Sexual orientation OCD (SO-OCD) causes obsessive doubts and compulsive behaviors around one’s sexuality, leading to distress and a constant need for certainty. Exposure and response prevention (ERP) therapy is the most effective approach to treating SO-OCD, helping individuals tolerate uncertainty and reduce anxiety without relying on compulsions.
It’s completely natural to wonder about your sexuality from time to time. Questioning who you’re attracted to, reflecting on your identity, or even feeling uncertain at moments is a normal part of life. But when these thoughts feel constant—taking over your mind, causing distress, and leading you to check, analyze, or seek reassurance—it could be a sign of something more: sexual orientation OCD (SO-OCD).
SO-OCD is not about self-discovery but rather an obsessive, anxiety-driven need to be certain of your sexual orientation at all times. It can feel all-consuming, making you question what was once clear, replay past experiences for clues, or test your reactions to people in an attempt to “prove” your sexuality.
If this sounds familiar, you are not alone. SO-OCD is a serious and manageable condition, and understanding it is the first step toward getting relief.
What is sexual orientation OCD (SO-OCD)?
Sexual orientation OCD (SO-OCD) is a subtype of obsessive-compulsive disorder (OCD). All types of OCD are characterized by intrusive, unwanted thoughts, images, or feelings called obsessions. In response, people with OCD engage in compulsions—repetitive actions or mental rituals meant to relieve anxiety. However, the relief is only temporary, so the cycle of OCD continues.
In SO-OCD, this cycle revolves around your sexual orientation. It goes beyond curiosity, creating an overwhelming need for certainty, making it feel impossible to stop thinking about your orientation no matter how much reassurance you try to find. The fear isn’t about having any particular sexual identity—rather, it’s about the doubt itself and the distress that comes with not feeling 100% sure.
Community discussions
Is SO-OCD the same as HOCD?
SO-OCD was previously referred to as homosexual OCD (HOCD), but this term is now discouraged because it inaccurately suggests that SO-OCD only affects people who fear being gay. In reality, SO-OCD can affect anyone, regardless of their sexuality. As Dr. Nicholas Farrell, Director of Clinical Development & Programming at NOCD, explains, “The term ‘HOCD’ can be misleading because it implies that the fear is about being gay when, in reality, the core struggle in SO-OCD is an intolerance of uncertainty. People with SO-OCD aren’t necessarily afraid of a specific orientation—they’re afraid of not knowing for sure.”
The core struggle in SO-OCD is an intolerance of uncertainty. People with SO-OCD aren’t necessarily afraid of a specific orientation—they’re afraid of not knowing for sure.
Dr. Nicholas Farrell
Anyone can experience SO-OCD
It’s important to note that SO-OCD is not reliant on someone’s actual sexual orientation. You can be straight and have SO-OCD. You can be gay and have SO-OCD. You can be bisexual, asexual, or anywhere on the spectrum and still have SO-OCD. The intrusive doubts don’t reflect your real identity—they’re part of an obsessive cycle that makes it feel like you need to “figure it out” over and over again.
Sexual orientation OCD (SO-OCD) symptoms
People with SO-OCD experience intense fears and doubts about their sexual orientation, often feeling the need to analyze their thoughts, feelings, and behaviors for signs of “proof.” They may question whether they’re truly the orientation they’ve always identified with or worry that their sexuality could suddenly change. As Dr. Farrell explains, “People with SO-OCD aren’t just curious about their sexuality—they feel a persistent, distressing need for certainty. Their minds become stuck in a cycle of doubt, making it difficult to feel secure in their identity.”
Like all forms of OCD, the main symptoms to look out for are obsessions and compulsions.
Examples of sexual orientation OCD obsessions
Obsessions are intrusive thoughts, images, feelings, sensations, or urges that can lead to intense, all-consuming distress. Here are some examples of SO-OCD thoughts Dr. Farrell provides:
- Why did I have a dream where I was attracted to a man? Does that mean I’m gay?
- What if I’m actually straight and I don’t actually love my partner?
- What if I am bisexual and don’t know? What if I found out and it ruined my relationship?
- How would I be able to show myself to my religious community if I am actually gay? I would be exiled.
- Yesterday, when I saw my friend, I had such a good time with her. We were laughing so hard. What if I’m attracted to my best friend?
- What if I am wrong about my sexuality? What if everything I thought was true about myself is false?
- What if I’ve been lying to my partner for 17 years? Am I actually attracted to them?
- I got sexually aroused when watching a sex scene from a movie with two lesbian women. What does this mean about me?
Examples of SO-OCD compulsions
Compulsions are physical or mental behaviors performed in an attempt to try to prevent a bad thing from happening or cope with the distress caused by the obsessions. Here are some examples of compulsions in sexual orientation OCD, shared by Dr. Farrell:
- Avoidance: A person may steer clear of situations that trigger intrusive thoughts, like avoiding certain places, people, or even sexual experiences for fear that their doubts could be confirmed.
- Checking physical sensations: Many people with SO-OCD become hyper-aware of their bodily reactions, such as their “groinal response,” and analyze them as proof of their true sexual orientation.
