What Is Sexual Orientation OCD?

Obsessive thoughts and compulsive actions centered around doubts of your own sexual identity can be debilitating. But there is hope.

January 27, 2023

Sexual identity is an important part of how we view ourselves. Most people have little trouble knowing who they find attractive.

This may not always be easy, of course. Varying factors, like religion, community values, social fears, etc., may create obstacles for someone trying to actualize their inner self. However, they still know what their true identity is.

People who have obsessive compulsive disorder (OCD) related to sexual orientation are not so lucky. They often find themselves stuck in obsessive doubt around their sexual identity, even though they may say that deep down they know what their sexual identity is. As such, they spend much of their time engaging in various compulsions to try to have complete certainty around any doubt.

The result is a massive amount of time dealing with the uncertainty rather than living life. If this goes on long enough, it can affect every aspect of existence. School, work, and relationships with family and friends eventually all begin to suffer.

This form of OCD is called sexual orientation OCD, or SO-OCD. Until recently, SO-OCD was known as homosexual OCD (HOCD) to refer to a heterosexual person’s fear of identifying as gay. The term has been updated to be more sensitive, inclusive, and accurate.

While a straight person’s fear of being gay is a common presentation of the condition, obsessions and compulsions around sexual identity can affect anyone of any gender or sexual orientation.

Fortunately, there is help for those struggling with SO-OCD.

Keep Reading To Learn

  • What the obsessions and compulsions of SO-OCD look like
  • The impact of these obsessions and compulsions on daily life
  • Available therapies to reduce the presence of SO-OCD thoughts and behaviors

Identity & Mental Well-Being

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In this webinar, Dr. Chase Anderson shares how identity applies to mental health and how we can encourage and support others in discovering their identities.

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What Is Sexual Orientation Obsessive Compulsive Disorder (SO-OCD)?

At the core of SO-OCD is the feeling of doubt that is common in obsessive compulsive disorder. Deep down, the person with SO-OCD wonders if they are a fraud and if they have been confused about their real self all along.

Since they are concerned that they have been wrong about their sexual identity, they may feel terrified about the implications their orientation may have on romantic partners and other aspects of their life.

Such obsessions revolve around fear that you are gay when you’ve otherwise identified as straight. You may experience “gay thoughts” or fears of gay thoughts (e.g., a heterosexual woman might think, ‘Why am I thinking of women all the time? I don’t want to have sex with women. But I think about them constantly. It must mean I’m gay.’).

The same thing can happen the other way around: a gay person with SO-OCD can develop a fear of being straight, with “straight thoughts” or fears of straight thoughts.

Most likely, you will also experience the fear that you will act on those thoughts. The thoughts become obsessive and intrusive, which means you cannot control their presence, and you cannot make them go away.

Although it may seem like it, the thinking that is part of SO-OCD does not mean a person has homophobia. Nor does it involve denial of one’s actual sexual identity.

It’s an obsession about one’s sexual orientation, just as other forms of OCD are connected to different types of obsessions. For example, scrupulosity is a form of OCD that involves the fear of sinning; contamination OCD involves an obsession with and fear of germs.

Thoughts Become Actions

For obvious reasons, SO-OCD is extremely psychologically distressing. In an attempt to combat obsessive thoughts, people experiencing this condition develop compulsive rituals. However, no matter how hard they try to dispel the thoughts, they do not go away. And no matter how hard they try to succeed in their self-imposed rituals, such actions do not quiet the thoughts.

The obsessive thoughts associated with SO-OCD can cause confusion and fear. These thoughts can be so distressing that they shut down otherwise functioning, flourishing people.

SO-OCD is not a hopeless condition, but overcoming it takes hard work and practice. With professional help, you can learn to manage your distressing thoughts so they do not trigger the compulsive and damaging behaviors anymore.

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What Are the Symptoms of SO-OCD?

As with any other mental health disorder, sexual orientation obsessive compulsive disorder presents in many ways. Symptoms take two main forms:

  • Compulsively rechecking your thoughts and creating rituals to combat them
  • Engaging in OCD rituals in other mediums as a way of regulating feelings of doubt and uncertainty

Note that the second form means you do not need to have rituals directly related to your sexual orientation in order for SO-OCD to be present. You may have fearful thoughts about being gay, for example, but your OCD rituals have nothing to do with it, per se.

For instance, some people unlock and lock doors a compulsive number of times, or they may wash their hands in certain ways or say certain ritualistic words aloud. If you have doubtful thoughts about your sexual identity and perform compulsive actions even against your will, there’s a strong likelihood SO-OCD is present.

