Sexual orientation OCD is a subtype of OCD that includes obsessive, intrusive doubts and worries about not knowing for certain your sexual identity. This can look like intrusive, unwanted sexual thoughts, images and/or urges about individuals that don’t fit with what you believe your current sexual identity to be. It also includes compulsive behaviors such as checking for feelings or attractiveness, groinal response checking, avoidance behaviors, ruminating/replaying, reassurance-seeking, and more. 

This subtype used to be referred to as homosexual OCD (HOCD), but that does not accurately encapsulate what this subtype actually looks like. You do not have to be a straight person who worries ‘what if I’m actually gay and just don’t know it yet?’ to have sexual orientation OCD. Individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, or asexual can also have sexual orientation OCD. Sexual orientation OCD is chronic doubt about the sexual orientation you identify with. What if I’m actually a different sexual orientation and am just lying to myself and everyone else and don’t really know who I am? What if I realize later in life that I actually identify with a different sexual orientation and hurt the person I am with? What if I’m suppressing or denying my true sexual orientation/identity? What if I’m attracted to people that don’t fit with my sexual orientation? Each of these are examples of intrusive, obsessive thoughts that would fit within this subtype of OCD regardless of the sexual orientation an individual identifies with. 

One of the problems with calling sexual orientation OCD homosexual OCD is the misconception that it only impacts heterosexual individuals who are worried that they could be homosexual. Another problem is that individuals tend to assume that anyone with homosexual OCD must be homophobic. This is not true. At the heart of sexual orientation OCD is excessive fear that the sufferer doesn’t truly know, and can never know, how they identify sexually and that means they could hurt loved ones and/or experience intense pain themselves, both of which they want to avoid having happen. Most individuals with sexual orientation OCD do not judge others who identify with different sexual orientations. They might have urges to avoid others that identify with a different sexual orientation due to fears that they will experience an awakening that changes their entire life, which is scary because of the uncertainty that comes with it (i.e. I’d have to give up everything I know and am comfortable with along with the hopes/visions I had for my future). The key piece here is the fear of not knowing for sure which means something bad could happen or everything an individual thought was true could completely fall apart, not that the sexual orientation they fear they might be suppressing is inherently bad or wrong. 

Another key aspect of sexual orientation OCD is black-or-white thinking that we all must fit into one of those sexual orientation categories or boxes perfectly (LBTQIA+). If I identify as lesbian and have sexual thoughts about individuals of the opposite sex that must mean I’m not a true lesbian. If I identify as gay, I cannot find individuals of the opposite sex attractive and must find all individuals of the same sex attractive. If I identify as bisexual I must find all genders attractive and if I don’t find someone attractive that must mean I’m not actually bisexual. If I identify as straight, I can never have a sexual thought about someone of the same sex. If I feel a groinal response when thinking about someone that doesn’t fit with my sexual orientation, that must mean I’m in denial of who I truly am. These are all cognitive distortions used to question or doubt sexuality when the reality is that sexuality is more fluid than that and we simply cannot control the thoughts that pop into our heads (we can only control our reaction). We don’t fit perfectly into any categories in life. Being human is more complicated than that. 

How can you be certain of your sexual identity no matter how you identify? You can’t be. And that feels intolerable to individuals with OCD. ERP for sexual orientation OCD works to change the relationship individuals have with their thoughts and feelings, incorporates psychoeducation about human sexuality, exposes individuals to intolerable thoughts/images/fears, increases flexibility for black-or-white thinking, challenges thought-action fusion, and helps individuals get comfortable not knowing their sexual orientation for certain while still engaging in life.