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A comprehensive guide to Sexual Orientation OCD (SO-OCD)

Sexual Orientation OCD (SO-OCD) is a type of OCD that involves obsessions, compulsions and fears concerning one’s sexual orientation and sexual preferences.

According to fairly recent evidence, almost one in three (32%) OCD patients have sexual obsessions; as SO-OCD is invariably one of the primary forms of sexual OCD, it is therefore a fairly common subcategory of the disorder.

This guide to Sexual Orientation OCD (SO-OCD) is meant to provide useful information about the symptoms, causes, treatment options and other relevant information on the topic.

A short history of the term “Sexual Orientation OCD (SO-OCD)”

Sexual Orientation OCD (SO-OCD), according to Google Scholar search query data, is a term that has been in use in academia for less than 10 years (with the search query “Sexual Orientation OCD” yielding only 1 result in papers from 2012 and earlier, and 57 results between 2013 and 2022).

According to a paper from the journal “Behavior Therapy”, sexual orientation-related obsessions and compulsions were initially assumed to only apply to heterosexual persons having fears that specifically revolve around potentially being or “turning” gay or bisexual; this is due to widespread beliefs of heteronormativity (that heterosexuality is the “standard” sexual orientation) before the LGBTQ movement started gaining significant momentum in the early-to-mid 2010s.

Before the term SO-OCD, the term H-OCD (homosexual OCD) was used in internet self-help communities and forums in the early days of the internet/world-wide web. The term SO-OCD essentially replaced H-OCD, since it is simply a more inclusive and all-encompassing term (the explanatory scope of H-OCD is also too narrow).

How many people have Sexual Orientation OCD (SO-OCD)?

The current data shows that 2-3% of the general population has OCD; however, an estimate of the amount of people who have SO-OCD is difficult to establish.

As nearly 1 in 3 people have sexual obsessions, it can therefore be assumed that roughly ~0.66%-1% of people have some sort of OCD that revolves around sex or sexuality; nonetheless, SO-OCD is specific and can only apply to people who have a combination of obsessions and compulsions particularly to do with sexual preference and/or orientation.

Interestingly, sexual compulsions are more common in men, which makes it quite likely that the majority of people who suffer from SO-OCD are male.

Examples of SO-OCD

• Thoughts of potentially being sexually attracted to members of the same sex, despite being of a heterosexual orientation

• Thoughts of potentially being attracted to both men and women (bisexuality), despite being of a heterosexual orientation

• Wanting to seek reassurance about one’s sexual orientation from others

• Constant analyzing of how others view your sexual orientation

• Reviewing one’s memories for any sign that might suggest one’s sexual orientation has changed over time

• Avoiding erotica or pornography involving the same sex due to fears of having one’s sexual orientation changed

• Compulsively checking one’s house or belongings (e.g. clothing) for signs that could identify them as already being of a different sexual orientation

• Avoiding people of the same sex, or anything that could be associated with the same sex, out of fear of being “infected” with same-sex attraction

What causes Sexual Orientation OCD (SO-OCD)?

According to Storch and Lewin’s “Clinical Handbook of Obsessive-Compulsive and Related Disorders”, the cognitive-behavioral model of OCD states that sexual obsessions are caused by a person adding too much personal significance to their unwanted/intrusive sexual thoughts, impulses and images, which subsequently results in them feeling doubt and distress.

In more general terms, nature (genetics) and nurture (physical/social environment) both seem to play a role in regards to how obsessive-compulsive behaviors develop, with the former accounting for 36% and the latter accounting for about 64% of behavioral factors.

How can SO-OCD be treated?

With SO-OCD, the most effective treatment is probably what’s known as ERP (exposure and response prevention), which has an average 50-60% efficacy rate for reducing OCD symptoms.

In one 2011 study with a 51-year-old male patient named Simon with sexual orientation-related OCD, the patient had ERP sessions for 12 weeks; at his baseline evaluation, his OCD symptoms were rated a “24” on the YBOC (Yale-Brown Obsessive Compulsive) scale, which is on the high side of “moderate symptoms” (which is “14-25” on the scale, with “26-34” being “moderate-severe symptoms”). His score reduced to a “3” after his ERP sessions, which means his OCD was no longer considered clinically significant.

Another option is medication, such as SSRI-category antidepressants. According to the current data, 40-70% of patients respond well to SSRI trials and usually have a remission rate of 10-40% in terms of their symptoms.

What is the Sexual Orientation Obsessions and Reactions Test (SORT)?

The SORT (Sexual Orientation Obsessions and Reactions Test) is a clinical scale specifically made by mental health professionals to assess the severity of SO-OCD symptoms, and to also have a scale that can be used to differentiate SO-OCD from unrelated issues or concerns to do with sexual orientation, such as a sexual identity crisis.

The scale has twelve items, which are statements that the patients has to rate on a 5-point scale from 0 (“never”) to 4 (“always”); the questions revolve around sexual orientation, fantasies, arousal, and worries about potentially being LGBTQ, or having a different sexual orientation.

You can look at (or take) the test here.

What is the difference between SO-OCD and a sexual identity crisis?

A sexual identity crisis is essentially a period in someone’s life when they’re unsure of their sexual orientation; this can be a time of confusion and stress, but it is a fairly common occurrence (especially in adolescence or early adulthood) and it is not usually considered to be a mental disorder.

In contrast, SO-OCD is a mental disorder that is characterized by intrusive thoughts and compulsions specifically related to one’s sexual orientation.

Talk to other people about Sexual Orientation OCD (SO-OCD)

Make sure to check out our community forum where we even have an SO-OCD subcategory; here you can speak to other sufferers of OCD and talk to them about personal experiences, treatments and so on!