Sexual orientation obsessions in obsessive–compulsive disorder: Prevalence and correlates
Open accessAbstract
Sexual obsessions are a common symptom of obsessive-compulsive disorder (OCD) that may be particularly troubling to patients. However, little research has examined concerns surrounding sexual orientation, which includes obsessive doubt about one's sexual orientation, fears of becoming homosexual, or fears that others might think one is homosexual. The present study reports rates and related characteristics of individuals with sexual orientation obsessions in a clinical sample. Participants from the DSM-IV Field Trial (n=409; Foa et al., 1995) were assessed with the Yale-Brown Obsessive Compulsive Symptom Checklist and Severity Scale (YBOCS). We found that 8% (n=33) reported current sexual orientation obsessions and 11.9% (n=49) endorsed lifetime symptoms. Patents with a history of sexual orientation obsessions were twice as likely to be male than female, with moderate OCD severity. Time, interference, and distress items from the YBOCS obsessions subscale were significantly and positively correlated with a history of obsessions about sexual orientation. Avoidance was positively correlated at a trend level (p=0.055). Obsessions about sexual orientation may be associated with increased distress, interference, and avoidance, which may have unique clinical implications. Considerations for diagnosis and treatment are discussed.
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Past research on sexual minorities with OCRDs has mostly focused on sexual orientation-related obsessions in heterosexual individuals, while experiences of sexual minority individuals with OCD have not been studied.
“Past research involving sexual minorities with OCRDs has mostly focused on sexual orientation-related obsessions in heterosexual individuals (Williams & Farris, 2011; Williams et al., 2014), whereas the experiences of individuals with OCD who identify as a sexual minority have not been studied.”
From Examination of outcomes among sexual minorities in treatment for obsessive-compulsive and related disorders (2022) · cites this paper as Williams & Farris, 2011
The Introduction (page unavailable) and Results (page unavailable) show that this study focuses on sexual-orientation obsessions among people with OCD. They do not establish that the patients were heterosexual or that past research mostly concerned heterosexual individuals. The statement about sexual minority individuals’ experiences follows the citation rather than being directly attributed to it. (LLM, conf=0.82)
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“Lifetime prevalence rates are estimated at 1.6% to 2.3% (Kessler et al., 2005; Ruscio et al., 2010), while current (12-month) rates range from 0.6% to 1.3% (Crino et al., 2005; Ruscio et al., 2010).”
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“For example, in a study investigating the treatment effects of citalopram, sexual thoughts were a predictor of positive medication response (Stein et al., 2007); however, in another SRI study individuals with sexual obsessions had poorer long-term outcomes (Alonso et al., 2001).”
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Research works printed but not linked: 1
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Epidemiological and Clinical Gender Differences in OCD
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“1 3 obsessions can sometimes have sexual or aggressive themes, creating additional anxiety for the person experiencing intrusive thoughts [61].”
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“One type of taboo obsessions that may be culture‐bound are known as sexual orientation obsessions in OCD (SO‐OCD), occurring in approximately 10% of US patients (Williams & Farris, 2011).”
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“Given thatpeoplewith sexual obsessions are more depressed (Dell’Osso et al., 2012; Grant et al., 2006), and those with SO-OCD experience greater distress (Williams & Farris, 2011), it is reasonable to conclude that increased depression may be part of the clinical picture.”
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“…may help further define differences, as well as how to treat these experiences by taking an inclusive, justice-oriented approach. prevalence research Prevalence and understanding of these types of OCD is extremely limited and likely underestimated (e.g., Pinto et al., 2008; Williams & Farris, 2011).”
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“They may also include concerns about sexual orientation (Williams & Farris, 2011).”
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Self-citationSexuality and obsessive-compulsive disorder: the hidden affair
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Obsessive-compulsive tendencies are related to seeking proxies for internal states in everyday life
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“It is estimated that 11.9% of OCD sufferers experience obsessions about homosexuality, and that 65.3% of these are male (Williams & Farris 2011).”
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“A plausible explanation of this outcome can be attributed to protracted periods of lockdowns and isolation, which increases the complexity of experiences for a group still grappling with social exclusion and marginalization [63].”
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“…found that approximately 24.9% of individuals with OCD had experienced sexual obsessions (inclusive of SO-OCD symptoms) at some point during their lives, and Williams and Farris (2011) found that 8.0% and 11.9% of individuals seeking treatment for OCD reported current and lifetime SO-OCD symptoms.”
