ERP Therapy Stories: Sexual Orientation OCD (SO-OCD)
I created this “ERP Therapy Stories” series to share a glimpse of how the application of ERP therapy could look within the context of different OCD subtypes. I hope to provide some examples of ERP therapy while channeling my creative and imaginative side. The stories and characters that I write about are fictional, but the ERP strategies depicted are ones that I teach and use in therapy with my clients. This particular post focuses on illustrating Sexual Orientation OCD symptoms (SO-OCD), including commonly seen SO-OCD obsessions and compulsions. As an OCD therapist who enjoys storytelling, I hope these vignettes can help you feel less alone and see hope in ERP therapy.
Keisha is a 29-year-old freelance Digital Media Designer who lives in San Francisco. She is a lesbian who recently married her wife, Zoe, after being together for 3 years. Keisha started to notice some strange thoughts coming up shortly after their wedding.
These thoughts were distressing and caused her to question her sexual identity.
Keisha found this odd. She has not doubted being gay for nearly a decade, why is she questioning it now?
The thoughts got louder as the days passed. Anytime she noticed an attractive male, her mind would hound her with “You think he’s attractive. How can you be sure that you’re not into men? What if you’ve been wrong about being a lesbian this entire time?” She was compelled to look for signs of arousal to prove to herself that these thoughts weren’t true. The thoughts were hard to pull away from. They started to consume her throughout the day. She would find herself scrolling through images of men to see if she found them attractive. This would cause her more anxiety and confusion, as well as take her away from being productive with work.
It got to the point where Keisha started asking Zoe questions like, “Did I just act like I was straight?” or making confessions like, “I’m worried that I might secretly like men” just to get reassurance from Zoe that her thoughts were unlikely to be true. The questions seemed ridiculous to Zoe and she initially thought Keisha was joking. But Keisha’s behavior started to become excessive and she began doing the same with friends. Zoe started to get concerned. She realized that Keisha wasn’t looking for an honest answer when she asked these questions, she was looking for a specific answer. And if Zoe said the wrong thing, Keisha would get upset or ask the question again in some other way. She also noticed that Keisha was in her mind often, causing a disconnect between the two. Keisha started skipping the gym and declining meetups with some of their straight friends. This seemed unusual and Zoe started doing some research. She suspected that Keisha might be struggling with OCD symptoms.
Zoe spoke to Keisha who agreed to meet with an OCD therapist in San Francisco.
Keisha met with her therapist and it was confirmed that these were Sexual Orientation OCD symptoms (SO-OCD). Keisha learned that SO-OCD, previously referred to as Homosexual OCD (H-OCD), can happen to anyone regardless of their sexual identity. She realized that this was very different from when she questioned her sexual identity back in high school. Back then Keisha was curious and did a lot of exploring to learn more about herself. She did experience some anxiety, but it was more around the new sexual experiences that she was having and also not knowing what her family would think.
Keisha’s current thoughts are obsessive. They have an illogical feel to them because deep down she knows that she’s a lesbian- she figured this out already. But her mind keeps getting stuck on the possibility that she was wrong. And in the moment it feels scary that this could be true. She’s not so much afraid of being straight, she just wants to be certain of the truth. Her fear is about the possibility that she is living a false life and unknowingly denying her true identity. And the consequences that this could lead to. Losing and hurting Zoe would be devastating, as well as losing her place within her tight-knit LGBTQ+ community and friend group.
Keisha and her OCD therapist worked on some goals for ERP therapy, including doing the activities that she has been avoiding, cutting down on reassurance-seeking behaviors, and resisting checking for arousal. Keisha learned about arousal non-concordance and that checking for a groinal response doesn’t prove anything. Zoe joined a session and learned how to respond to Keisha with supportive statements that will not reinforce and accommodate the OCD. Keisha went to the gym and noticed the men around her, she started going out with her straight friends again, and she was more affectionate with Zoe.
She practiced not answering her mind’s questions.
Instead, she accepted that she could never be sure of her ever-evolving identity. She could choose to channel her energy on activities she enjoys and the people she cares about, even without a definitive answer.
Keisha brings her laptop to her favorite San Francisco coffee shop near her apartment today. Pride Month is in a few months and Keisha was hired to design creative digital media for a community event. It has been hard for her to focus on this project because of the thoughts it would trigger. She decided to start working on this and stop avoiding it. But her thoughts were already starting, “They hired a designer who could capture the spirit of Pride, how are you the right person for this? You might be straight and that would be a huge disservice to the community.” Keisha feels the urge to text Zoe and ask her if it’s ok that she is working on this project. But she knows Zoe won’t answer these questions since starting ERP therapy.
Instead of turning to Zoe, Keisha responds to her thoughts with a non-engagement response, “Who knows? But I’m gonna work on it anyway.” Her mind goes at it again “But you don’t even know if you’re a lesbian! Look at that guy over there, could you be attracted to him? Do a quick check just to see.” Keisha is tired of these thoughts and questions and decides to be firm. “No, I won’t do that. It’s never gotten me anywhere.” By not engaging in the thoughts, her mind doesn’t get in a spiral like in the past. She’s practiced this in ERP therapy and it’s gotten much easier.
Keisha returns home feeling proud that she got most of her project done. Zoe greets her with a hug and kiss and Keisha returns the affection. She learned that she could be in a coffee shop without turning her attention to every man that walks in. The groinal response is not as much of an issue anymore. She has learned to accept that it might show up here and there.
She could just let it happen without figuring out why, what, when, or how.
Most importantly, she feels connected to her partner and friends again. Her friends can tell when Keisha is addressing her OCD and they’ve learned how to give her non-reassuring support, which she is grateful for. The thoughts might still show up, but Keisha no longer feels like they are in control.
