Sexual Obsessive-Compulsive Disorder (Sexual OCD) and Sexual Orientation OCD (SO-OCD) are two distinct but related manifestations of obsessive-compulsive disorder that revolve around intrusive and distressing thoughts and doubts regarding one’s sexual identity, desires, or orientation. While both conditions share common themes of uncertainty and distress, they differ in their focus and impact on an individual’s understanding of their sexuality. In this post, we will delve into the characteristics, symptoms, and treatment considerations of Sexual OCD and Sexual Orientation OCD, shedding light on these complex aspects of the broader spectrum of obsessive-compulsive disorders.

What is Sexual Orientation OCD?

(SO-OCD) is a sub type of OCD that is seen as intrusive thoughts/obsessions and compulsions surrounding a persons sexual orientation/sexuality. (SO-OCD) has been referred to in the past as Homosexual OCD or HOCD but this term has been discouraged due to lack of sensitivity and accuracy.

(SO-OCD) Fears

Do I have a sexual orientation other than the one I thought I had?

Denial of their “true” sexual orientation.

Sexual orientation could abruptly change (e.g., “turn” gay or straight).

(Will their relationship with their current partner end? Can they ever feel truly secure in their sexuality?)

Common (SO-OCD) Obsessions

Doubts about my sexual orientation.

What if I’m gay and I don’t know?

What if I’m actually straight and I don’t actually love my partner?

I got sexually aroused when watching a sex scene from a movie. What does this mean about me?

Doubts about my behaviors- Did I look at that person in a sexual way? What if I am not straight?

What if my orientation changes in the future?

Common (SO-OCD) Compulsions

Avoidance Behaviors-Avoidance of certain people/places/situations. I might avoid the gym, sex scenes in movies, certain stores or places.

Checking Behaviors- Checking physical behaviors. Looking for groinal responses. Being hyper-aware of the physical sensations they are experiencing. Obsessing with this groinal response and viewing this as proof of their true sexual orientation.

Compulsive porn watching as a way of confirming or disproving their doubts.

Mental Review- Replay certain memories over and over again. Reviewing a certain moment compulsively. Questioning my behaviors or what I had said. Trying to get that 100% certainty over my actions.

Reassurance Seeking- Asking my friends or loved ones trying to get the reassurance over my doubts. Looking for them to give me the answer. This could look like asking someone physically or making posts online looking for the reassurance.

Researching- Spending excessive time on message boards, Reddit, Youtube etc. Similar to reassurance seeking behaviors.

Praying: People with SO-OCD may pray excessively. Praying often throughout the day or week. Looking to find clarity on their sexual orientation or for forgiveness for perceived “sins.”

Sexual identity is an important part of how we view ourselves. Most people have little trouble knowing who they find attractive. Varying factors, like religion, community values, social fears, etc., may create obstacles for someone trying to actualize their inner self. The obsessive thoughts associated with SO-OCD can cause confusion and fear. These thoughts can be extremely distressing and lead to a negative impact on ones functioning. SO-OCD is a form of OCD: it is not a gender or sexual orientation crisis in the average sense. Looking at oneself, the person does know the truth about their orientation. But with OCD being the doubting disorder, the person will have trouble believing that general intuition due to the constant obsessions and doubts.

What is Sexual OCD?

OCD can manifest in a wide array of sub-types, including sexually-based thoughts. Sexual OCD obsessions might involve the person experiencing obsessive thoughts about sexual themes that can range from mild to violent ones. These thoughts and fears are unwanted and intrusive. As a result of the obsessions and fears, a person might engage in a compulsive behavior in order to get relief from these obsessions. Obsessions could include intrusive thoughts, images, urges, doubts and fears. Sexual OCD is an overwhelming and uncomfortable sub type for someone that could make them feel hesitant to wanting to start therapy. Confusion can arise in seeing the difference between sexual fantasies and sexual obsessions. Sexual fantasies might provide pleasure while obsessions and fears cause distress. A person might feel disgust, anger, shame, embarrassment about these thoughts. As a licensed therapist specializing in OCD, trained in ERP, I am able to help improve your understanding of this sub type and to implement the effective change.

Common Sexual OCD Obsessions

Fear of being attracted to a family member, animal, dead/inanimate objects, or children

Far of committing a sexually heinous act

Fear of becoming violent during sex

Intrusive thoughts or images about distressing sexual acts with undesirable entities, such as children or animals

Common Sexual OCD Compulsions

Performing mental rituals to replace unacceptable sexual thoughts with acceptable sexual thoughts

Avoiding sex so they do not harm their partner

Avoiding situations where they may interact or encounter a subject of their intrusive thoughts

Mentally reviewing past sexual behaviors for signs of perversion or depravity

Checking for genital arousal when encountering or interacting with the subject of their obsessions

Sexual OCD and Sexual Orientation OCD Treatment Using Exposure Response Prevention

ERP is a collaborative approach that you and I will do together. Exposures are done in a gradual sense that we will develop together early in sessions. We will develop a list of fears/obsessions/exposures in a hierarchical fashion. ERP will teach you how to cope by approaching fears rather than avoiding them. Success with ERP starts with a gradual approach. Starting with facing obsessions/fears that cause the lowest level of distress. By approaching ERP in a gradual manner, we can continue to learn and practice through each exposure effective response prevention and make progressive progress. We do not want the distress to get too high at the start that we are not able to use effective response prevention. Having a solid foundation of response prevention and plans of exposures will ensure we are following evidence based protocols.

