Treating Sexual Orientation OCD in a Culturally Sensitive Manner
Obsessive Compulsive Disorder (OCD) is characterized by distressing, unwanted intrusive thoughts, images, or urges that can occur with or without compulsions, or actions taken in response to the obsession for the purpose of decreasing one’s distress. OCD can be experienced in a variety of ways, causing a wide range of fears from germs to suicide. While some subtypes are commonly talked about and widely understood (ex: contamination, perfectionism, or just right OCD), there are some forms of OCD that are considered to be “taboo” and consequently less understood. This article focuses on discussing sexual orientation OCD (SO-OCD) and providing recommendations on how to treat it effectively.
What is Sexual Orientation OCD?
SO- OCD, formerly known as Homosexual OCD, is a common subtype of OCD in which the individual experiences doubt about their true sexual orientation. This form of OCD can impact individuals of all sexual orientations and tends to include concerns about one’s ability to live an authentic life. Common compulsions include rumination, checking for signs of attraction when around specific individuals, mental reviews of interactions with triggering individuals, researching topics such as “How do I know if I am gay,” avoiding specific people, topics of conversation, or places, and watching specific media to determine if they are sexually aroused by certain love scenes.
How SO-OCD is Treated
Historically, we have treated SO-OCD through exposures that may be triggering or offensive to the LGBTQ+ community. For example, we may have encouraged someone to watch videos in which a same-sex couple kisses while tolerating their feelings of disgust or talk to someone who “looks gay.” While these exposure may seem logical through solely ERP lens, they are inadvertently reinforcing negative stereotypes of the LGBTQ+ community as well as contributing to the minority stress felt by clients, clinicians, and the greater community. Asking someone to stand next to a stranger that “looks gay,” for instance, reinforces the belief that people who identify as being gay have a specific look. Pairing disgust to a video of a same-sex couple kissing is facilitating the belief that there is something wrong with this expression of affection.
Continuing to treat SO-OCD this way also impacts our ability to target the true underlying fear that is supporting this type of OCD. For instance, for many individuals who experience SO-OCD fear, their underlying fear is that they may be leading an inauthentic life. For others, they fear that their realization of their true sexual orientation may inadvertently hurt someone they love (i.e., hurt their spouse) or cause a huge disruption for their family. It is for this reason that it is imperative that we take time to fully understand one’s SO-OCD before jumping into exposure work.
If an individual is fearing the possibility of leading an inauthentic life, exposures should target this fear directly. That is, clinicians can encourage their patient to write an imaginary script in which they wake up one day and realize that their life has been inauthentic. Perhaps the patient may also benefit from watching movies or videos in which someone is leading an inauthentic life. These types of exposures are more effective as they not only target the true fear, they do so in a way that is respectful to all.
How to Take Care of Yourself – Tips for Clinicians
As clinicians, we often focus so much on our patients that we forget to check in with ourselves about how this work is impacting us. It is important to recognize how helping someone overcome their SO-OCD may impact you on a personal level. We recommend engaging in regular check-ins with yourself to determine if the work is causing you stress of any kind. Seek consultation when appropriate and engage in regular self-care. Recognize how your patient’s fears may be targeting some of your fears, beliefs, insecurities, etc.
For more on this topic, read “Call to Action: Recommendations for Justice-Based Treatment of Obsessive-Compulsive Disorder With Sexual Orientation and Gender Themes” (Pinciotti, C. M. et al., 2022).
Alejandra “Ally” Sequeira, PhD is a psychologist, licensed in Texas, California, and through PSYPACT. She obtained her doctorate in Counseling Psychology and Masters of Education in Educational Psychology from Texas A&M University. She is the owner of Houston OCD & Anxiety where she provides individualized, evidence-based treatment to children, adolescents, and adults with OCD, OCD-related disorders, anxiety disorders, disordered eating, depression, parenting-related challenges, and other life stressors in both English and Spanish. She is a graduate of the IOCDF BTTI and TLC Foundation for Body-Focused Repetitive Behaviors’s Virtual Professional Training Institute and is trained in Supportive Parenting for Anxious Childhood Emotions. She serves as the Secretary of the Houston Psychological Association Board and is a volunteer for OCD Texas.