Sexuality OCD

What is Sexual Orientation OCD (SO-OCD)?

Sexual Orientation OCD (SO-OCD) is a subtype of Obsessive-Compulsive Disorder (OCD) that involves intrusive thoughts and compulsive behaviors related to doubts about one’s sexual orientation. Individuals with SO-OCD experience persistent fears about whether their sexual orientation might differ from what they have always believed it to be (e.g. worries about wether I am gay or not?). These fears are not really about actual sexual orientation but rather an overwhelming need for certainty and an inability to tolerate doubt about one's sexual oritentation.

Sequence of Experiences in SO-OCD:

1. Triggers:

   • Seeing someone attractive and questioning feelings about them.

   • Watching movies or reading material featuring different sexual orientations.

   • Experiencing confusing physical sensations, such as arousal, and doubting what they mean.

   • Hearing discussions about sexual orientation or LGBTQ+ topics.

   • Experiencing dreams or fantasies that raise questions about attraction.

2. Core Fears:

   • Fear of being in denial about one's “true” sexual orientation.

   • Fear of life being ruined due to a sudden realization about one’s sexuality.

   • Fear of harming others emotionally, such as a partner, if one’s orientation changes.

   • Fear of being a "bad person" for having certain thoughts.

3. Compulsions / Safety Behaviors: Compulsions are actions taken to reduce anxiety caused by intrusive thoughts. For SO-OCD, these may include:

   • Repeatedly checking feelings or bodily sensations for signs of attraction.

   • Seeking reassurance from friends, partners, or online forums about sexual identity.

   • Avoiding situations that might trigger doubts, such as change rooms or dating.

   • Reviewing past memories to analyze interactions for signs of attraction.

   • Engaging in mental rituals, such as repeating affirmations about one’s sexuality.

What Causes Sexual Orientation OCD?

SO-OCD likely develops from a combination of genetic, environmental, and psychological factors:

• Genetics: OCD often runs in families, suggesting a hereditary component.

• Brain Differences: Abnormal activity in the orbitofrontal cortex and anterior cingulate cortex has been linked to OCD.

• Childhood Experiences: Early experiences of bullying, rejection, or rigid cultural or religious beliefs may create sensitivity to doubts about identity.

• Stress and Trauma: Major life changes or stress can exacerbate OCD symptoms.

• Personality Traits: People with perfectionistic tendencies and intolerance for uncertainty are more prone to OCD.

How Do You Treat Sexual Orientation OCD?

The gold-standard treatment for SO-OCD is Exposure and Response Prevention (ERP), a form of Cognitive Behavioral Therapy (CBT). ERP helps individuals confront their fears without performing compulsions, reducing anxiety and building tolerance for uncertainty.

• Exposure Therapy: Patients are gradually exposed to thoughts, situations, or images that trigger anxiety while resisting compulsions. For example, they might read LGBTQ+ articles or watch movies with diverse sexual orientations.

• Response Prevention: Patients practice avoiding compulsive behaviors such as reassurance-seeking or mental reviewing. Instead, they learn to sit with uncertainty and discomfort.

• Cognitive Restructuring: Therapists help patients challenge irrational beliefs, such as the idea that a fleeting thought or feeling determines their sexuality.

• Medication: Selective serotonin reuptake inhibitors (SSRIs) may be prescribed to help reduce symptoms.

ERP is highly effective, with most patients experiencing significant improvement. Success depends on consistency, and a willingness to face fears.

Summary

Sexual Orientation OCD (SO-OCD) causes individuals to experience distressing doubts about their sexual orientation, leading to compulsive behaviors aimed at achieving certainty. Despite being unrelated to actual sexual identity, these doubts can be debilitating. SO-OCD often arises from genetic, neurological, and psychological factors. Effective treatment, particularly ERP, helps individuals face uncertainty, resist compulsions, and regain control over their life. With the right support, people with SO-OCD can lead fulfilling lives free from the grip of obsessional doubt.

Sources

• https://www.ocduk.org/ocd/clinical-classification-of-ocd/dsm-and-ocd/

• https://www.treatmyocd.com/blog/what-is-sexual-orientation-ocd-so-ocd-your-guide-to-this-ocd-subtype

• https://www.mcleanhospital.org/essential/so-ocd

• https://iocdf.org/expert-opinions/sexual-orientation-obsessions/