What Is Exposure and Response Prevention Therapy?

Exposure and Response Prevention Therapy (ERP) is a form of Cognitive Behavioral Therapy (CBT) developed specifically to address Obsessive Compulsive Disorder (OCD). ERP is an evidenced based practice. Our thoughts, feelings and behaviors are all interconnected. Within the OCD cycle, we think about the thing we’re afraid of, we feel fear which causes us to behave/respond in fearful ways in order to achieve short term relief. OCD relies on the illusion of control and worry.

ERP is broken in two parts. Exposures, which are stimuli or situations that are meant to illicit distress. Exposures can be things that you and I read, write, watch, talk about, imagine, or physically do. The goal of the exposure is to illicit distress and focus on the obsessions/fears that you hold. Exposures target obsessions/thoughts/fears. The second part of ERP is response prevention. Response prevention will target compulsions/behaviors. Response prevention will include resistance of compulsive behaviors and measures to use to help manage distress.

With ERP, we are gradually looking to exposure ourselves to the feared stimuli. To confront what causes you distress and resist the urge to engage in the compulsion to get that short term relief. OCD offers up the short term relief of the compulsions which leads us to long term distress as the OCD cycle is continued to be reinforced. While ERP is feeling short term distress with the exposures, it will eventually lead to long term relief as you break the OCD cycle.

Outcomes of ERP

That anxiety/distress will lessen the longer you stay in the distress.

You’ll learn the feared outcomes are more bearable than you expected.

You can tolerate distress better than you thought and without compulsions.

Distress lessening over time.

Learn to accept uncertainty behind the obsessions.

Acknowledge unwanted thoughts/images/urges without feeding into them/engaging with them.

Challenge the way we think.

Learn that fear is uncomfortable but not dangerous.

Becoming comfortable with the uncomfortable.

Like all skills, ERP needs to be practiced in and outside of the therapy sessions. The more practice, the more confident you will become in your ability to manage distress without compulsions.

ERP is a collaborative approach that you and I will do together. Exposures are done in a gradual sense that we will develop together early in sessions. We will develop a list of fears/obsessions/exposures in a hierarchical fashion. ERP will teach you how to cope by approaching fears rather than avoiding them. Success with ERP starts with a gradual approach. Starting with facing obsessions/fears that cause the lowest level of distress. By approaching ERP in a gradual manner, we can continue to learn and practice through each exposure the effective response prevention and make progressive progress. We do not want the distress to get too high at the start that we are not able to use effective response prevention. Having a solid foundation of response prevention and plans of exposures will ensure we are following evidence based protocols.

Habituation and Inhibitory Learning

During exposure and response prevention (ERP), repeated exposures along with effective response prevention that leads to reduction in distress is called habituation. When you are experiencing habituation or have habituated, you have learned to tolerate anxiety/distress that is brought on by the obsessions without having to engage in a compulsion. That with time, the distress decreases naturally. Habituation is like jumping into a cold pool. I am staying in the cold water until my body acclimates or habituates to the temperature. I am not able to habituate to the temperature if I jump out of the pool the moment by body hits the cold water. During ERP, signs of habituation can show progress.

Habituation is not the only sign of progress in ERP, inhibitory learning can be involved. Inhibitory learning involves a fear or a belief that is inhibited by additional knowledge and experiences. An example of inhibitory learning can be seen with compulsions of washing clothes excessively. If I fear that I will get sick if I do not wash my clothes every day, and I resist the compulsion to wash over and over, you will come to learn that the compulsion was not necessary in keeping you safe. Inhibitory learning looks to add the knowledge and beliefs about these events through the experiences you engage in. My new take away after the repeated exposures becomes that I did not get sick as a result of not washing my clothes every day. This new information inhibits the old belief that I “had” to wash my clothes every day in order to not get sick.

While we look for habituation and inhibitory learning during ERP, there are also other things that can indicate that ERP is working and that you are developing the skills you need to manage OCD in the long term such as:

Developing acceptance of uncertainty and unpredictability.

Strengthening your connection with your values and identity.

Willingness to enter into uncomfortable situations.

Greater tolerance for anxiety, levels of anxiety may remain the same or fluctuate.

Final Thoughts on Treating Sexual OCD and Sexual Orientation OCD (SO-OCD)

Thank you for reading this resource on Sexual OCD vs Sexual Orientation OCD: Treatment Using Exposure and Response Prevention. I hope you found this resource helpful in understanding the difference between Sexual OCD and Sexual Orientation OCD, as well as how ERP can treat these conditions.

If you need help with either Sexual OCD or Sexual Orientation OCD, I can help. Contact me today!