Sexual orientation-themed obsessive-compulsive disorder in a lesbian woman: Phenomenology and implications for affirmative assessment and treatment

Abstract

Individuals with sexual orientation-themed obsessive-compulsive disorder (SO-OCD) typically experience persistent, intrusive doubt about their sexual orientation despite having an established sexual identity. SO-OCD has been studied almost exclusively among heterosexual samples, highlighting the need for more reports on the phenomenology of SO-OCD among members of the lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) community. A clear understanding of the presentation and treatment of SO-OCD in LGBTQ+ individuals is an essential first step to affirmative care. Therefore, we presented a case example of a lesbian cisgender woman (Danielle [pseudonym]) describing her experience with SO-OCD, doubting her sexuality, and wondering “Am I actually attracted to men?” In this case example, we illustrated how Danielle's comfort and stability in her sexual identity prior to the onset of her SO-OCD symptoms helped rule out sexual orientation questioning or internalized homophobia. We also discuss how much of Danielle's experience with her SO-OCD symptoms overlapped with those of heterosexual patients described in the literature. We conclude with a call to action among clinicians working with all patients with SO-OCD to conduct assessment and therapy procedures in an affirmative manner.