Some common thoughts include:

  • How do I know whether I actually like men or women?
  • What if I’m wrong about myself?
  • Is it even possible to really know who I find sexually appealing?
  • What if I never know who I’m really attracted to? How can I know for certain?
  • What if I accidentally act on these thoughts?
  • What if everyone finds out?
  • Did I act gay (if I am actually straight) or straight (if I am actually gay) just now? Did they notice?
  • If I like this material (erotic literature, pornography) does that mean it’s who I am?

The compulsions might look like:

  • Checking for arousal or feelings after seeing a photo
  • Avoiding situations that make you have fearful thoughts, such as a locker room or a night club
  • Reading or watching sexual materials counter to your orientation to see if you get a reaction
  • Conversely, refusing to read or watch anything that might have sexual content counter to your orientation—for fear that it could trigger a reaction
  • Imagining yourself in sexual situations counter to your orientation to see how you react
  • Forcing yourself to imagine over and over again sexual situations to reassure yourself of your sexual orientation
  • Constantly self-monitoring to determine whether you look or act gay or straight
  • Spending an undue amount of time trying to ensure you don’t come off as gay or straight to other people
  • Refusing to say words such as “homosexual,” “gay” or “lesbian” if you identify as straight or “straight” if you identify as gay

Other common compulsions can affect your relationships:

  • Repeatedly questioning others about whether you seem to conform to your gender or sexuality
  • Asking others to affirm beliefs you think you hold about yourself, sometimes over and over again, even if they ask you to stop
  • Losing a relationship with a boyfriend or girlfriend because you can’t seem to commit to your own interest in people of their gender (which is understandably hurtful to them)
  • Avoiding touching members of the same sex if you are straight, or the opposite sex if you are gay, in ways that are patently nonsexual
  • Avoiding people who are gay (if you identify as straight) and people who are straight (if you identify as gay)

Confusion Around Sexual Orientation Compared to SO-OCD

Sex is a taboo topic in many societies, including in the United States. Talking about it is difficult under the best of circumstances. Because of this, many people don’t know how fluid sexual arousal actually is. Almost everyone experiences stimulating thoughts of activities or people with whom they would never actually engage sexually.

The occurrence of these thoughts means essentially nothing about a person’s true sexual leanings. Rather, they are a poorly understood and little talked-about component of every normal human psyche.

The problem comes in being unable to distinguish truth from passing thought. For example, while most gay people would dismiss a dream about a teacher of the opposite sex, a gay person with SO-OCD could not. They would obsess about the dream and worry it meant they were heterosexual.

Many straight people might briefly admire a colleague of the same sex and move on without thinking anything of it, but a straight person with SO-OCD could not do that without severe recriminatory thinking.

In people with SO-OCD, a fleeting thought of attraction can set off a cascade of doubt and terror that is not experienced by most people. Most people would dismiss the thought for what it was: just a thought.

Also confusing is the fact that arousal and anxiety feel quite similar.

They increase your heart rate and make it hard to think about anything else. They put you in the position of feeling like you need to do something. Obviously, this creates even more confusion. If you are actually anxious when thoughts occur, but you mistake that elevation for arousal, your fears become even more deeply engrained.

People living with SO-OCD aren’t just a bit anxious. They are truly debilitated by their inability to think about other things without these thoughts intruding.

Because of our societal taboos about sex, gender confusion and fear of coming out are not uncommon.

However, SO-OCD is relatively uncommon. It does not affect many people. It impacts about 12% of those living with OCD.

Understanding OCD in Kids and Teens

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Young people can be particularly affected by OCD. Learn more about what OCD is, how to recognize symptoms of OCD in children and adolescents, and how to successfully manage and treat OCD in young people.

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Sexual Orientation Obsessive Compulsive Disorder in Kids and Teens

One of the main differences between children and adults is the environment in which they spend most of their time.

Children and teens are likelier than adults to be surrounded by large numbers of people of the same gender. Most societies segregate girls and boys in gym class, in after-school sports, and in locker rooms. Girls and boys tend to segregate themselves in the lunchroom, in the halls, and at recess.

Young people, for instance, are often members of sports teams. In this environment, they spend time with other youth of the same gender in the locker room. They are also in close physical contact on the field or court.

Magazines about sports are common, showing other—usually older and more physically impressive—individuals in competitive situations. That’s a lot of physicality to deal with, and those with SO-OCD may find themselves so triggered they simply withdraw.