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“[17] emphasize that many more men reported obsessions about their sexual orientation.”
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“The current study, which was begun independently of the recent studies by Williams et al. (2014) and Wetterneck et al.”
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“…disgust and OC concerns about sexual orientation will thus address the need to better understand these symptoms, given the substantial prevalence of such concerns in individuals seeking treatment for OCD (10%; Williams & Farris, 2011) and the extreme associated distress (Williams et al., 2015b).”
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“Intrusive thoughts about sexual orientation are common (10% of OCD patients; Williams & Farris, 2011), and are often experienced as highly distressing (Williams, Wetterneck et al., 2015).”
BackgroundSelf-citationEgo-dystonic stance-taking in sexual orientation obsessive-compulsive disorder (SO-OCD)
Coimbra-Gomes, E. (2020) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2020.100576 · Cited by 9 · see citing works
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“…fears around key themes such as contamination, harm, need for symmetry and so forth, sexual obsessions (e.g. paedophilia, unwanted homosexual acts, incest, etc.) are also common (Gordon, 2002; Pinto et al., 2008; Rachman, 2007; Ruscio et al., 2010; Williams et al., 2014; Williams and Farris, 2011).”
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“Furthermore, in most sexual obsessions research, there seems to be an equation of SO-OCD with homosexual anxiety (Williams & Farris, 2011).”
The Study of Sexual Fantasy in Women: a Review of the Findings and Methodological Challenges
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“However, higher levels of distress associated with SO – OCD are reported in women (Williams and Farris, 2011; Williams et al., 2015).”
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Homosexual Obsessive Compulsive Disorder (HOCD): A Rare Case Report
Bhatia, M. S. (2015) · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · doi:10.7860/jcdr/2015/10773.5377 · Cited by 5 · see citing works
“In addition, it appears that more males experience sexual orientation obsessions than females [5].”
BackgroundInfluentialPozza, A., Barcaccia, B., & Dèttore, D. (2019) · Measurement and Evaluation in Counseling and Development · doi:10.1080/07481756.2019.1594913 · Cited by 4 · see citing works
“…that pure obsessions could be a specific subtype of OCD, which predicts a more deteriorating course of the illness and greater severity over time (Williams & Farris, 2011); indeed, pure obsessions are associated with poor response after cognitive-behavioral therapy in adults (Mataix-Cols et al.,…”
BackgroundSpecific and general cognitive predictors of Sexual Orientation-Obsessive Compulsive Disorder
Melli, G., Gelli, S., Moulding, R., Stopani, E., & Pinto, A. (2018) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2018.01.005 · Cited by 4 · see citing works
Petersen, J. M., & Twohig, M. P. (2023) · Journal of Cognitive Psychotherapy · doi:10.1891/jcp-2021-0005 · Cited by 3 · see citing works
Association Splitting for Obsessive-Compulsive Disorder: A Systematic Review
Ching, T. H. W., Jelinek, L., Hauschildt, M., & Williams, M. T. (2019) · Current Psychiatry Research and Reviews · doi:10.2174/2352096512666190912143311 · Cited by 3 · see citing works
Self-citationBramante, S., Quarato, F., Mehanović, E., Rigardetto, S., & Maina, G. (2021) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2021.100642 · Cited by 3 · see citing works
Luxon, A. M., Chasson, G. S., Williams, M. T., Skinta, M. D., & Galupo, M. P. (2021) · Journal of Cognitive Psychotherapy · doi:10.1891/jcpsy-d-20-00013 · Cited by 3 · see citing works
Self-citationHallion, L. S., Sockol, L. E., & Wilhelm, S. (2015) · Springer eBooks · doi:10.1007/978-3-319-13060-6_4 · Cited by 3 · see citing works
Unacceptable Obsessional Thoughts in Children and Adolescents
Johnco, C. J., & Storch, E. A. (2017) · doi:10.1002/9781118890233.ch24 · Cited by 3 · see citing works
Weidle, B., Skarphéðinsson, G., Højgaard, D. R. M. A., Thomsen, P. H., Torp, N. C., Melin, K., & Ivarsson, T. (2022) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2022.100708 · Cited by 2 · see citing works
Treatment of Sexual Obsessive-Compulsive Symptoms During Exposure and Response Prevention
Reid, A. M., Flores, C., Olsen, B. T., Barthle-Herrera, M. A., Rahmani, M., Rakhshani, A. C., Nguyen, M. L., Geffken, G. R., & McNamara, J. P. H. (2015) · Springer eBooks · doi:10.1007/978-3-319-17139-5_3 · Cited by 2 · see citing works
Gibby, B. A., Jagannathan, N., Chasson, G. S., Mathes, B. M., & Hollern, E. A. (2020) · Journal of Cognitive Psychotherapy · doi:10.1891/jcpsy-d-19-00001 · Cited by 1 · see citing works
“…of SITs can encompass a variety of themes, such as images of sexual acts with inappropriate individuals (e.g., religious figures or parents), fears of acting sexually inappropriate (e.g., having sex in a public place), or thoughts questioning one’s sexual orientation (Williams & Farris, 2011).”
