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What is OCDOCD SubtypesWhat is my sexuality? A therapist’s advice on trying to figure it out

What is my sexuality? A therapist’s advice on trying to figure it out

8 min read
Melanie Dideriksen, LPC, CAADC

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If you find yourself experiencing doubts or uncertainty about your sexuality, you might feel very alone. But to tell you the truth, this is not an uncommon predicament. While it’s understandable if you want to be “sure” about your sexuality and sexual identity, it’s quite normal to be unsure, to go through changes with your sexuality over time, and to question what you once believed was true about yourself. 

That said, as a therapist, I’ve worked with plenty of patients who feel deep distress over doubts about their sexuality. Instead of feeling empowered to explore their sexuality with a blank slate, they are filled with dread when thoughts of sexual identity arise. Sometimes, doubts about one’s sexuality turn into a repeating loop of thoughts like these:

Although no one can define your sexuality for you, we can help you understand some of the reasons that you might be grappling with your sexuality, as well as how to get help and learn to accept uncertainty about your identity.

How sexuality is defined

Sexuality is defined in many ways and using many terms. It can refer to one’s ability to feel and experience sexual feelings, or one’s identity in relationship to the gender or genders they are attracted to. Sexual orientations can include heterosexual or “straight,” lesbian, gay, bisexual, queer, asexual, and many others. Since sexuality is made up of so many different components, our understanding of our own sexuality is ever-changing, and it’s normal to question your sexuality well into adulthood. 

When should you “know” your sexuality for sure?

There’s a lot of conflicting information about when someone typically feels that they know what their sexuality is, and that’s because there are no set rules on when you “should” know. Some statistics show that 1% of 9 year olds identify as LGBTQ+ and that 48% of college students knew their sexual orientation by the time they were in highschool. However, there is no definitive time by which people know. What’s more, there are so many factors that can play a role in a person’s understanding of their sexuality, and whether they choose to come out with their sexual orientation at all. Sexuality is the subject of political debates, family feuds, church sermons—and, sadly, often the reason behind bullying and self-harm. As a result, many people feel unsure about how they identify, or they become overwhelmed by the many ways to explain their sexuality.

When struggling to figure out your sexuality affects your mental health

There’s no denying that we live in a society where you can still encounter expectations of what is “normal” or “acceptable” in terms of sexuality. It’s no wonder that your mental health can take a hit in the process of exploring your sexuality. 

If you’re struggling, it may be time to talk to a professional. Knowing that your struggle is real, normal, and a part of figuring out who you are is important. A trained mental health therapist can help you in dealing with issues like depression and anxiety that may arise. There are also LGBTQ+ alliances and support communities including Alliance for LGBTQ Youth, NAMI, and the American Counseling Association.

A misunderstood mental health condition: Sexual Orientation OCD (SO-OCD) 

If obsessive thoughts about your sexuality are plaguing you, that’s one thing. But what happens when these doubts consume your life?

For example, some people avoid the gym where they’ve previously noticed attractive people and experienced intrusive thoughts or doubts about their sexual orientation. Others may compulsively watch porn as a way of confirming or disproving their doubts about their sexuality, or compulsively date in order to prove to themselves that their sexual orientation is accurate. These are examples of compulsions: repetitive physical or mental acts that a person feels compelled to engage in to relieve the distress they feel about not knowing their sexuality and try to achieve certainty about it. 

Whatever the compulsion (and this was certainly not an exhaustive list of examples), it’s easy to see how this can take a real toll on someone’s mental health. But what’s at the root of it?

In some cases, the issue can be linked to something called sexual orientation OCD (SO-OCD), a subtype of obsessive-compulsive disorder. People with SO-OCD experience intrusive thoughts, images, sensations, or urges related to their sexuality, most often triggering doubt or uncertainty. Someone with SO-OCD may experience fears around being perceived as having a certain sexual orientation, such as gay, bi, or straight. They might wonder if they have a sexual orientation other than the one they always thought, or fear they are in denial about their “true” sexual orientation. Or, they might fear that their sexual orientation could abruptly change (e.g., “turn” gay, straight, or asexual) and worry about what this change will mean for their life.

Talk therapy doesn’t work for OCD. This does.

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It’s important to note that having this condition isn’t actually about one’s sexual orientation, but the sense of doubt and uncertainty that’s common among all subtypes of OCD. People with SO-OCD are sometimes not concerned at all with one sexuality or another, but rather feel an urgent need to be 100% certain about what their sexuality 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.

Unfortunately, engaging in compulsive behaviors only provides temporary relief, and actually reinforces the idea that every time an obsession arises, one must engage in a compulsion in order to make it okay. Compulsions “feed” OCD and strengthen the hold that OCD has on you. You don’t need to erase all uncertainty in order to be okay. In fact, uncertainty is the reality that everyone—with or without OCD—has to live in!

How to get help for sexual orientation OCD 

While traditional talk therapy effectively treats many mental health 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 OCD, it may only feed their compulsive need for reassurance. It might feel good in the short term to have your anxieties relieved, but in the long term, this isn’t helping SO-OCD. Endlessly seeking 100% certainty about your identity only makes OCD stronger, which means the distress and impairment it causes will keep growing unless properly treated.

So what is the best course of treatment for SO-OCD? It’s a specific type of therapy called exposure and response prevention (ERP) therapy. The idea behind ERP is that by purposely exposing yourself to triggers and then preventing yourself from engaging in your compulsions—which is made easier by working with a trained ERP therapist—you teach yourself a new way to respond, without reinforcing the vicious cycle of OCD. As a result, you’ll experience a noticeable reduction in your anxiety about your sexuality, and gain a newfound ability to accept uncertainty.

Let’s take the example of Kris, a person who is happily married to their husband of 8 years, yet starts to have intrusive thoughts about their sexuality that are triggered when they go on Facebook and see a photo of a cheerleader they shared a kiss with one night in college. Kris engages in compulsive behaviors like reassurance-seeking (asking friends if their relationship seems stable) and avoidance (not going on Facebook). 

Kris decides it’s time to get help and seeks out a therapist who specializes in OCD. Their therapist works with them to gradually engage in the situations they’ve been avoiding. For instance, Kris spends one minute looking at pictures of the woman who initially triggered their SO-OCD fear, or writing the statement “I may or may not know my true sexuality” over and over on a piece of paper. Kris’s therapist helps them learn what it means to sit with their discomfort about this fear, and to accept uncertainty without engaging in compulsive behaviors. Over time, Kris notices that they’re no longer bothered when they see a picture of that cheerleader from long ago—they can feel confident in their relationship, without needing the perfect answer to their uncertainty. 

This is just one example of how ERP therapy works. It’s always specifically tailored to a person’s needs, and a therapist with specialty training in ERP will create a treatment plan that’s designed for your individual symptoms and needs.

The bottom line

Whether you’re struggling with fears about sexuality because of SO-OCD, or you’re just struggling with feeling alone and uncertain about your sexuality, you do not have to go through it on your own. If you think SO-OCD may be affecting you, please reach out to NOCD for a free 15-minute call today, so you can get on the road to health and well-being. 

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

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.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

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.

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