Sexual Orientation Obsessions and Suicidal Thoughts
The disturbing connection between sexual-orientation worries, OCD, and suicide.
Posted January 7, 2012
New Research About Sexual Orientation Obsessions
Part 2 in a Four Part Series on Sexual Orientation Themed OCD
Among those with obsessive-compulsive disorder (OCD), obsessional fears can come in many forms, and worries about sex are among the most common. Previously, I described one type of sexual fear that is often misunderstood — sexual orientation obsessions in OCD (SO-OCD). This is sometimes referred to as (H-OCD for "homosexual OCD" or as "gay OCD".) In OCD, obsessions are unwanted thoughts, images, or impulses that cause distress and won't go away.
To better understand the nature of these fears and the people who have them, I conducted a study of over a thousand people visiting one of several OCD websites. I used a battery of specific questions about sexual orientation worries, developed with input from other OCD experts at the University of Pennsylvania and experienced colleagues.
Survey to Capture Sexual Orientation Worries
Participants were asked to rate their distress over several items that described sexual anxieties, behaviors, and thoughts. The items were selected to capture a wide range of sexual orientation concerns, including worries typical of people with SO-OCD and concerns that others might have as well. Each item was rated on a scale of 1-5, with 1 being "Always" and 5 being "Never." Some items were reverse scored. Here is an example of some of the items from the survey.
- I worry about the thoughts I am having about people of the same sex.
- I avoid people of the same sex.
- I feel sexually aroused by people of the same sex.
- Thoughts about having a same-sex romance are unappealing to me.
- I worry that others will think negatively about me because of my homosexual (same-sex) thoughts.
- I worry that my thoughts about same-sex relationships mean I will have to give up opposite-sex relationships.
- I am sexually attracted to people of the opposite sex.
Of those who completed the survey, three-quarters were male and one-quarter were female, with an average age of 26 years. The majority were from United States and other English-speaking countries (87%).
Types of Worries in Obsessive-Compulsive Disorder
Based on responses to questions about obsessional content, sexual orientation, and treatment history, we selected 232 heterosexual participants who appeared most likely to be suffering from SO-OCD and studied their responses. Using a principal components analysis, four main areas of worry were identified:
- fear of becoming gay,
- negative beliefs about the meaning/consequences of being gay,
- worries about being attracted to the opposite sex, and
- finding same sex thoughts upsetting.
Each of these areas was significantly correlated to overall level of distress, with worries about becoming gay producing the greatest distress.
Extreme Distress and Suicidal Thoughts Common
Participants with SO-OCD symptoms were also asked to rate the amount of distress they experienced from their sexual orientation worries on a scale form 1-6, where 1 equaled "Some Distress" and 6 equaled a "Suicidal" level of distress. The vast majority reported a very high level of distress (92%), with over half (52%) endorsing "Extreme" distress and another 19% reporting a "Suicidal" level of distress — the two highest categories. Being male was a predictor of greater distress.
In Their Own Words: My Life is Horrible
It was clear that these worrisome thoughts were taking a heavy toll on those afflicted, as mirrored by comments received from our survey participants. One person lamented, "My life these days is horrible. I can't hold a job down long-term because I feel that [others] think I'm gay, so then I become uncomfortable around them. I have no friends because of the anxiety that I may be gay. It's hard to look at an attractive person my age because of the anxiety. I just sit around in the safety of my house... waiting... fearing..."
Others shared similar sentiments that spoke of ongoing misery. One wrote, "These thoughts I have about sexual identity are intrusive and unwarranted. I hate that they constantly enter my head even when I am doing an activity that has nothing to do with sexual things." Another wrote, "I am confident I am heterosexual but yet battle with this HOCD every second of every day." Even those who seek help often cannot find it. One person wrote, "I spoke to a therapist. I found it to be very discouraging because the therapist did not understand my anxiety."
It's not hard to imagine why people who are tormented with these worries might consider ending their lives. The thoughts are constant and sufferers feel tortured and misunderstood. Their minds are flooded with obsessions about an upsetting topic they can't turn off. The OCD makes them question who they are at their very core. One of the most heartbreaking comments was from a young Middle Eastern man. "I want help but there is not help :-(. I'm living in Sweden right now and my education is being disturbed by my these problems. Ah, how can I get rid.... hang myself is only solution, isn't it?" A few others described actual suicide attempts.
More Research Needed
Although this study was an important first step in understanding SO-OCD concerns, there were still several limitations. Participants in the study may be skewed toward those interested in this topic, and measures used to assess other OCD symptoms and sexual orientation were somewhat limited. More study will be needed to better understand this dimension of OCD and to find the best way to assess people who are suffering. In the words of one participant, "Please continue your beautiful work, it will save the lives of many people."
Go to next part: Sexual Orientation Compulsions in OCD
Williams, M. T., Davis, D. M., Tellawi, G., & Slimowicz, J. (2015). Assessment and treatment of sexual orientation obsessions in obsessive-compulsive disorder. The Australian Clinical Psychologist, 1 (1), 12-18.
Williams, M. T., Wetterneck, C., Tellawi, G., & Duque, G. (2015). Domains of distress among people with sexual orientation obsessions. Archives of Sexual Behavior, 14(3), 783-789. doi: 10.1007/s10508-014-0421-0
Williams, M. T. & Wetterneck, C. T. (2019). Sexual Obsessions in Obsessive-Compulsive Disorder: A Step-by-Step, Definitive Guide to Understanding, Diagnosis, and Treatment. Oxford University Press. ISBN: 9780190624798. doi: 10.1093/med-psych/9780190624798.001.0001