Obsessive compulsive disorder - OCD treatment and therapy from NOCD

What Is Sexual Orientation OCD (SO-OCD)?

By Nicholas Farrell, Ph.D

Aug 24, 20239 minute read

Reviewed byPatrick McGrath, PhD

Sexual orientation OCD (SO-OCD) is a subtype of OCD that is characterized by intrusive thoughts and compulsive behaviors around a person’s sexuality. It has been referred to as homosexual OCD (H-OCD); however, this term is increasingly discouraged due to its lack of sensitivity and accuracy. People with SO-OCD experience intrusive thoughts and urges around denial of or confusion about their true sexual orientation, no matter what their sexuality is.

Sexual orientation OCD symptoms 

Someone with SO-OCD may experience fears around being perceived as having a certain sexual orientation, such as gay or straight. They might wonder if they have a sexual orientation other than the one they thought. They may fear they are in denial of their “true” sexual orientation. Or, they might fear that their sexual orientation could abruptly change (e.g., “turn” gay or straight) and what this change will mean for their life. (Will their relationship with their current partner end? Can they ever feel truly secure in their sexuality?) 

A person with SO-OCD might analyze their own behaviors very diligently and be excessively concerned with whether 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. 

The impact of SO-OCD

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 sometimes 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 a universal part of life.

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.

Examples of sexual orientation OCD obsessions: 

  • What if I’m gay and I don’t know? 
  • I thought the actor in the movie was attractive. I just found out that he is gay. Does it mean that I am gay? Why would I like someone gay if I’m not?
  • Why did I have a dream where I was attracted to a man? Does that mean I’m gay?
  • What if I’m actually straight and I don’t actually love my partner? 
  • What if I am bisexual and don’t know? What if I found out and it ruined my relationship?
  • I couldn’t help notice how muscular those men at the gym are. Does that mean I’m gay?
  • How would I be able to show myself to my religious community if I am actually gay? I would be exiled from my community. 
  • Yesterday, when I saw my friend, I had such a good time with her. We were laughing so hard. What if I’m attracted to my best friend? What would my husband think if he knew I was asking myself this question?
  • I feel more comfortable with my male friends than my female friends. Does that mean I’m straight? 
  • What if I am wrong about my sexuality? What if everything I thought was true about myself is false? What if I wake up one day and I can no longer live with myself? 
  • What if I’ve been lying to my partner for 17 years? Am I actually attracted to them?
  • I got sexually aroused when watching a sex scene from a movie with two lesbian women. What does this mean about me?

Examples of SO-OCD compulsions 

  • Avoidance: A person with SO-OCD may avoid certain situations that could trigger their intrusive thoughts. For example, they may avoid the gym where they’ve previously noticed attractive people and experienced intrusive thoughts about their sexual orientation. A person may avoid speaking to their friends or attending certain events, or avoid sexual situations entirely for fear that their doubts could be confirmed.
  • Checking physical sensations: People with SO-OCD may be hyper-aware of the physical sensations they are experiencing, particularly their sexual arousal response or “groinal response,” and view this as proof of their true sexual orientation. This may provide them with either reassurance or further fuel for their doubting thoughts and compulsions. They may even compulsively watch porn as a way of confirming or disproving their doubts.
  • Compulsive dating: Someone with SO-OCD may compulsively date in order to prove their sexual orientation is accurate. They might think, “See, I like him. Everything is fine. I’m not actually lesbian. I can relax.” This is a way for the person to reassure themselves and relieve the anxiety of their intrusive thoughts. 
  • Mental review: Someone with SO-OCD may replay memories in their head over and over. They may think, “In high school, I really liked Anna and I wanted her to be my friend. Was it just platonic?” They might review every single moment with Anna over and over. “That one time Anna bought me ice cream and it felt really good. But does that mean I felt romantic interest?” This mental review and questioning can go on for hours until the person has felt like their doubting thoughts have been answered. Of course, this is only temporary, and it’s only a matter of time until new doubts come back. 
  • Reassurance seeking: This may entail talking to friends or family members to get reassurance about one’s sexual orientation. A person may ask, “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. Other people might feel embarrassed to speak about this with the people in their lives, and instead turn to online chat rooms to receive reassurance from strangers. They may post online about what they are experiencing and ask whether this makes them gay, straight, or the sexual orientation they fear they are. They may ask questions like, “Is this SO-OCD, or do you think this means I’m actually gay?” Even when someone has been diagnosed with SO-OCD, they may convince themselves that specific experiences are cause for concern. 
  • Repeating statements: Individuals with SO-OCD may repeat statements to themselves as a way to relieve their anxiety. For example, someone might have a ritual to repeat, “I am not gay” 17 times whenever an intrusive thought comes to their mind. 
  • Praying: People with SO-OCD may pray excessively—dozens or even hundreds of times per day—to ask for clarity on their sexual orientation or for forgiveness for perceived “sins.” 

