genital response does not automatically equal arousal/desire. People with sexual obsessions commonly experience genital responses that do not line up with what they truly desire. There’s a word for this: arousal non-concordance. Your body’s genitals may respond to what is “sexually relevant” (i.e., a sexual intrusive thought) even if it is not “sexually appealing” to you. You can have an erection, feel wet or lubricated, etc. and not find an obsession appealing or desirable.
I had SO-OCD as a kid and ended up bi. Does that mean my more taboo obsessions (ex. POCD) are real, too?
Sexuality is fluid and can change over time. In the context of OCD, we are looking at a person’s here-and-now experience. Obsessions oppose what a person desires and knows about themself in the now. “What if I’m attracted to women?” might not have been true for a person 10 years ago and was obsessional, but something may have shifted in the present. This does not mean that POCD is now true or real—or that it will be in the future.
Am I homophobic for living with SO-OCD as a heterosexual person?
Experiencing sexual orientation OCD a heterosexual person does not automatically mean that you are homophobic. Many people with OCD are allies and wouldn’t actually care if they were gay. As opposed to being fearful of a sexual orientation, people with OCD are commonly worried that they will be forced to live a life that doesn’t align with their true sexual desires or sense of self.
Am I homophobic? can also be a secondary obsession for people with OCD.
*And* some people with SO-OCD are homophobic, which can make living with SO-OCD more difficult (i.e., not wanting to accept the presence of intrusive thoughts because they think being gay is gross).
Can SO-OCD be treated with ERP?
Exposure and response prevention (ERP) therapy is the frontline treatment for OCD, regardless of the subtype. This treatment involves exposure to stimuli that trigger obsessions (ex. watching a TV show with gay love stories) while simultaneously practicing response prevention (ex. resisting the urge to check feelings and bodily sensations).
It’s important that ERP for SO-OCD is justice-based, meaning that exposures should not harm marginalized communities. Your therapist should not ask you to to dress or “act” gay (it reinforces the misconception that you can look at someone and determine their sexual orientation or gender identity), go to a gay bar and flirt with gay people (the gay person is a prop in an exposure that they did not consent to participate in), or write an imaginal script about how disgusting it would be to live as a gay person (reinforces that being gay is wrong). Exposures should be neutral or positive, not negative, and can help you recover from OCD without harming others.
If you’re struggling with doubts like these, NOCD can help. Our licensed therapists deeply understand OCD and are specialty-trained in treating OCD with ERP. They’ll work with you to create a treatment plan personalized to your unique needs and help you regain your life from OCD. You can book a free 15-minute call with our team to learn more about getting started with OCD treatment.
