When Identity Feels Uncertain: Understanding Sexual Orientation OCD
It's human to question aspects of ourselves as we grow- including our sexual orientation. For many, questions about sexual orientation are a natural and often meaningful part of this self-reflection. But when those questions become persistent, intrusive, and distressing, it might be more than just exploration.. If you find yourself trapped in an unrelenting loop of “What if?” thoughts around your sexual orientation, you may be experiencing a specific subtype of OCD known as Sexual Orientation OCD, or SO-OCD.
This subtype of obsessive-compulsive disorder is often misunderstood, but it's more common than many realize and I see many clients in my private practice who struggle with this subtype of OCD. Understanding what SO-OCD is, how it shows up, and what you can do about it is the first step toward getting relief.
What Is Sexual Orientation OCD?
SO-OCD is a manifestation of Obsessive-Compulsive Disorder in which a person is consumed by unwanted and intrusive thoughts about their sexual orientation. These are not typical curiosities or self-reflection. They are repetitive, unwanted, anxiety-provoking, and often accompanied by compulsions aimed at getting certainty or relief.
Someone with SO-OCD might identify as heterosexual, gay, bisexual, but suddenly they’re caught in an internal storm of doubt: “What if I’m not really straight?” “What if I’ve been lying to myself?” “What if this means I need to get a divorce or break my relationship to find out?” These thoughts may come on suddenly or might be triggered by watching a sexy TV show, experiencing physical symptoms of arousal, or even a random thought that seems to come out of nowhere.
It's important to emphasize that SO-OCD is not about homophobia or discomfort with any sexual orientation. It is about uncertainty—and the intense, compulsive need to resolve that uncertainty immediately.
What It Can Feel Like
Living with SO-OCD can be incredibly confusing and exhausting. It can feel like your mind is constantly playing tricks on you, offering up unwanted “what ifs” and demanding answers. Many of my clients report feeling a sense of shame or fear about their thoughts, and question if they mean something deeper about who they are.
Some common experiences include:
Repeatedly checking your physical reactions to others (“Did I feel aroused”?
Groinal Responses: a physical sensation in the genital area that is interpreted as proof of their feared sexual orientation. (can include tingling, tightness, warmth, arousal-like feelings, or pulsing that occur involuntarily and without ant try sexual desire)
Reviewing past relationships or memories to look for clues
Avoiding situations that might trigger doubt (e.g., watching certain TV shows or spending time with certain friends)
Seeking reassurance—either from others (“Do you think I might be gay?”) or internally (“I’ve never had a relationship with someone of the same sex, so I must be straight, right?”)
None of these actions truly resolve the anxiety. In fact, the more you engage with the thoughts, the more intense and sticky they become.
The Difference Between SO-OCD and Sexual Identity Exploration
It’s perfectly normal for people to explore their sexual orientation. That exploration may even include some uncertainty. But SO-OCD feels urgent, distressing, and unwanted. Rather than feeling open and self-reflective, it feels analytical and rigid.
A helpful distinction is to ask yourself “Am I questioning because I want to understand myself better—or because I’m desperate to make the anxiety stop and know with certainty what the answer is?”
If you identify with the latter, you’re not broken and you’re not alone. You may simply be struggling with a form of OCD that’s incredibly misunderstood.
Why This Can Be So Painful
Sexual orientation is deeply tied to our sense of self. When OCD targets this part of your identity, it can feel really personal. People with SO-OCD often report feeling isolated and ashamed because they worry others won’t understand.
Some of my clients fear offending others by even bringing it up, worrying that they will sound homophobic or disrespectful to the LGBTQ+ community. But in reality, SO-OCD can affect people of any orientation, and the distress isn’t about being one orientation or another—it’s about being unable to tolerate the uncertainty and feeling stuck.
How Healing Begins
The most effective treatment for SO-OCD is Exposure and Response Prevention (ERP), a specialized form of Cognitive Behavioral Therapy (CBT) designed for OCD. ERP helps you face the uncomfortable thoughts without trying to neutralize them with compulsions. Over time, this builds tolerance for uncertainty and reduces the hold the thoughts have.
In therapy, we might practice sitting with the idea that “maybe I’ll never be 100% sure”—and learning to be okay with that. Or “This is just a thought…This is just a sensation. There is nothing I have to do.” You might also work to identify the mental checking or avoidance behaviors that are keeping the cycle going and gently challenge them.
Most importantly, treatment is never about convincing you of your sexual orientation. It’s about helping you live with more peace, clarity, and trust in your ability to navigate life’s uncertainties.
You Are Not Alone
If this sounds like your experience, please know: you are not alone, and there is nothing wrong with you. SO-OCD is real, and it can be painful—but it is also treatable. You don’t have to keep going in circles or feel ashamed of your thoughts.
Therapy can offer a compassionate, nonjudgmental space to begin understanding what’s happening in your mind and body—and start building a new relationship with your thoughts.
Moving Forward
If you're struggling with thoughts that leave you feeling scared, unsure, or disconnected from yourself, it’s okay to reach out for help. You don’t have to have it all figured out. You don’t have to be certain to be okay. And you absolutely don’t have to go through it alone.
I would be honored to support you from my Westchester therapy practice or for clients in NY or CT virtually. Together, we can work toward greater ease, resilience, and a relationship with yourself that feels more grounded and whole.