Compulsive dating: Some may repeatedly enter relationships to “prove” their sexual orientation to themselves. They might think, See? I like him. Everything is fine. - Mental review: A person may endlessly replay past interactions, questioning whether a moment of admiration or connection was actually romantic.
- Reassurance seeking: Whether it’s asking friends, searching online forums, or posting in chat rooms, many people with SO-OCD seek external confirmation that their fears aren’t real. But as Dr. Farrell emphasizes, “No matter how many times a friend or family member reassures you, it’s only a matter of time before the obsessions start up again.”
- Repeating statements or prayers: Some individuals develop rituals, such as repeating affirmations (“I am not gay”) a specific number of times or praying excessively for clarity or forgiveness.
While these compulsions might bring temporary relief, they only reinforce the cycle of doubt. Recognizing them is the first step toward breaking free.
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The impact of SO-OCD
SO-OCD can be incredibly distressing, affecting relationships, self-esteem, and overall well-being. The anxiety is about the need for absolute certainty of your sexuality, which is something no one can truly have. Many people with SO-OCD even express, “I don’t care what my sexual orientation is—I just want to know for sure.”
Because sexual orientation plays such a big part of a person’s life, and because OCD tends to latch on to what an individual values, it can feel like there is endless fuel for these intrusive thoughts and anxieties.
Dr. Nicholas Farrell
As Dr. Nicholas Farrell explains, “Because sexual orientation plays such a big part of a person’s life and identity, and because OCD tends to latch on to what an individual values, it can feel like there is endless fuel for these intrusive thoughts and anxieties.” The more a person seeks reassurance or engages in compulsions, the stronger the cycle becomes—trapping them in endless what-ifs and mental analysis.
Sexual OCD vs. sexual orientation OCD
Although SO-OCD involves intrusive thoughts about sexuality, it’s not the same as sexual OCD. Sexual OCD involves distressing, unwanted sexual thoughts that don’t align with a person’s values or desires.
However, someone with SO-OCD may also experience intrusive sexual thoughts, so the two subtypes may overlap. In some cases, SO-OCD can even trigger symptoms of Sexual OCD, creating additional distress and uncertainty. While the themes may be different, both subtypes share the same OCD cycle of obsession, compulsion, and temporary relief that ultimately reinforces anxiety.
Treatment for sexual orientation OCD (SO-OCD)
The most effective treatment for SO-OCD, like all forms of OCD, is exposure and response prevention (ERP) therapy. ERP is a structured, evidence-based approach that helps people gradually face their fears without engaging in compulsions.
With ERP, you work with a specialized therapist trained in OCD and ERP who will guide you through exposures designed to help you face intrusive thoughts in a safe, controlled way. You are never forced to do anything you are not ready for. Instead, your therapist will help you gradually face these thoughts at a challenging but manageable pace. Over time, you’ll learn to experience uncertainty and doubt about your sexuality without relying on compulsions.
How ERP works for SO-OCD
Rather than trying to find the “right” answer about your sexual orientation, ERP helps you accept that certainty isn’t necessary to live a fulfilling life. As you practice sitting with discomfort, the distress caused by intrusive thoughts decreases, and compulsions lose their grip.
If someone with SO-OCD starts having intrusive doubts about their sexual orientation whenever they talk to a close friend, they may compulsively avoid that friend. ERP would help them slowly reintroduce interactions, working toward being able to spend time with that friend without fear. Dr. Farrell explains: “A therapist may ask you to expose yourself to the source of anxiety on purpose. In this case, you may be asked to make plans with your friend. At first, you might think, ‘Are you serious? Isn’t there another way? I’m willing to do anything but that.’” But with guidance, they learn to sit with their discomfort instead of trying to avoid it.
At first, these exposures can feel overwhelming, but they’re carefully structured to match your comfort level. Over time, repeated practice helps intrusive thoughts lose their power. The goal isn’t to prove or disprove your sexual orientation—it’s to help you recognize that you don’t need certainty to live your life. With ERP, you learn to let go of the endless analysis and move forward with confidence.
Bottom line
Opening up about SO-OCD can feel overwhelming, especially if you fear being misunderstood. Many people worry, “Will my therapist judge me for these thoughts?” But as Dr. Nicholas Farrell reassures, “A trained therapist will have worked with this OCD subtype before and will not judge you for your OCD-related thoughts.”
If you’re struggling with intrusive thoughts about your sexual orientation, you don’t have to navigate it alone. ERP therapy can give you the tools to break the cycle of obsessions and compulsions, teaching you to tolerate uncertainty without letting it consume your life.
With the right support, healing is possible. You don’t have to keep searching for certainty—you can learn to let go and live with confidence in your identity, despite not being absolutely certain.
Key takeaways
- Sexual orientation OCD (SO-OCD) is a subtype of OCD characterized by intrusive thoughts and compulsive behaviors about your sexual orientation, causing significant distress and uncertainty regardless of your actual identity.
- SO-OCD is not about sexual orientation itself but about the OCD-driven need for absolute certainty, and trained therapists can provide nonjudgmental support.
- The most effective treatment for SO-OCD is exposure and response prevention (ERP) therapy, which helps you face obsessive thoughts without engaging in compulsions.
