Table of Contents

Homosexual Obsessive Compulsive Disorder (HOCD), also known as Sexual Orientation OCD, is a form of OCD. The individual obsesses that their sexual preference has changed. This unsettling realisation causes them to constantly check their sexual identity or seek reassurance that it has not changed. 

The term is a popular expression (not a diagnosis1) for a cluster of obsessive thoughts regarding a person’s sexuality. The person questions and doubts their long-standing sexual preference. People with the condition may miss effective treatment as they cannot recognise it as a subtype of OCD. They believe they do not have compulsions, which are necessary for a diagnosis of OCD. However, to help ease the anxiety and confusion created by their obsessive thoughts, the person performs mental compulsions to reduce the relentless questioning in their mind.

Homosexual OCD does not discriminate. If you are a lesbian woman, gay man or heterosexual man or woman, if you suffer from the doubt caused by OCD, you can obsess and question your long-standing sexual identity. This form of OCD causes significant distress to the person, but you can end the cycle of doubt by engaging in treatment.

This page contains informational content on HOCD. If you were looking for Self Help, you could find it here; if you wish to read more articles on sexual orientation OCD, you can find them here.

 

 

 

 

Estimated reading time: 26 minutes

 

30-second summary

  • If you have HOCD, you will experience both obsessions and compulsions.
  • Obsessions are the thoughts and images in your head regarding your sexual identity.
  • Compulsions are the things you do to check if your sexual identity has changed, e.g. check if you are attracted to members of the same sex or opposite sex.
  • Obsessions and compulsions fall under a mental health condition called OCD.
  • Doubt makes you engage in more compulsions to check out your sexual preference. This eases your distress short term but ends up in a cycle of obsessions and compulsions, which is the trademark of all OCD. Your sexuality has not changed; break the cycle by seeking out treatment.
  • Treatments available include CBT, ERP and ACT.

Taken from my online self-help course

 

 

What is HOCD?

HOCD stands for Homosexual Obsessive Compulsive Disorder, and it is characterised by having unwanted thoughts about your sexual orientation.

 

It is essential to understand that thoughts are unwelcome. This is not thinking about your sexuality, where you choose to think the thoughts. It is not thinking about coming out.

If you are suffering from HOCD, the ideas have nothing to do with your sexuality at all. It just feels like it does, and feelings are not fact.

Let that sink in.
The thoughts you consider related to HOCD have nothing to do with your sexual identity or sexual preference.

They are intruders wreaking havoc with established beliefs about yourself, your long-established sexual identity, interfering with your current or future relationship and injecting doubt and uncertainty into your daily life.

An important point to note is that it is not the content of the thoughts that are the problem, i.e., whether you are gay, lesbian or heterosexual. The problem is what you do with them; the analysis, the checking, the need for certainty and reassurance is the problem; the compulsions. These are all characteristics of OCD and can be treated.

The compulsions in HOCD arise from the doubt and uncertainty that the unwelcome thoughts have created.
Most people are familiar with compulsions such as handwashing in OCD. The person feels contaminated and performs a washing ritual to ease the anxiety. However, the compulsions that arise with HOCD make some people believe that they need to come out, or worse, ill-informed therapists, thinking their client is struggling to come out or denying their sexuality.


The things you end up doing to reassure yourself that your sexual identity is intact revolve around reassurance-seeking behaviours to help stem the doubt and uncertainty.

How is it diagnosed?

Neither Homosexual OCD nor Sexual Orientation OCD is diagnoses in their own right; instead, they fall under the umbrella of OCD

OCD is a diagnosis in its own right because it has defining characteristics that can help form a diagnosis. 

The Diagnostic and Statistical Manual for Mental Disorder, Fifth Edition (DSM-5); American Psychiatric Association [APA], 2013) does not list HOCD as a condition. I would suggest you think of it as a ‘label’ that falls under the umbrella of Obsessive-Compulsive Disorder.  

For a diagnosis of OCD to be made, the person needs to;

  • have obsessions and compulsion that take up over one hour per day, and
  • cause distress or disruption to the person’s life in that they find it challenging to carry out day-to-day activity.

Why do they not have a separate diagnosis?

My answer to this is that they are both OCD or subcategories of OCD if you like.  

