Talking Sexual Orientation OCD with Dr. Steven Phillipson

What is Sexual Orientation OCD and How Should it be Treated?

Written by Lauren O'Shaughnessy

01 Dr. Steven Phillipson is a licensed clinical psychologist who has specialized in the Cognitive-Behavioral Treatment (CBT) of OCD since 1986.

02 In this video, he defines and discusses Sexual Orientation OCD. For more info on Dr. Phillipson, please visit:

03 OCD3 is a web series that brings professional perspectives to the OCD community so sufferers can make healthy decisions and lead better lives.

04 Sexual Orientation OCD used to be referred to as Homosexual OCD (HOCD). Dr. Phillipson uses this terminology in the video, but keep in mind that HOCD is no longer an accepted term.

OCD3: What is Sexual Orientation OCD?

Read the full transcript below: 

1) What is Homosexual OCD (HOCD)?

Persons with HOCD are very invested in coming up with a conclusion about whether or not they are attracted to persons of the same sex. They are often confused if they even see someone of the same sex, and have the thought, “oh, that’s a very attractive person,” that could become very provocative for them to think that persons who are straight don’t find people of the same sex attractive. So that’s a very common misconception for people with HOCD.

People with HOCD often around adolescence develop this focus as a never-ending need to confirm or conclude that they are indeed straight. It’s not uncommon that persons with HOCD can have years of dating in an undistracted way with persons of the opposite sex, but then when OCD springs forth, their history become meaningless because they might have had some very natural child play in pre-adolescence with persons of the same sex, and that history becomes very distressing to the idea that “what does that really say about me?” You know, does that mean that I might have actually shown signs of early homosexuality way long ago in my childhood.

2) What are common symptoms of HOCD?

The topic of homosexuality whether it be a subset of OCD, a person’s sexual orientation, or just natural human thoughts, can become confusing for people with HOCD because they are so desperate to get answers, so knowing that it’s natural for all of us humans to find persons of the same sex to be attractive is not sufficient. It’s something that persons with HOCD have a profoundly desperate need to come up with a conclusion. Persons who are gay and coming out have a conclusion, but might struggle with the persons or timing of how they are going to disclose what they already have come to a conclusion about.

Common symptoms of people with HOCD often involve a tremendous amount of social avoidance, because being around others might trigger an awareness that they are finding others of the same sex attractive. Persons might also stop dating because being in bed with persons of the opposite sex might create such a distress at not knowing whether they have an answer or not, that they become sexually neutered in a way, and the lack of sexual response with some person in bed with them, because very more confirmatory that they actually might be gay, because here i am in bed with another person from the opposite sex and I’m not having the desired response, so that might means I would if I were in the bed with persons of the same sex.

3) How can you help someone suffering from Homosexual OCD?

It’s really important for loved ones of persons with HOCD is to be aware that their partner is not having a sexual orientation crisis. That they are just having a brain malfunction that has nothing to do with their actual sexuality. It can be very distressing when persons with HOCD confess to their partners that they are having this concern, because in today’s society it’s not unusual that people might actually have a sexual orientation crisis. But the difference is that people with HOCD where they were functioning completely naturally in a heterosexual relationship.

4) Can homosexual persons have Sexual Orientation OCD or “HOCD"?

I’ve had one or two cases of persons who have clearly established themselves as being homosexual, and have had anxious associations that they might be straight. Here they’ve gone through the courageous coming out process and all of the sudden their brain is telling them they may might have done that prematurely and that they might actually be straight. Once again they’re experiencing a desperate need to come up with a conclusion and have a definite answer about a topic where there is no definite answer to have.

5) How do you treat HOCD?

The treatment most recommended for persons with HOCD involves Exposure and Response Prevention. And in this regard, might involve them carrying pictures on their phone or on their persons of persons of the same sex that they find very attractive. And by exposing themselves to these pictures over and over and over again, and actually encouraging their mind and body to have a potential sexual response, fosters the habituation which is the goal of most subsets of OCD. It might involve walk down the street and even rate the kissability of persons of the same sex, it might involve rating the attractiveness of persons of the same sex to show one’s brain that this idea of finding persons of the same sex attractive, or possibly even having a sexual response, is something that they are going to make room for and give permission to.

Recovery with a patient who has suffered from HOCD would create a relationship that others of the same sex can be attractive, that they may have a attraction to members of the same sex, and that this is very natural part of the human condition that they do not need to be distressed about. So recovery from OCD involves the brain’s biochemistry really dialing back the voracity of response in terms of its intensity, so that a person can look at persons of the same sex and not have that emotional distress signal but just be aware and accept that others of the same sex can be seen as attractive.

For more videos from our OCD3 series, head to our YouTube channel here.

About the author

Lauren is the editorial director and cofounder at the Made of Millions Foundation. She has been a part of the team since its launch in 2016. She has been open about her personal struggles with Generalized Anxiety Disorder and social phobia. You can follow her on Instagram at

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