Jamie, a freshman in college, was referred to me by the student health service. She had developed a state of agitation: sleeping poorly, highly anxious, often tearful, and sometimes very withdrawn. She wouldn’t tell anyone the nature of her problem, except that she was having “terrible thoughts.” They had started after a party in her dorm with some new friends. The conversation, playful but too lurid for Jamie, had turned to the topic of homosexuality. A couple of the girls were teasing each other about being “gay,” and alluding to homosexual acts. The next day, vivid images of sexual acts began popping into Jamie’s mind, much to her dismay. To fight them off she would tell herself over and over “It’s not true,” and pray endlessly.

“I don’t want to be gay,” she told me, trying not to cry. “It would bother me so much if I were, because God says it is a sin. Then under that, if I were one, then everyone in my family would look on me in disgust. Loss of salvation would be a big one, too. I know if I were involved like that, there would be no way I would be a Christian.”

I explained to Jamie the nature of OCD, including how it can be a trial of faith. We began to do work on the obsessional images. Yet, for several weeks we made only minimal progress. Finally, in a tearful moment, she shared her deepest fear, the one that she had been too embarrassed to reveal. “Sometimes…I feel like I really do want to have sex with girls. That makes my stomach turn. I can’t stand it.” It turned out Jamie had been having a sense of sexual excitement in response to the obsessions. This was her biggest source of shame and guilt.

False sexual excitement can drive an OCDer right off the deep end. It is often the coup de grace in a series of obsessional fears. First there is an unwanted thought that is not dismissed from awareness as it should be (the basic problem in OCD). In Jamie’s case, it was the idea “What if I’m gay?” Then, fighting the thought and performing compulsions makes the troublesome thought stronger. More unwanted images arise, and soon a cascade of worsening obsessions occurs. Finally, false sexual excitement turns up, which, terrifyingly, seems to provide incontrovertible evidence that the worst fear is, indeed, true.

Yet the sexual excitement caused by an obsessional fear does not indicate true desire. It is an automatic, robotic reaction of the most primitive part of the brain (think alligators) that can occur in response to any sexual ideas or images that persistently stay in conscious awareness—doesn’t matter what the thoughts are, or whether they stem from fear or desire, as long as they have to do with sex.

False sexual excitement is a truly devious trick of the mind. It can cause excruciating distress and a sense of complete despair in OCD sufferers, who are by nature overly conscientious and guilt prone. It is now clear that false sexual excitement can be a natural part of OCD. It even has a name, an ugly one, the “groinal response.” Once Jamie understood what was happening to her, she was able to engage in OCD treatment strategies, and deal with her fears.

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7 Response Comments

  • Joe  October 6, 2016 at 1:28 pm

    Hi Dr. Osbourne,

    I know this is off topic but I was wondering if you treat generalized anxiety disorder in a similar fashion to OCD?

    • admin  October 6, 2016 at 3:17 pm

      Not really…in so far as using ERP is concerned. ERP works for habituating to one, overgrown fear that is fueled by prominent compulsions. In GAD, there are lots of different worries that are not so intense, and often the worries are about quite realistic concerns. So ERP just isn’t effective. People with GAD can definitely have some of their fears escalate and begin to involve compulsions, though. Then they have OCD.

  • Joe  October 6, 2016 at 4:12 pm

    Ok thank you. I thought I remembered reading that learning to tolerate uncertainty and the anxiety it produces was a way to treat GAD.

    • admin  October 6, 2016 at 5:28 pm

      Yes, that’s a good strategy for both OCD and generalized anxiety. It’s just the intensive ERP exercises–i.e., prolonged exposure and prevention of compulsions–that are not generally used in GAD.

  • Brett  June 10, 2019 at 10:51 am

    Hi Dr. Osbourne,

    What would ERP look like for us who struggle with the “groinal response” or hypersensitivity to sexual anatomy with feared obsessions? Thanks

    • admin  June 10, 2019 at 4:20 pm

      ERP would involve purposeful exposure to the anxiety producing idea or image. The key here, in my experience, is that this may or may not be the image or idea that induces the groinal response. It may be, for example, “I’m really a monster and am going to hell for getting excited over this perverted thought.” So, in that case the image/urge that is perverse is just the trigger to the anxiety producing thought (the obsessional fear). Obviously, there is a lot to say about how best to do ERP. That’s all I can really say here.

      • Brett  June 10, 2019 at 5:33 pm

        That makes sense. Thanks for the insight.


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