For instance, a young person in this situation might:

  • Throw away the magazines
  • Develop eccentric behaviors regarding where they will and will not get dressed
  • Avoid being near others in states of undress
  • Avoid being touched on the court or field, an eccentricity that dramatically reduces playing prowess, not to mention being noticed by others
  • Quit the team

Such behavior can have devastating consequences for youth, regardless of whether they had a future as an athlete. It takes away a valuable social outlet in which they might otherwise have thrived.

Another aspect of SO-OCD in minors is that no one that age really has an understanding of how human sexuality works.

Almost every teen is trying to figure out who they are, who they like, and what to do about it. The addition of SO-OCD to such a mix can make it feel impossible to decide how they really feel. The younger the child experiencing SO-OCD, the less information is available from peers.

This obviously proves challenging for nonbinary and trans people. Feeling as though you aren’t conforming to gender or sexual roles when everyone expects you to do so is traumatizing.

It can also be challenging for straight people who have SO-OCD. If you constantly fear that you might be gay, and you are surrounded by dozens of people you fear you may be attracted to, life can feel very stressful.

Sexual Orientation Obsessive Compulsive Disorder in Adults

If there is one benefit about being a teen experiencing SO-OCD, it is that teens are expected to feel turmoil surrounding their sexuality. While that doesn’t make it pleasant for them (far from it), society does give a margin in which young people can safely flail while figuring themselves out.

Adults are not so fortunate. For many people, choosing a partner does not require first thinking through whether or not their gender is a problem. They simply choose the gender and sexual orientation that fits.

People with SO-OCD don’t have that luxury. Even more challenging, though: the adults with whom they might potentially partner expect them to. There is little room for error. Adults are less willing to spend time “figuring things out” than teens are.

In adults, SO-OCD might not be as noticeable as it is in youth, who have more social situations they may feel the need to escape. But adults with SO-OCD struggle with healthy romantic relationships and disrupt their schedules to perform pointless rituals. The effects can be just as damaging.

What You Need To Know About ERP

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Exposure and response prevention (ERP) therapy is one of the most effective forms of treatment for OCD. Learn more about how ERP works, who benefits from this therapy, and how to find a clinician trained to provide ERP.

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How Sexual Orientation Obsessive Compulsive Disorder Is Diagnosed

The difference between passing thoughts and true obsessive compulsive disorder is the disruption it creates in your life. The obsessions of OCD are unwanted and intrusive thoughts. The compulsions, while done in response to the obsessions, are repetitive and do not bring pleasure.

If you are constantly torn between your believed identity and the “what-ifs” that make you question it, that is obsession. If you feel the need to change your behavior, usually significantly, to try and make up for these thoughts, that’s compulsion. Together, they form OCD. And if your thoughts and behaviors surround your fears that you are of a sexual orientation other than the one you identify with, that’s SO-OCD.

In order to get a true diagnosis, you will need to speak to a mental health professional. It’s important to find a therapist who specializes in treating OCD. Therapists who are inexperienced in treating OCD may confuse the symptoms of SO-OCD with anxiety and depression related to sexual-identity conflict.

SO-OCD can also be difficult to diagnose because symptoms more frequently include mental compulsions (e.g., saying a “magic word” in one’s head, mental checking behaviors, etc.) and reassurance seeking rather than overt rituals (e.g., turning a light switch on and off a certain number of times).

Your mental health professional will ask you questions regarding your thoughts and actions, and form a diagnosis.

If diagnosed with OCD, they will prescribe a course of treatment that should include a specific form of cognitive behavior therapy called exposure and response prevention (ERP) therapy. In some cases, they will prescribe medication—or refer you to a psychiatrist who can do so.

Management of Sexual Orientation Obsessive Compulsive Disorder

SO-OCD is a form of OCD: it is not a gender or sexual orientation crisis in the classic sense, because deep down the person does know the truth about their orientation. They just have trouble believing it due to the constant presence of misleading and distressing thoughts.

These thoughts cause them to perform ritualistic behaviors, which further contribute to their OCD.

To help someone with SO-OCD, they need assistance to change the behaviors and their relationship with the thoughts and anxiety so that they can experience freedom from their OCD symptoms.

In this article from the International OCD Foundation, a clinician describes how he diagnoses and treats SO-OCD

Exposure and Response Prevention Therapy

As the name suggests, this form of cognitive-behavioral therapy rests on the idea that triggering situations and thoughts are at the core of OCD. Ongoing exposure to these triggers without engagement in rituals can reduce their incidence and severity. This can take the following forms:

  • Reading or listening to stressful material to reduce its upsetting effects
  • Repeating anxiety-inducing phrases or ideas until they lose their meaning and stop causing distress
  • Coming into contact with items that trigger one’s OCD, such as pictures of members of the same/opposite sex (depending on one’s sexual orientation)
  • Reducing avoidance of people, places, or things that one would typically engage with but has been avoiding due to OCD fears

For successful outcomes of ERP, it is important to note that exposures should be done with ritual prevention. Rituals (mental or external compulsions) that someone would typically engage in should be prevented after exposures.