The obsessions within OCD can cause the person to focus on;

Understanding the OCD in homosexual OCD

Whether you use the label Homosexual OCD or Sexual Orientation OCD, we are still talking about OCD. The prefix homosexual or sexual orientation refers to the type of obsessions generated by Obsessive Compulsive Disorder.

 

You must remember the OCD in the label of homosexual OCD. What you are experiencing has nothing to do with your sexual preference; that remains the same as before you started having these uncomfortable obsessions. 

 

As with OCD, the condition comprises obsessions and compulsions, which I shall talk about now.

 

If you would like my help, please see my self-help course for HOCD.

Are there symptoms to alert you to Sexual Orientation OCD/HOCD?

I am going to split this into two groups

  • Obsessions, and
  • Compulsions
Obsessions

The word ‘obsession‘ comes from the Latin’ obsidere’, which means ‘to besiege’. Obsessions are the unwanted intrusive thoughts that you get in your head, for example.

  • You worry that the thoughts you have in your head, or the feelings and sensations you may get in your body, may mean that your sexual preferences have changed. If you are heterosexual (straight), you may now be concerned that you are gay.
  • You worry about things that may have occurred in the past, which are some sort of proof that you are now gay.
  • Noticing something beautiful about members of the same sex may make you see this as evidence that you are gay.
  • You are worried you are indeed gay and are living in denial of your sexuality.
  • Worried if you cannot get an erection or aroused if you are female could mean that you are gay.

When you get these obsessions, i.e., the thoughts about your sexuality that you dislike, like many other people, you do some things to help you decide if you are gay or reassure yourself that you are still straight. The things you do are known as compulsions.

Compulsions

I shall divide the compulsions into two groups, as it is more helpful.

Covert–things that other people can’t see, for example, what goes on with your thought processes

Overt–something that other people could see you doing, for instance, watching porn to make sure you’re not gay.

Being aware of obsessions and compulsions is how to think about your HOCD. Rather than worrying whether you are gay, you can think, “oh, that thought was an overt compulsion.” Doing this can distance you from the thoughts and see them as HOCD symptoms and not prove that you are gay or heterosexual.

The compulsions are what you do to make yourself feel better or try to ‘check out if you are gay’.

Covert Compulsions

You are going over in your mind previous sexual encounters with members of the opposite sex to reassure yourself that you are not gay.

You might try to imagine being with a member of the same sex to check out your theory that you might be gay.

You might have remembered an event from your childhood that you now see as evidence that you are gay. Children can engage in a type of exploration play; you heard it called ‘doctors and nurses.’ If you recall this type of game, you may mentally go over it, matching it up with other pieces of ‘evidence’ to help you make sense of what is happening to you.

Overt Compulsions

You are seeking reassurance. This reassurance-seeking could google HOCD Symptoms to get information to show you whether you are gay and asking current or previous partners questions to help you decide about your sexuality.

  • Watching same-sex porn to see if you get aroused
  • Watching straight porn to see if you get aroused
  • Going to gay bars to see if you are attracted to anyone

Accepting that you are suffering from obsessions and compulsions instead of experiencing a change in your sexual preference is the first step towards recovery, and I shall talk to you about what treatment options are open to you now.

HOCD Treatment and Self Help

The primary treatment for HOCD is Cognitive Behavioural Therapy, CBT. Still, I find people do better if they also use Mindfulness-Based approaches.

In all the approaches I shall explain below, the following is essential if you want to overcome HOCD.

  • You need to not only change your thought processes but stop reacting to them as if they are true
  • You need to stop reassurance-seeking behaviours

If you would like my help, all the things you need to overcome HOCD are included in my online course, which is available for you to start. 

My self-help course can be taken at home, in your own time, and follows the same format as if you were to see me in person. 

Dr Elaine Ryan

I understand many people may not wish to meet with someone in person to discuss what is happening to them but still want access to help; hence I made a course.

Cognitive Behavioural Therapy.

CBT is a model of therapy that looks at the role of your thoughts and behaviours in HOCD. Put more simply, there will be things you keep going over in your head (thoughts and doubts) and things that you do (maybe to look for reassurance) that contribute to your experience of HOCD. CBT helps to take this apart for you and change what needs changing.

You will learn to identify unhelpful thought patterns and unhelpful behaviours. If you can change how you think and change the things you do, that is making it worse; that’s half the battle over. Think about it this way; if you were no longer stuck in your head with your worries and no longer seek reassurance, your life would be back to normal.

