Obsessive-compulsive disorder (OCD) is a mental health condition that causes repetitive behaviors and thoughts. Some people may have distressing, intrusive thoughts. In sexual orientation obsessive-compulsive disorder (SO-OCD), these thoughts involve doubts about sexual orientation.

Though “homosexual OCD” (HOCD) is another common name for SO-OCD, people of any sexual orientation may experience intrusive thoughts. Many people may question their sexual orientation, but if a person develops obsessive thoughts or compulsive behaviors surrounding this topic, they may have SO-OCD.

SO-OCD can arise from a variety of factors, including internalized homophobia. Because of this, psychoeducation is a large part of treatment.

According to the National Institute of Mental Health, an estimated 1.2% of adults in the United States have OCD, more than 50% of whom may have severe impairment resulting from the condition. OCD is usually a chronic and long lasting disorder but is manageable with various treatment options.

This article will explain what SO-OCD is, its causes, and the available treatment options.

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SO-OCD, or HOCD, is a mental health condition or a theme of OCD.

A person with SO-OCD may have obsessive, intrusive thoughts in which they constantly doubt or question their sexual orientation. People of any sexual orientation can experience this — it is not exclusive to people who are heterosexual and have obsessions about homosexuality.

Questioning one’s sexual orientation and experimenting to understand it better are standard, healthy things to do. Additionally, having SO-OCD does not necessarily mean a person may be homophobic.

However, if a person develops obsessive, intrusive thoughts or compulsions about sexual orientation, there may be a cause for concern.

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In OCD, intrusive thoughts, obsessions, or compulsions may involve:

  • excessive worrying about something
  • an inability to manage unwelcome thoughts
  • an inability to manage upsetting or distressing thoughts
  • an inability to regulate urges or compulsions
  • constant anxious feelings
  • repetition of certain activities or behaviors to ease mental discomfort

OCD can result in an inability to regulate thoughts and behaviors. This often stems from fear or worry that not acting on compulsions or not thinking certain thoughts may result in overall harm.

In SO-OCD, a person may excessively worry about being attracted to people of a different sex than they originally thought they were attracted to. This worry is not necessarily rooted in homophobia. It may result from fears about a person’s identity or fears stemming from their upbringing.

In a 2011 study involving 431 people with OCD, 11.9% of participants reported experiencing past or current obsessive thoughts about sexual orientation.

Read more about HOCD here.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision states two specific criteria for OCD: obsessions and compulsions. To receive a diagnosis, a person must experience obsessions, compulsions, or both at the same time, and these must cause significant distress and last up to 1 hour per day.

Those with SO-OCD may experience obsessions or compulsions relating to sexual orientation.


A person with SO-OCD may experience obsessions such as:

  • repeated, obsessive thoughts about whether they have a particular sexual orientation
  • excessive doubt about their sexual orientation
  • distressing thoughts about sexual orientation
  • worry about whether people of the same sex may find them attractive and, because of this, active avoidance of people of the same sex
  • fears that others will perceive them as having a different orientation than they do
  • fears of relationship issues resulting from changes in orientation
  • fears of losing their identity or being excluded from communities


Compulsions differ from obsessions in that they are mainly physical rituals a person may do to ease discomfort or eliminate obsessions.

A person’s SO-OCD compulsions may include:

  • engaging in sexual acts to “test” their orientation
  • repeating certain actions or behaviors to ensure that no harm or intrusive thoughts “come true”
  • overanalyzing their feelings toward others, including attraction
  • looking at pornography to “test” their orientation
  • avoiding talking about sexual orientation
  • excessively ruminating on scenarios to see whether they experience arousal
  • repeatedly asking others for reassurance of their sexual orientation

Sexual arousal and SO-OCD

Some people may worry about having intrusive sexual thoughts about people of another sex, which may lead them to constantly check their genitals for signs of arousal.

The attention and checking may increase the blood flow to the genital area, causing the person to mistake physical arousal for sexual arousal. A person may believe these thoughts arouse them when this is not true. This is the “groinal response.”

Many people with OCD or SO-OCD worry that these intrusive thoughts and feelings about their sexual orientation define them and that these thoughts may represent what they truly want to act on.

According to the Anxiety & Depression Association of America, having these thoughts actually points to the opposite — that a person does not want to act on any obsessions or compulsions relating to sexual orientation. Thoughts become more distressing and overwhelming as a person tries to control them.

The first step in understanding these thoughts is to realize that they are automatic and not connected to who the person may be.

To better understand their intrusive thoughts, a person can try:

  • watching each thought flow through the mind, the same way they would watch a TV screen, and accepting that it is there but that it is intrusive and not part of their identity
  • understanding that the brain can produce “junk” sometimes and that some thoughts are automatic
  • avoiding pushing the thought away — accepting that it is there and may return

Read more about intrusive thoughts here.

Various treatment options are available for OCD overall, including SO-OCD. Psychotherapy and medication are usually the first-line treatments.

Treatment can include:

  • Exposure and response prevention: This treatment encourages people to confront the obsessive thoughts they may experience while resisting the urge to carry out compulsive behaviors and actions.
  • Justice-based treatment: This focuses on SO-OCD that may arise from internalized homophobia. It involves education about LGBTQ+ identities and understanding core fears.
  • Cognitive behavioral therapy (CBT): This therapy focuses on how a person’s thoughts can influence their actions, beliefs, attitudes, and behavior.
  • Cognitive therapy: This therapy focuses on identifying negative thoughts and feelings alongside patterns.
  • Meditation: This can involve using breath work or mindfulness to calm and relax the mind.

A doctor may also prescribe antidepressants, such as selective serotonin reuptake inhibitors (SSRIs).

Antidepressants may take 8–12 weeks to start working. In the meantime, the following tips may help a person manage obsessive, intrusive thoughts:

  • Label the thoughts as “intrusive.”
  • Remember that the thoughts are automatic and not indicative of identity.
  • Avoid the urgency to eliminate the thoughts — instead, accept them and let them pass.
  • Expect the thoughts to return.
  • Avoid engaging with the thoughts or trying to figure out what they mean.

It is important to understand that treatment should not try to “change” or “alter” a person’s sexual orientation. That is conversion therapy and can be harmful in some cases.

OCD is a common disorder that may arise from a variety of factors. Although there is no known cause, possible risk factors include:

  • genetics, such as having first-degree relatives with OCD
  • brain structure, including a connection between OCD and abnormalities in the brain
  • childhood trauma
  • childhood infections, such as streptococcal infection
  • anxiety arising from particular situations
  • post-traumatic stress disorder

A person who thinks they may have SO-OCD may want to consult a psychiatrist to discuss the obsessive, intrusive thoughts and compulsive behaviors.

Diagnosing SO-OCD may involve asking a person whether they experience intrusive thoughts about their sexuality and what behavior patterns they engage in to calm the thoughts.

A mental health professional may also consider whether a person has a family history of mental health conditions.

With the right treatment, people can manage the symptoms of OCD and SO-OCD and live fulfilling lives.

SO-OCD can involve repetitive behaviors and recurring thoughts about sexual orientation that are difficult to manage. These may include doubts about a person’s own sexual orientation and whether they have an attraction to people of another sex.

Treatment for OCD and SO-OCD includes therapy such as CBT, which can help a person acknowledge their thoughts and behaviors without engaging, and medications such as SSRIs. With treatment, people with OCD and SO-OCD can manage symptoms and live healthy, fulfilling lives.