Sexual orientation OCD — often called homosexual OCD — refers to obsessions and compulsions around doubting your orientation.
Many people question their sexual orientation over the course of their lives. This isn’t necessarily a cause for concern — in fact, it can be healthy. But if you develop obsessions and compulsions around your orientation, you could have sexual orientation obsessive-compulsive disorder (OCD).
Though it’s often called homosexual OCD (HOCD), people of all orientations can experience sexual orientation OCD.
Sexual orientation OCD is an OCD theme rather than a subtype. For example, contamination OCD, symmetry OCD, and religious OCD are all themes.
You might experience a few themes that can overlap and change over time. If you have sexual orientation OCD, you may or may not also experience other themes.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) doesn’t distinguish between different types of OCD, which means that sexual orientation OCD is not considered a separate disorder.
Sexual orientation obsessions are distressing thoughts in which you constantly doubt your orientation. This can happen to people of all orientations — it’s not limited to heterosexual people who have obsessions around being homosexual.
It’s important to note that there’s nothing wrong with being LGBQ. There’s also nothing wrong with experimenting or questioning your sexual orientation. But if you develop obsessions or compulsions around questioning your orientation, that is cause for concern.
By definition, obsessions — when it comes to OCD — are upsetting, persistent, intrusive thoughts and images.
So, if you’re questioning your orientation or curious about your sexuality, that’s OK. But if you’re constantly distressed about it, or if you’re developing time-consuming compulsions around it, you might want to reach out for help.
You might wonder whether it’s homophobic or heterosexist for a straight person to fear so deeply being homosexual. Homophobia isn’t necessarily at the root of HOCD — more often than not, the fears relate to losing a sense of identity due to their orientation changing or hurting others (e.g., a spouse or partner).
For many people with OCD, doubt and uncertainty are intolerable, so not knowing can, in itself, be upsetting.
The DSM-5 notes two significant symptoms of OCD: obsessions and compulsions. To be diagnosed with OCD, you must fit the following criteria:
- You experience obsessions, compulsions, or both.
- Your obsessions or compulsions take up at least an hour every day.
- Your obsessions or compulsions cause you significant distress or affect your day-to-day functioning.
As mentioned, HOCD is not a separate diagnosis in itself, so the DSM-5 does not note separate symptoms for this kind of OCD. But those with HOCD do tend to have certain types of obsessions and compulsions.
HOCD-related obsessions can include anxiety about the following:
- your orientation changing
- being seen as having another orientation
- hurting your partner by becoming another orientation
- being in denial about your orientation
- relationship issues or sexual performance issues arising because of a change in orientation
- losing your identity or community
Compulsions are actions or rituals that are meant to neutralize or get rid of these obsessions. They often include seeking reassurance or “testing” your orientation.
HOCD-related compulsions can include:
- Overanalyzing your feelings toward others to see whether you’re attracted to their gender.
- Repeatedly asking yourself whether you’re a different orientation than how you identify.
- Asking people you’re close to if they think you could be that orientation.
- Watching pornography or looking at attractive photographs of people to test whether that gender appeals to you.
- Avoiding “looking” like someone of another sexual orientation so as not to be mistaken for a person with a different orientation, possibly by avoiding clothing and behavior that fits into stereotypical ideas of that orientation.
- Avoiding discussions on sexual orientation.
It’s worth repeating that it’s OK to question your sexual orientation. Still, when your obsessions or compulsions around it become time-consuming and distressing, you might fit the definition of OCD. In this case, you could benefit from talking with a therapist.
There are various forms of treatment for OCD. When it comes to sexual orientation OCD, the treatment should address the obsessions and compulsions without trying to “change” your orientation.
“Treatments” that try to change your orientation are called conversion therapy. Conversion therapy can be extremely harmful, and it is not evidence-based. There is no evidence that any form of therapy can change your orientation.
The point is not to change your orientation but to help you work through distress around doubting and questioning your orientation.
The most common treatment for OCD is a kind of cognitive behavioral therapy (CBT) called exposure response prevention (ERP) therapy. It involves allowing yourself to experience obsessions without engaging in compulsions. ERP is done under the supervision of a qualified professional.
If you feel that your OCD affects your relationship, relationship counseling might be beneficial for you and your partner.
Other kinds of talk therapy, such as acceptance and commitment therapy (ACT), can also be helpful.
Some people with OCD could also benefit from medication, such as selective serotonin reuptake inhibitors (SSRIs). In this case, you’ll need a prescription from a medical professional, such as a psychiatrist.
Therapy should be your first port-of-call if you have or suspect you have OCD. There are, however, some things you can do at home to help with your OCD symptoms. These suggestions should supplement therapy, not replace it.
Some helpful ways to cope with OCD include:
- basic self-care, such as eating nutrient-based meals and sleeping adequately to prevent mood disruptions
- exercising, which a 2018 review suggests can help with OCD symptoms
- yoga and meditation, which might benefit people with treatment-resistent OCD, according to
2019 research - mindfulness, which
2020 research suggests can help reduce OCD symptoms when combined with ERP therapy - doing OCD workbooks, such as Getting Over OCD: A 10- Step Workbook for Taking Back Your Life and The Mindfulness Workbook for OCD
- joining OCD support groups, such as those on the International OCD Foundation (IOCDF) support groups list
- managing stress in healthy ways, such as through creative hobbies, journaling, and reducing unnecessary responsibilities
Guided by a therapist, you can find other ways to cope with OCD and doubts around your sexual orientation.
Sexual orientation OCD, like all kinds of OCD, is treatable, and many people who have OCD learn to manage their symptoms in a healthy way. Finding a therapist is a good first step when facing OCD.
You might also benefit from seeking OCD resources. The IOCDF offers an OCD therapist directory and local support finder and a directory of OCD support groups.
Everything OCD is a helpful Facebook page for OCD support.