Mindfulness for HOCD

I find mindfulness helpful to help with HOCD; it takes the ‘sting’ out of your thought processes. Let me explain. Being human, we react to most of our thought processes as if they are real.

Mindfulness will teach you that these are just thought processes and that you do not have to pay attention to every thought that pops into your head. Once you can do this, you are less likely to experience these types of thoughts in the future. The reason being is that your brain learns whatever you teach it, be it good or bad. 

Read more on treatment

Psychologists’ understanding of HOCD

In the following part of the article, I shall try to explain some points I would cover in session with clients.

Understanding how HOCD works

Most people who first experience unwanted thoughts about their sexual identity focus most of their attention on the fear that their sexual preference has changed. However, these thoughts about your sexuality are a symptom of OCD. Understanding how OCD works will help you negotiate your way through HOCD.

The critical point to note with Sexual Orientation OCD is that the content of the obsessions is not as relevant as realising that you are suffering from obsessions that occur within OCD.

Dr Elaine Ryan

Focusing on the content keeps your suffering going

The content of thought is not important. In a psychologist’s mind, helping someone with unwanted thoughts about their sexuality is the same as treating a person who is suffering from obsessions regarding, for example, contamination. They are both obsessions. 

Suppose you focus on the content, analysing every unwanted thought you have regarding your sexual identity. In that case, this does not solve your problem. Instead, it results in distress that makes you feel compelled to check out what is happening to you—your obsession results in a compulsion.

Further Reading: Compulsions make your intrusive thoughts worse

An important point to note is that it is not the content of the thoughts that are the problem, i.e., whether you are gay. The problem is what you do with the thoughts; the analysis, the checking, the need for certainty and reassurance is the problem; the compulsions. These are all characteristics of OCD.

Avoidance

It is not being able to listen to or see anything that might make you think about being gay.

This could be certain songs or artists that you associate with being gay, types of TV programs, magazines or books, that you might associate more with same-sex couples.

You might avoid going out or mixing with a same-sex couple or showing support for same-sex couples. You may avoid many things, fearing that they could ‘trigger’ your HOCD, and I shall give a list below.

  • Avoiding men if your HOCD is concerned with being gay
  • Avoiding women is your HOCD is related to the feeling that you are lesbian
  • Avoiding taking part in things that you believe are too manly or too female
  • Avoiding changing rooms where you will see members of your sex dress and undress
  • Not being able to make eye contact with members of the same sex or avoid hanging out with them
  • Any topics of conversation relating to sexual preference
  • Movies where same-sex actors may kiss or be romantically involved

Faulty Belief Systems

If you are like most people, you will not question the thoughts in your head (you will examine all the HOCD thoughts) but will not question the validity of your own beliefs.

You can think of a belief system as being a set of rules. You have to make sense of our world and your experiences, but many of them will not be correct or not helpful to you as a person.

For example, suppose you grew up thinking you had to please others to be liked. In that case, this is quite hard to maintain as an adult and does not allow because people will like you whether you are doing things to please them!

I shall give a couple of examples so you know what I am talking about.

  • Finding members of the same sex attractive means that you are gay
  • My thoughts mean something about my sexual preference

Finding members of the same sex attractive

If you notice you find members of your own sex attractive, there are more things than faulty beliefs at play here. You are also more likely to, what I call, spotlight this feeling of attraction. I’ll talk about the spotlight in a second.

Suppose you hold a faulty belief (see above) that finding members of your own sex attractive means that you must be gay. In that case, you are a victim of your belief system, as opposed to being gay.

Human beings find many things attractive. Houses, cars, people, gardens, and the list goes on. If you think of the word attractive as meaning ‘pleasing,’ you can find and appreciate many things as pleasing; this also includes appreciating the physical characteristics of the personality of someone who is the same sex as you. This does not mean that you want a physical and romantic relationship with them. Still, if you have a faulty belief system, it will cause you difficulties.

My thoughts mean something about my sexual preference.

This is also a faulty belief system as if you get an HOCD related thought. Your belief system will guide you to think that it must mean that you are gay. Random thoughts mean nothing.

I can think I am 21 years old and a multi-millionaire, and it is not valid, as thoughts mean nothing. I shall contradict myself now; thoughts only have the meaning you give to them, so be careful about any faulty beliefs you may hold.