Effective treatment for Sexual Orientation OCD

The best course of treatment for SO-OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. The idea behind ERP is that repeated exposure to obsessive thoughts without engaging in compulsions is the most effective way to treat OCD. When you continually reach out for the compulsions, it only strengthens your need to engage in them. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety. 

ERP is considered the gold standard for OCD treatment and has been found to be effective for 80% of OCD patients. The majority of patients experience results within 12-25 sessions. As part of ERP therapy, you will track your obsessions and compulsions and make a list of how distressing each thought is. You’ll work with your therapist to slowly put yourself into situations that bring on your obsessions. This has to be carefully planned to ensure it’s effective and so that you’re gradually building toward your goal rather than moving too quickly and getting completely overwhelmed.

While traditional talk therapy effectively treats different issues, it can potentially be counterproductive for SO-OCD. Here is a brief example. Say you are struggling with the idea that you could be gay and have to leave your partner. In talk therapy, you might focus on the fact that this isn’t actually true. The therapist may point out that there’s no basis for your fear of being gay, and remind you that you’ve been happily married for nine years. Although this comment may feel helpful, for someone struggling with magical thinking OCD, it may fulfill the compulsive need for reassurance.  

ERP works very differently. Let’s say you’re experiencing SO-OCD and have realized that you have intrusive thoughts questioning your sexual orientation every time you speak with a specific friend. These doubting thoughts have been so stressful that you try to minimize contact with this friend, despite being very close. With a therapist, you’ll work toward overcoming this compulsion so that you’re eventually able to spend time with your friend without fear. A therapist may ask you to expose yourself to the source of anxiety purposely. In this case, you may be asked to make plans with your friend. At first, you might think, “Are you serious? Isn’t there another way? I’m willing to do anything but that.” If an exposure feels too overwhelming to start with, you’ll work with the therapist to find the right intensity for you.

You might start by becoming more comfortable with your intrusive thoughts. For example, a therapist may ask you to talk about what it would mean to have your fears about your sexual orientation confirmed? Would your partner and children leave you? Would you end up all alone? Would your entire social circle abandon you? Would you be exiled from your religious community? Speaking about the worst-case scenario helps you become familiar with the underlying fear driving your obsessive thoughts and compulsions, which eventually helps relieve it. With practice, you’ll find the intense need to engage in your compulsion will wane. You will get to a point where the anxiety subsides, and you are able to speak to your friend without becoming overwhelmed. 

How to get help for SO-OCD

It may feel challenging from someone to talk about intrusive thoughts from SO-OCD for fear of being judged, both for their intrusive thoughts and doubts, and for the distress their doubt and uncertainty may cause them. Someone might think, “If this therapist knows how scared I am of potentially being gay, they will think I must hate gay people. Otherwise, why am I so afraid of it?” A trained therapist will have worked with this OCD subtype before and will not judge you for your OCD-related thoughts.

If you’re interested in learning about SO-OCD and how it’s treated with ERP, I encourage you to learn more about NOCD’s evidence-based approach to treatment. All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is. NOCD offers live face-to-face video therapy sessions with OCD therapists, in addition to ongoing support on the NOCD telehealth app, so that you’re fully supported during the course of your treatment.

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