Successful ERP treatment involves the removal of rituals and avoidance, as well as the addition of exposures. People who actively engage in ERP should see their insight increase and their OCD symptoms decrease. By doing so, they can live a full life with freedom from OCD.

Medication Can Also Help

Even slight imbalances in brain chemistry can make it difficult to impossible to block out negative thoughts or address doubts.

Medication that balances that chemistry is often needed, and may make therapeutic sessions much more fruitful.

McLean: A Leader in OCD Care

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Do you feel alone in your battle against OCD? Our expert treatment team is ready to teach you the critical skills that will help you successfully manage your OCD. Contact us today.

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Fact vs. Fiction Around Sexual Orientation OCD

Myth: Sexual Arousal and Sexual Orientation Are the Same Thing

Sexual arousal in any sexual situation is normal. Straight people can become aroused by gay imagery, real or imagined. Gay people may find straight sex appealing in idea if not in practice. It is not true that becoming aroused at a thought of being gay means you are gay, or vice versa.

Myth: Anxiety and Sexual Arousal Are the Same Thing

As discussed above, anxiety and sexual arousal share some common features. Intrusive thoughts can cause nearly the same physical reaction as erotic ones. They are not the same thing, though.

Just because both types of thoughts make it challenging for you to think about anything else does not mean you are aroused by triggering material or circumstances. It may simply mean you are anxious about it as a result of intrusive thoughts.

The same goes for increased pulse, heavy breathing, or the inability to look away.

Myth: You Definitely ARE the Orientation You Fear

No. You can fear you are gay and be straight, and vice versa.

Myth: You Definitely ARE NOT the Orientation You Fear

This is also not true. You may fear being gay and it may turn out to be true, and vice versa. If this is the case, these thoughts may not be SO-OCD, which means a fear unrelated to your actual sexuality. However, you will need to discuss this with a mental health care provider to find out where that fear is coming from and how you can openly live as who you are.

There Is Help and Hope for Sexual Orientation Obsessive Compulsive Disorder

SO-OCD is a serious and distressing mental health problem, but it is treatable. It can be confusing to constantly doubt your sexual identity—and exhausting to try to relieve that doubt. You are not alone, though. There are others who understand what you’re going through and who can help you obtain freedom from your OCD.

If you think you may be struggling with SO-OCD, reach out to a mental health professional who specializes in OCD. With the right help, you can find relief from your obsessions, and engage more fully with life.

Want More Information?

Looking for even more information on sexual orientation OCD, OCD, or LGBTQ+ support resources? You may find these resources helpful:

OCD Resources

International OCD Foundation
The mission of the International OCD Foundation is to help people affected by obsessive compulsive disorder and related disorders live full and productive lives. The IOCDF aims to increase access to effective treatment through research and training, foster a hopeful and supportive community for those affected by OCD and the professionals who treat them, and fight the stigma surrounding mental health issues.

OCD Massachusetts
As a non-profit affiliate of the IOCDF, OCD Massachusetts aims to provide public and professional education about OCD to raise awareness and improve the quality of treatment provided in Massachusetts. They also work to improve access to resources for those with OCD and their families and advocate and lobby for the OCD community in Massachusetts.

LGBTQ+ Resources

The Trevor Project
The Trevor Project’s main goal is to end suicide among LGBTQ youth. They do this through crisis services for those in need, and public advocacy and education to spread useful information for allies, friends, and family. The Trevor Project also offers a national hotline via phone, text, and online chat. Counselors are trained to help LGBTQ young people with a variety of problems they may be facing.

PFLAG is an organization founded in 1973 “dedicated to supporting, educating, and advocating for LGBTQ+ people and their families.” The organization focuses on how important family support and acceptance are for the well-being of an LGBTQ individual.

GLAAD was founded in 1985 in response to media coverage of the AIDS epidemic. Their mission continues to be fighting for the acceptance of LGBT individuals. They do a lot of work to spread messages of acceptance and hold those who stand in the way of their mission accountable, but they also do work to support and uplift the LGBTQ community.

LGBT National Hotline
This is a hotline for peer support for the LGBTQ community. The trained volunteers identify somewhere on the LGBTQ spectrum, and they can help listen or advise a caller on issues from coming out to bullying to relationship problems and more.