HOCD in the Spotlight

You might have noticed that in your life before HOCD, you never questioned your sexual preference, took heterosexual relationships for granted, and never noticed who was gay and who was straight. Now you have a radar, or a spotlight as I like to think of it, where everything you do, and everywhere you go, you seem to notice things that make you question your sexual preference.

A term called selective attention can explain this. There are too many things in life to focus on, so we can filter out the noise and focus on what is essential. Think about driving your car; you filter out the background noise and scenery and pay attention to the road and the signs you need to read.

In your life before HOCD, you would have filtered out all the things that are causing you distress now. If you were meeting friends for a coffee, you would have filtered out the people you walked past, how you were walking and focused on getting to the coffee shop and filtered out the background noise to enjoy your friend’s company.

Now you have a spotlight; you can selectively attend to everything you associate with being gay. You might be concerned about people on the street, how you appear to them, are you walking funny, should you have left the manbag at home? It could be challenging to pay attention and just enjoy being with your friends, as you might wonder if they think you are gay.

All of this does not mean that you are gay; it means that you are shining a spotlight on things that you associate with being gay, which brings me to an important point; what’s the difference between HOCD and being gay?

Case Study HOCD

Paul was a 25-year-old man who referred himself for therapy. He stated his reason for wishing to begin treatment was that he believed he was suffering from anxiety and affecting his ability to work.

I undertook an assessment and found that Paul was indeed anxious. No previous history of mental illness. He had a full social life and friends.

Paul did not say he was having intrusive thoughts or uncomfortable thoughts regarding his sexuality during our initial assessment. This is not uncommon, as many people who present for therapy come because they have been feeling anxious or depressed. It is up to the therapist’s skill to determine why.

During the assessment session, Paul made a ‘throwaway’ comment regarding his sexuality. I explored this topic with him as I could see that he was feeling uncomfortable, and later, he informed me that this was the first time he had spoken about it. He stated he had been heterosexual all his life and would have no problem if he was attracted to men. Still, he could not understand what was happening to him.

Paul has been sexually active since he was 17, always with women, and has been in a long-term relationship with his girlfriend for three years. Two months ago, he started having intrusive thoughts that he might be attracted to men.

Before the intrusive thoughts, his work colleagues teased him about his love of clothes and how he maintained his physique and hair. He started comparing himself to other men in terms of their appearance and how well they kept themselves.

Paul stated he noticed men more often when he was walking down the street as he was comparing himself to them in terms of ‘maintenance levels.’ He noted which men were attractive and which were not, and this is when he questioned the content of his thoughts.

Paul was clear that he did not wish to have a sexual or romantic relationship with a man, that he wanted to stay in his current relationship with his girlfriend. Still, his intrusive thoughts were affecting the quality of his relationship. He had obsessed about his appearance and choice of clothes and how he appeared to other people. He also looked at other men to test to see if he felt an attraction.

During the session, I found out that Paul had mild OCD in his late teens. It explained that thought processes alone could not make a person’s sexuality change. It would appear that he was experiencing unwanted intrusive thoughts about his sexuality that affected his relationship and made him anxious.

The psychological explanation for what was happening to Paul

  • We found Paul had a faulty belief system that men who take care of themselves are effeminate.
  • men should be rough

When teased about his appearance, Paul was very aware of his choice of clothes and how he liked to use products for his hair and skin. This did not match up with faulty belief systems that he did not know he held until he began therapy. 

He focused on how he behaved, walked, and talked (this is the spotlight of attention I mentioned above.)

Over time, Paul avoided people and places that made him question his sexual identity. He found it difficult to be intimate with his girlfriend, which made him question his sexuality further.

We agreed to meet for an initial six sessions to start treatment using CBT and Exposure Response Prevention.

Questions about HOCD

I will answer some more common questions that I have been asked in relation to HOCD below.

Does having HOCD mean you need to ‘come out?

HOCD is not having thoughts about ‘coming out.’ Coming out is where you choose to think about your sexuality, knowing you are attracted to members of the same sex and want to think about how to live your life as gay or lesbian. The thoughts that arise in what we call HOCD are symptoms of a mental health condition, OCD.

