Sexual Orientation Worries (HOCD or SO-OCD)

Help for anxiety, fears, and obsessions
about sexual orientation

Most people think of obsessive-compulsive disorder (OCD) as an extreme fear of dirt or germs or a strong desire to make things orderly. However, OCD symptoms can involve intrusive and disturbing thoughts about one’s sexuality, which can be upsetting or shameful. OCD sufferers who have never questioned their sexual orientation may experience high anxiety because of excessive doubts, urges, and images that are contrary to their sexual orientation. People who have never had any same-sex experiences or attractions are still at risk for developing these obsessions. Fears associated with sexual orientation OCD (SO-OCD) may include:

  • Fears about being a closeted homosexual person
  • Worries about changing in sexual orientation
  • Anxiety over others thinking that one is LGBTQ

Frequently Misdiagnosed

Unfortunately, many mental health professionals do not understand how to properly diagnose and treat sexual orientation worries. New research appearing in the Annals of Clinical Psychiatry has shown that therapists are most likely to attribute a patient’s SO-OCD symptoms to “sexual identity confusion” rather than OCD (Glazier et al., 2013). Misattributing the content of the obsessions to latent wishes is particularly damaging to people with OCD, who typically have high levels of doubt and whose anxiety is already fueled by the tendency to misinterpret their obsessions as important and meaningful. The aforementioned study assessed psychologists’ ability to correctly identify common symptom presentations of OCD. One of five OCD symptom vignettes was assigned to each clinician, who was asked to give a diagnostic impression. 77% misidentified the vignette on obsessions about sexual orientation, and classified the problem as sexual identity confusion. In contrast, only 16% misidentified contamination obsessions as being indicative of OCD. Of the respondents, 82% were doctoral-level psychologists, 81% were licensed, and over half reported a CBT orientation. This high degree of misidentification leaves little hope that most people with SO-OCD will obtain a proper diagnosis and appropriate treatment.

Therapists at the Louisville OCD Clinic are very familiar with this form of OCD and have found that exposure and ritual prevention (Ex/RP) therapy is effective in treating SO-OCD, when carefully tailored to the client’s specific fears. The treatment process is outlined under the OCD Treatment Program. Therapists at Louisville OCD Clini specialize in the treatment of SO-OCD.


There is no complete cure for SO-OCD, and people with sexual-themed OCD may require a longer course of treatment than people with other forms of OCD. Nonetheless, the vast majority of our clients feel much better and experience a major reduction in symptoms. Generally, those who attend sessions and do the homework improve, and those who do not follow the program will experience less improvement. For most people, this type of treatment is more effective than medication for OCD. However, some will require both medication and the treatment program for maximum results. We also have a special combined intensive and online program for those coming from out of town. More about our OCD Treatment Program.

Learn More About SO-OCD

Scientific articles about sexual orientation OCD

Selected presentations about sexual orientation OCD

    • Williams, M.T., Hyman, B., Wetterneck, C.: “What If I’m Gay and Don’t Know It!” – Understanding Sexual Orientation Obsessions in OCD, talk presented at the International OCD Foundation Annual Conference, Chicago, IL, Jul 27-29, 2012.
    • Williams, M., Tellawi, G., Wetterneck, C.T.: Understanding Sexual Orientation Obsessions in OCD, talk presented for the 45th Annual Convention of the Association of Behavioral and Cognitive Therapies, Toronto, ON, Nov 10-13, 2011.
    • Williams, M.T.: Homosexuality Anxiety (HOCD): A Misunderstood Symptom of OCD, Quarterly Meeting of the OC Foundation of New Jersey, Robert Woods Johnson Hospital, New Brunswick, NJ, Sep 8, 2008.

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