Assessing Sexual Orientation Symptoms in Obsessive-Compulsive Disorder: Development and Validation of the Sexual Orientation Obsessions and Reactions Test (SORT)

Abstract

Obsessive-compulsive disorder (OCD) includes many symptom presentations, which creates unique diagnostic challenges. Fears surrounding one's sexual orientation are common within OCD (also called SO-OCD), but SO-OCD is consistently misdiagnosed by physicians and psychologists. To address this issue, we describe the development of a self-report measure for assessing SO-OCD to help distinguish OCD from distress caused by a sexual orientation identity crisis. The current paper details two studies that established the psychometric properties and clinical utility of this measure. In Study 1, the factor structure, validity, and reliability were examined for the measure's 12 items in a sample of 1,673 university students. The results revealed a two-factor solution for the measure (Factor 1: Transformation Fears; Factor 2: Somatic Checking) and preliminary evidence of validity and reliability. In Study 2, the measure was tested with LGBTQ and heterosexual community samples and clinical samples of individuals with SO-OCD and other types of OCD. The two-factor solution and evidence of validity and reliability were supported in these samples. Cut-off points were established to distinguish between community members and SO-OCD sufferers, as well as between those experiencing SO-OCD and other types of OCD. Limitations and future directions are discussed.

Brooding Over the Closet: Differentiating Sexual Orientation Rumination and Sexual Orientation Obsessions

“…While a case study, clinical observations, and recent findings also suggest that it may be possible for sexual minority individuals to have sexual orientation obsessions about one's orientation changing to a heterosexual orientation, the emphasis here is on the more prevalent presentation of the heterosexual experience of sexual orientation obsessions (Goldberg, 1984;Williams et al, 2018). Individuals with sexual orientation obsessions often doubt and question the significance and meaning of their thoughts and come to interpret these thoughts as indicating they are a sexual minority (Williams, 2008).…”

“…In addition to both being repetitive, intrusive, and interfering, sexual orientation rumination and obsessions are also similar in some themes of thought content. These similar themes can be gleaned from two self-report instruments that have been constructed to measure sexual orientation rumination (i.e., SRRS; Galupo & Bauerband, 2016) and sexual orientation obsessions (Sexual Orientation Obsessions and Reactions Test [SORT]; Williams et al, 2018). One shared theme between sexual orientation rumination and sexual orientation obsessions is that both involve excessive thoughts about changes or stability of one's sexual orientation.…”

“…It is well established that an adversarial political climate surrounding the LGBQ+ community can create opportunities for resilience or distress (e.g., Russell & Richards, 2003); similar to the coping mechanism of sexual orientation rumination possibility leading to either resilience or distress (Galupo & Bauerband, 2016;Hatzenbuehler, 2009). On the other hand, because research suggests that most individuals experiencing sexual orientation obsessions are predominately heterosexual and not LGBQ+ (Williams et al, 2018), these obsessions appear to develop less as a coping mechanism or reaction to stigma and more as a result of overestimation of negative outcomes (Rachman, 1997) and misinterpretation of one's thoughts (Salkovskis, 1985).…”

“…The obsessions, by nature, tend to be inconsistent with an individual's historical patterns of sexual thoughts, attractions, and arousal. However, clinicians must also be careful not to rely too heavily on this distinction, as initial evidence has suggested that individuals struggling with sexual orientation obsessions may eventually identify as LGBQ+ despite initial distress, or experience sexual orientation obsessions and sexual orientation rumination concurrently (Williams et al, 2018).…”

“…For instance, individuals experiencing sexual orientation rumination may reassess if they still identify as LGBQ+ (Galupo & Bauerband, 2016), and individuals experiencing obsessions fear that their sexual orientation is changing from a desired to an undesired identity (Williams, 2008;Williams et al, 2018).…”