BackgroundSchild, S. M., Moore, A., Mattera, E. F., Fitzpatrick, M., Entezar, T., Fram, G., & Ching, T. H. W. (2024) · Psychiatry Research Case Reports · doi:10.1016/j.psycr.2024.100211 · Cited by 1 · see citing works
Sexuality and Related Disorders in OCD and Their Symptoms
de la Iglesia-Larrad, J. I., Bolaños, R. K. G., Navarro, I. M. P., de Alarcón, R., Casado‐Espada, N. M., & Montejo, A. L. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14196819 · Cited by 1 · see citing works
“Homosexual obsessions are commonly mistaken by clinicians with concerns about one’s own sexuality [136,169,170], although patients presenting with these in the course of the illness tend to have a moderate severity of OCD symptoms in general [22,114].”
InfluentialPalmer, A. M., Schlauch, R. C., & Darkes, J. (2019) · Clinical Case Studies · doi:10.1177/1534650119838628 · Cited by 1 · see citing works
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Clark, D. A., & Hilchey, C. A. (2017) · doi:10.1002/9781118890233.ch23 · Cited by 1 · see citing works
Igartua, K. J. (2016) · Santé mentale au Québec · doi:10.7202/1034915ar
Assessment Instruments for Obsessive-Compulsive Disorder
Guzick, A. G., Reid, A. M., & Storch, E. A. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108164313.015
Distressed Lonely Siblings’ Struggle with Obsessive Compulsive Disorder
Nehra, D. K., Bathla, J. C., & Kumar, P. (2019) · Indian Journal of Psychiatric Social Work · doi:10.29120/ijpsw.2019.v10.i2.134
Nares, A. E., & Arriaga, K. J. (2023) · International Journal of Education and Social Science Research · doi:10.37500/ijessr.2023.6606
Bonato, F. R. C., Gund, B., Baccarim, R. C. G., & Cardoso, N. D. O. (2024) · Revista Brasileira de Sexualidade Humana · doi:10.35919/rbsh.v35.1198
Osivwemu, E.-O., Simmonds‐Buckley, M., Gaskell, C., & Kellett, S. (2025) · Reports — Medical Cases Images and Videos · doi:10.3390/reports8020051
Sheikh, M. A. (2025) · Clinical Case Studies · doi:10.1177/15346501251405859
“Individuals with S-OCD may also fear being misunderstood or judged, which inhibits disclosure and impedes therapeutic engagement (Williams & Farris, 2011).”
InfluentialPinciotti, C. M., Foshee, K. L., Upshaw, B. M., Spencer, S. D., Hershfield, J., Park, J. M., Franklin, M. E., & Storch, E. A. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117285
Diagnosing obsessive–compulsive disorder
Belli, G. M., Hernandez, S. M., & Petersen, J. M. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-27446-6.00010-8
- Authors
- Williams, M. T., & Farris, S. G.
- Affiliations
- University of Pennsylvania (US)
- Corresponding author
- Williams, Monnica T.
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2011-05
- Volume
- 187
- Issue
- 1-2
- Pages
- 156-159
- ISSN
- 0165-1781 (ISSN-L)
- PMC
- PMC3070770
- OpenAlex
- W2170003188
- Cited by
- 67
- References
- 26
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 5 · 2019: 6 · 2018: 6 · 2017: 8 · 2016: 3 · 2015: 4 · 2014: 1 · 2013: 5 · 2012: 2
- FWCI
- 3.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Health/NIMH (3 R01 MH045404-17S1)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, prevalence, OCD severity, avoidance, distress, interference, gender differences
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Sexual Behavior
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