"What If I'm Gay?"

What is Sexual Orientation OCD?

Sexual Orientation OCD (often called SO-OCD) is a subtype of Obsessive-Compulsive Disorder where individuals experience persistent, unwanted doubts about their sexual orientation. These intrusive thoughts cause intense anxiety, confusion, and compulsive attempts to gain certainty. This condition can affect people of any sexual orientation—but in men, it often manifests as a nagging fear or obsessive question: “What if I’m gay?”

The distress arises mostly from a person's urge to be absolutely certain about their sexuality.

Doubts About Sexuality and Identity

Men with SO-OCD often become fixated on doubts and “what if” questions like:

• “Can your sexuality actually change?”

• “What if I’m just in denial and this is my real self?”

• “What if groinal responses or physical reactions mean I’m actually gay?”

• “Why am I thinking about this if it’s not true?”

• “What if I’m masking a real sexuality crisis with OCD?”

• “What if I’ve never really liked women and it was all conditioning?”

• “What if I live my whole life in ignorance of my true identity?”

• “Am I leading my partner on and ruining both our lives?”

• “What if this is just internalised homophobia?”

• “How can I be sure these aren’t genuine attractions?”

• “Is this OCD, or am I repressing the truth?”

• “What if I never know for sure?”

• “Is my OCD just a defense mechanism to avoid facing something real?”

Sequence of Sexual Orientation OCD

Triggers

SO-OCD in men can be triggered by common, everyday experiences:

• A moment of admiration or emotional connection with another man

• Groinal response or physical arousal around men (misinterpreted as attraction)

• Noticing an attractive man and then obsessing over what it means

• Hearing someone’s coming out story and suddenly fearing you relate

• Watching LGBTQ+ content and feeling uncomfortable or unsure

• Being in a stable, loving relationship with a woman and doubting your orientation

Core Fears

Men with SO-OCD often report fears like:

• Fear of living a lie and not being true to oneself

• Fear of ruining your life by not living authentically

• Fear of suffering endlessly in the “wrong” identity

• Fear of hurting your partner by being dishonest

• Fear of repressing a hidden identity that will one day emerge

• Fear of being a bad person for deceiving others

• Fear of making an irreversible mistake—by staying or acting on doubts

• Fear of eventually “discovering” that you were wrong all along

Compulsions / safety behaviours

To relieve the anxiety caused by these thoughts, men may engage in compulsive behaviours such as:

• Mentally checking how aroused they feel around different genders

• Watching gay or straight porn to test reactions

• Asking themselves or others: “Do I seem gay?” or “What if I’m gay?”

• Seeking reassurance from friends, partners, or therapists

• Avoiding men to prevent possible arousal or confusion

• Replaying memories or conversations to search for clues

• Comparing their relationships or sexual experiences to others

• Dating or sleeping with men “just to see” how it feels

• Engaging in mental rituals to neutralize or disprove unwanted thoughts

These behaviours bring brief relief—but they reinforce the OCD cycle.

What Causes Sexual Orientation OCD?

SO-OCD likely develops from a mix of genetic, neurological, and psychological factors:

• Genetics: Family history of OCD or anxiety increases susceptibility

• Brain Function: People with OCD have increased sensitivity to doubt and uncertainty

• Perfectionism and Morality: High moral standards and fear of being inauthentic

• Over-Identification with Thoughts: Mistaking intrusive thoughts for identity

• Cultural Influences: Rigid ideas about masculinity or sexuality may intensify fear

How Do You Treat Sexual Orientation OCD?

Exposure and Response Prevention (ERP)

ERP is the gold standard treatment. It involves facing feared situations and thoughts without performing compulsions. This is a highly effective treatment for OCD and helps a person accept certainty and imperfections in their life.

Cognitive Therapy

Targets distorted beliefs such as:

• “I must be 100% sure of who I am”

• “If I have the thought, it must mean something”

Therapy builds tolerance for uncertainty, not certainty.

Mindfulness and Acceptance

Teaches you to notice thoughts without overreacting. You learn that you don’t need to answer every “what if.”

Medication

SSRIs may help reduce the intensity and frequency of obsessive thoughts and compulsions.

Summary

Sexual Orientation OCD in men often shows up as intrusive fears about being gay—even when there’s no real desire to change orientation. The core issue is not identity, but a compulsive need for certainty. ERP, CBT, and mindfulness are effective treatments. With support and the right tools, it’s possible to break free from the cycle and live with confidence and clarity—even in uncertainty.