Understanding sexual orientation OCD: Symptoms & treatments

Key Takeaways

Sexual orientation OCD involves a cycle of distressing intrusive thoughts (obsessions) followed by repeated ritualistic behaviors (compulsions) related to one’s sexual orientation.

Questioning your sexuality or experiencing your sexuality as something fluid doesn’t mean you have OCD. To have OCD, the intrusive thoughts and compulsive behaviors must have a significant negative impact on your daily life.

Left untreated, sexual orientation OCD can create a pattern of unwanted thoughts and behaviors that can get in the way of a person’s ability to function. Fortunately, these symptoms can be managed with the right support.

Questioning your sexual orientation is an incredibly common experience. This is because sexual attraction can evolve, and there may be times when you feel unsure about your identity. While this uncertainty can be a little confusing or unsettling, it will typically resolve as you gain new experiences. However, this is not the case for people living with a presentation of obsessive-compulsive disorder (OCD) symptoms called sexual orientation OCD.

This presentation of OCD symptoms causes persistent doubts about one’s “true” sexual orientation. Despite having a clear understanding of their sexual identity at one time, people living with sexual orientation OCD experience intrusive thoughts about their attractions. They excessively question who they really are and often worry about being inaccurately perceived as gay, straight, etc.

Fortunately, like other forms of OCD, help is available for sexual orientation OCD. By working with a therapist, people living with this condition can learn to better understand themselves, affirm and embrace their sexual orientation, and manage their OCD symptoms.

What is sexual orientation OCD?

OCD involves a cycle of obsessions, compulsions, or both that are difficult to control without support. Obsessions are unwanted, recurring, intrusive thoughts, urges, or images that cause distress or anxiety. In the case of sexual orientation OCD, someone might experience an obsessive thought like:

“I used to be so sure I was gay. But what if I’m faking it? What if deep down I’m really straight? Everyone is going to know I’m an imposter.”

In response, the person might engage in ritualistic thoughts or behaviors called compulsions to reduce their anxiety. So in this case, the person might repeatedly view photos of someone of the same gender to “check” their level of attraction to that person. This compulsive behavior might provide some short-term relief, but it usually makes the obsessions worse in the long term because, over time, a person can become dependent on the compulsion as a source of relief. And left untreated, the ongoing pattern of obsessions and compulsions brought on by OCD can be difficult to control.

It’s important to note that questioning your sexuality is often a normal part of being human. And many queer people experience their sexuality as something fluid that can shift over time. So just because you’re having doubts about your sexual orientation doesn’t mean you have OCD.

The difference between questioning your sexuality and having sexual orientation OCD

OCD can take many forms and can impact people of all genders and sexualities. On the surface, symptoms of sexual orientation OCD can look similar to the typical process of exploring one’s sexual identity that many people experience. But these are two distinct experiences, and it’s important to highlight the differences between them.

A person’s sexual identity can change over time. Feeling unsure who you’re attracted to or which terms best fit your identity are not signs of a mental health condition. It’s okay to feel unsettled about your sexual orientation sometimes or to spend a lot of time thinking about it, especially before coming out.

Two key differences between typical questioning about sexual orientation and sexual orientation OCD are the amount of distress caused and how much time someone spends on the obsessions and compulsions.

Anyone can have moments of anxiety or confusion about their identity or need some reassurance from others from time to time. But people experiencing sexual orientation OCD may spend hours fixating on their sexual orientation each day. This creates a distressing cycle of obsessions and compulsions that interrupts their ability to live their lives.

Symptoms of sexual orientation OCD

Common symptoms of sexual orientation OCD include:

Excessive worrying that you’re straight if you’re actually queer (or vice versa)
Experiencing distressing intrusive thoughts related to doubts around your “true” sexual identity or orientation
Feeling the need to frequently verify your sexual orientation (like viewing media of people of a certain orientation and checking on the ways your mind and body respond)
Seeking out reassurance from other people to confirm who you’re really attracted to
Feeling distressed by your confusion about who you’re attracted to

Constantly questioning who you are and who you’re attracted to can take a toll on your mental health and your relationships. But sexual orientation OCD isn’t really about sexual orientation. A person who experiences OCD with these themes doesn’t necessarily have distress about their identity so much as the uncertainty around it. Feeling out of control can quickly trigger OCD symptoms in someone who has this condition.

Someone experiencing sexual orientation OCD might say that deep down, they don’t care whether they’re gay, straight, etc. They just want to be certain who they’re attracted to. Not feeling like they have a concrete understanding of that part of their identity is the main source of their stress and anxiety. This feeling is common among all presentations of OCD because OCD symptoms are often related to a perceived loss of control and a desire to gain that control back.

What causes sexual orientation OCD?

Sexual orientation OCD is not a formally recognized mental health condition. However, according to one study, it’s something that affects almost 25% of people living with OCD at some time in their lives.

More research is needed to better understand the causes of this form of OCD. But some experts suggest that negative cultural beliefs about homosexuality could be a key contributing factor.

While we don’t have much data on what causes sexual orientation OCD specifically, there are some known factors that can increase your risk of developing OCD. These include:

Genetic factors: Having a first-degree relative, like a parent or sibling, who has OCD
Environmental influences: Experiencing childhood trauma like abuse or neglect
Brain structure: Having abnormalities in the areas of the brain that control emotions and behavior
Temperament and personality: Being a person who is naturally more likely to express negative emotions
Co-occurring conditions: Having another mental health condition, like anxiety or depression

Most effective treatment options for sexual orientation OCD

If you or someone you know is living with sexual orientation OCD, know that help is available. OCD is a highly treatable condition, and the following supports can help you manage your symptoms.

Cognitive-behavioral therapy (CBT): This therapy can help you interrupt irrational, unhelpful, or distressing thoughts related to sexual orientation. With CBT, you can learn to manage your thoughts, which can help you respond to stressful situations differently and reduce your compulsive behaviors.
Acceptance and commitment therapy (ACT): Another form of CBT, this therapy encourages you to see your behavior as changeable. ACT can help you increase your mental flexibility and improve your stress tolerance.
Exposure and response prevention (ERP): This is a subtype of CBT that can help reduce the distress you feel when you question your sexual orientation. It involves a slow, gradual exposure to stressors under the supervision of a trained therapist.
Medication: Sometimes, certain medications may be used to alleviate OCD symptoms. You can talk to your provider about whether this option is right for you.

The goal of treatment for sexual orientation OCD is not to determine one’s sexuality, although exploring that will likely be a part of therapy. Rather, it is focused on relieving the distress related to obsessions and compulsions.

Find care with Rula

Living with any form of OCD can take a toll on your mental health. Intrusive thoughts and compulsive behavior can make it difficult to live your life and maintain your relationships. But the good news is that OCD is treatable.

With help from Rula, you can connect with a therapist who takes your insurance and access the support you need to manage your symptoms. When you’re ready to begin your mental health journey, check out our therapist-matching program. In just a few clicks, you can find the right provider for your needs and make your first appointment as early as this week.