OCD is characterised by having continual doubt. For example, doubt about cleanliness and germs, doubt about doing something correctly, and in this case, doubt about sexuality. HOCD has nothing to do with sexuality but has to do with the doubt and uncertainty that exist within OCD.

Difference between HOCD and being gay

It’s straightforward, HOCD is Obsessive-Compulsive Disorder, and being gay is enjoying and wanting romantic relationships with members of the same sex.

If you have HOCD, your thoughts processes are concerned about being gay–not your actions. If you are gay, your actions and thoughts show you are gay; you want, seek and enjoy romantic relationships with the same sex.

After reading that, you could well think, but how do I know? How can I be sure that I am not gay and don’t know it? This is a symptom of Obsessive-Compulsive Disorder–that need for certainty, which I shall talk to you about now.

HOCD and the need to ‘be sure.’

I don’t know how many times I have been asked, “but how do I know for sure that I am not gay?” I’m the psychologist behind MoodSmith; in case you were wondering, and this need for absolutes, reassurance and concrete evidence is a classic symptom of OCD. It’s what feeds the doubt and leads you into the repetitive nature of carrying out compulsions.

Needing to know for sure is just a symptom of OCD.

In my mind and all the sessions I have conducted over the years, this need to know for sure does not differ from someone needing to know that the surface they have just cleaned is clean; they always have doubt. I am mentioning more familiar traits of OCD to help you think that what is happening to you is a symptom of HOCD instead of a change in your sexual choices.

This ‘needing to know for sure’ is a symptom of OCD, and it is helpful if you can see it as a symptom. For the rest of your life, you do not have this need for absolute certainty. You do not need to know for sure what you will do next Tuesday or need to be sure what something you did in the past meant (unless you associate it with HOCD.)

Until you thought you might have HOCD, you would not have needed to know for sure what your sexual preference was. Now, you do not need to know for sure what your profession is–you take it for granted.

This ‘need for certainty is a symptom, but one that can cause you many hours of trying to find answers, and it is this ‘need to know and the things you do that help keep HOCD going.

What maintains HOCD?

The doubt that I mentioned above, and the need to know for sure, leads you into the cycle of looking for reassurance, analysing everything, and carrying out compulsions. This keeps it all going; it has nothing to do with your sexuality at all!

So what does this all mean?

If some things that I have written here make sense to you, or you recognise yourself in it, it means that

Whatever is happening to you is a symptom of HOCD; it does not mean that you are gay.

This doesn’t mean you are homophobic. It is, however, alarming if you question your sexuality, which you will have been taking as a ‘given’ for all of your life.

What causes Homosexual OCD?

Your brain is latching onto a thought and running wild with it.

The thought is harmless. It does not have to originate from thought; it can come from a feeling. You might have first thought.

  • Am I gay?
  • Am I attracted to him?
  • What would it be like to be with a guy?
  • Am I not attracted to women anymore?

Or it can start with sensations such as getting aroused in a situation that you consider inappropriate or not like you.

But the thought or original feeling is harmless (and normal). It is what you do with the thought and feeling.

If you just ignored it, you wouldn’t be reading this post, as it would have just wandered in and out of your attention like all the other random thoughts.

If, however, it shocked you or alarmed you, as I am assuming it did, your brain will note it. As you are human and have the capacity for rational thought, you will want to think about it, to make sense of it, and this is where you can get into trouble.

Having the capacity for thought is not always a good thing! Reassure yourself that you are not gay and analyse every single male encounter you have had in your life to date.

You are trying to reassure yourself, but then find evidence that makes you doubt yourself.

It is here you get into dangerous territory. You put it to the test.

Before you know it, you are watching porn, and not like before, just for the sake of it, but as some sort of experiment to make sure you are not gay.

But it is not like before. In the past, you would have been relaxed, maybe having a few beers. The perfect environment for everything to be in working order.

This time, the porn is an experiment, and you are stressed to the high heavens, and when you don’t get an erection, you take that as evidence you must be gay.

Let me tell you, if you are stressed, nothing down there works very well!

It is only a matter of time before these thoughts are ruining your life.

You can’t even walk down the street without thinking you are checking out guys or looking at them differently.

Maybe you are giving off some sort of gay vibe and never knew it!

If any of this is familiar to you, it screams of intrusive thoughts. You will not be gay. You are just afraid you are reacting to the thought as if it is reality.

If you were gay, it wouldn’t be causing you a thought.

HOCD or denial?

This is the question I get asked the most. “How do I know that this is HOCD and that I am not gay and don’t know it.” Trust me, you would know. I will explain to you what is happening, and it has a lot to do with ‘doubt.’

Doubt and the denial question

Forget the denial question for a minute. A nagging doubt characterises HOCD. The doubt arises because;

the ideas in your head are so foreign to who you are as a person, and

because you attach some significance to them, you believe they must mean something.

Being human, you have the capacity for thought; it’s both a gift and a curse. Without having a good understanding of how your brain works, you might not understand what is happening and therefore find it hard to dismiss thoughts relating to HOCD.

Your brain is wired to keep you out of harm’s way, so it shall pay more attention to the bad things than the pleasant experiences in your life–your brain does not need to protect you from good things.

Now here’s the thing. Your brain does not differentiate between ‘bad things’–threats. A threat could be genuine, such as approaching a poisonous snake or threats specific to you–things that disturb you.

If you are anxious about the obsessions in your head relating to HOCD, your brain may pick up on this and mark them as a threat. Once that happens, your mind pays more attention to them, sort of seeking them out to draw your attention to them.

Now that they are in your head more often, you can use your ability to think and try to analyse what is happening to you. You can question your sexuality, looking for evidence both in your life at the moment, and going into the past to see if you are in denial and didn’t know it.

I said to forget the denial question at the moment, and I did that for a reason. If you did my job (I’m a psychologist), you would see that this constant analysis and need to know ‘the truth’ occurs in all forms of OCD and Intrusive Thoughts.

This is very important–the content of your thoughts is not important; it is what you do with your thought processes that are important.

For example, it doesn’t matter if someone is seeking the ‘truth’ over

am I gay or in denial?

How do I know I won’t act on them?

How do I know something is clean and free from germs?

Instead, it is about recognising that this happens–a pattern if you like–that occurs not only in HOCD but also in all forms of intrusive thoughts. This is where acceptance and commitment therapy can help.

People who are gay know this, beyond any doubt. They do not spend hours analysing “how do I know.” They just know. Just the way I know I am a woman and a psychologist, I don’t have to give it a second thought.

Homosexual OCD and sexual arousal

Suppose you have experienced sexual arousal while thinking about or watching members of the same sex. In that case, this is where you can run into difficulty as you see this as evidence that you must be gay.

This is a mistake. Ask yourself where you experience the arousal. Are you watching porn? For example, of course, you will feel arousal; we are sexual beings!

But you could just be looking at a member of the same sex–but how are you looking at them? If I walked past you now in the street, I wouldn’t be thinking, do I feel anything? Am I getting aroused? I would just walk past you in the street.

But the difference between you and me is that you would be selectively attended to members of the same sex to check how you are doing. Your brain is actively searching them out; they might as well be walking about flying a flag to get your attention, and then you make the mistake of checking out how you feel in your genitals.

You can read more about sexual arousal here.

Further Reading

Footnotes

  1. HOCD is not a diagnosis that can be found in the Diagnostic and statistical manual of mental health disorders; DSM. DSM is used by mental health professionals to diagnose conditions. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Sources

Homosexual Obsessive compulsive disorder (HOCD): A rare case report Manjeet S. Bhatia,Jaswinder Kaur Journal of Clinical and Diagnostic Research (2015), 10.7860/JCDR/2015/10773.5377

Williams, M.T., Wetterneck, C., Tellawi, G. et al. Domains of Distress Among People with Sexual Orientation Obsessions. Arch Sex Behav 44, 783–789 (2015). https://doi.org/10.1007/s10508-014-0421-0

Viscusi, J. A., & Williams, M. T. (2019). Treating Sexual Orientation Obsessions. In Sexual Obsessions in Obsessive-Compulsive Disorder(pp. 163–206). Oxford University Press. https://doi.org/10.1093/med-psych/9780190624798.003.0006

Luxon, A. M., Chasson, G. S., Williams, M. T., Skinta, M. D., & Galupo, M. P. (2021). Brooding Over the Closet: Differentiating Sexual Orientation Rumination and Sexual Orientation Obsessions. Journal of Cognitive Psychotherapy35(3), 167–182. https://doi.org/10.1891/JCPSY-D-20-00013