Presented is a case report of exposure and ritual prevention (EX/RP) therapy administered to a 51-year-old, White, heterosexual male with sexual-orientation obsessions in obsessive-compulsive disorder (OCD). The patient had been previously treated with pharmacotherapy, resulting in inadequate symptom reduction and unwanted side effects. OCD symptoms included anxiety about the possibility of becoming gay, mental reassurance, and avoidance of other men, which resulted in depressive symptoms and marital distress. The patient received 17 EX/RP sessions, administered twice per week. The effect of treatment was evaluated using standardized rating instruments and self-monitoring by the patient. OCD symptoms on the Yale-Brown Obsessive Compulsive Scale (YBOCS) fell from 24 at intake to 3 at posttreatment and to 4 at a 6-week follow-up, indicating minimal symptoms. Improvement also occurred in mood, quality of life, and social adjustment. Issues concerning the assessment and treatment of homosexuality-themed obsessions in OCD are highlighted and discussed.
Abramowitz, J.S., Franklin, M.E., Schwartz, S.A., & Furr, J.M. ( 2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 71, 1049-1057.
2.
Ball, S.G., Baer, L., & Otto, M.W. ( 1996). Symptom subtypes of obsessive-compulsive disorder in behavioral treatment studies: A quantitative review. Behaviour Research and Therapy, 34(1), 47-51.
3.
Dozois, D.J.A., & Dobson, K.S. ( 2002). Depression. In M. M. Antony & D. H. Barlow (Eds.), Handbook of assessment and treatment planning for psychological disorders (pp. 259-299). New York, NY: Guilford.
4.
Eisen, J.L., Phillips, K.A., Baer, L., Beer, D.A., Atala, K.D., & Rasmussen, S.A. (1998). The brown assessment of beliefs scale: Reliability and validity. American Journal of Psychiatry, 155, 102-108.
5.
Eisen, J.L., Rasmussen, S.A., Phillips, K.A., Price, L.H., Davidson, J., Lydiard, R.B., . . . Piggott, T. ( 2001). Insight and treatment outcome in obsessive-compulsive disorder. Comprehensive Psychiatry, 42, 494-497.
6.
Endicott, J., Nee, J., Harrison, W., & Blumenthal, R. (1993). Quality of life enjoyment and satisfaction questionnaire: A new measure. Psychopharmacology Bulletin, 29, 321-326.
7.
Foa, E.B., Huppert, J.D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P.M. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment, 14, 485-495.
8.
Foa, E.B., Kozak, M.J., Goodman, W.K., Hollander, E., Jenike, M.A., & Rasmussen, S.A. (1995). DSM-IV field trial: Obsessive-compulsive disorder. American Journal of Psychiatry, 152, 90-96.
9.
Franklin, M.E., Abramowitz, J.S., Kozak, M.J., Levitt, J.T., & Foa, E.B. ( 2000). Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples. Journal of Consulting and Clinical Psychology, 68, 594-602.
10.
Goodman, W.K., Price, L.H., Rasmussen, S.A., Mazure, C., Fleischmann, R.L., Hill, C.L., ... Charney, D.S. ( 1989). The Yale-Brown obsessive-compulsive scale I: Development, use, and reliability. Archives of General Psychiatry, 46, 1006-1011.
11.
Gordon, W.M. ( 2002). Sexual obsessions and OCD. Sexual and Relationship Therapy, 17, 343-354.
12.
Grant, J.E., Pinto, A., Gunnip, M., Mancebo, M.C., Eisen, J.L., & Rasmussen, S.A. (2006). Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder. Comprehensive Psychiatry, 47, 325-329.
13.
Hamilton, M. ( 1960). A rating scale for depression. Journal of Neurology and Neurosurgical Psychiatry, 23, 56-62.
14.
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. ( 2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.
15.
Kocsis, J.H., Zisook, S., Davidson, J., Shelton, R., Yonkers, K., Hellerstein, D.J., . . . Halbreich, U. ( 1997). Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: Psychosocial outcomes. American Journal of Psychiatry, 154, 390-395.
16.
Kozak, M.J., & Foa, E.B. ( 1997). Mastery of obsessive-compulsive disorder: A cognitive-behavioral approach. San Antonio, TX: Psychological Corporation.
17.
Pinto, A., Greenberg, B.D., Grados, M.A., Bienvenu, O.J., Samuels, J.F., Murphy, D.L., . . . Nestadt, G. ( 2008). Further development of YBOCS dimensions in the OCD collaborative genetics study: Symptoms vs. categories. Psychiatry Research , 160, 83-93.
18.
Rachman, S., & de Silva, P. ( 1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16, 233-238.
19.
Renaud, C.A., & Byers, E.S. ( 1999). Exploring the frequency, diversity, and content of university students’ positive and negative sexual cognitions. Canadian Journal of Human Sexuality, 8, 17-30.
20.
Ruscio, A.M., Stein, D.J., Chiu, W.T., & Kessler, R.C. ( 2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry , 15, 53-63.
21.
Weissman, M.M., & Bothwell, S. ( 1976). Assessment of social adjustment by patient self-report . Archives General Psychiatry, 33, 1111-1115.
22.
Williams, M.T. ( 2008). Homosexuality anxiety: A misunderstood form of OCD. In L. V. Sebeki (Ed.), Leading-edge health education issues (pp. 195-205). Happauge, NY: Nova Science Publishers.
23.
Williams, M.T., & Farris, S.G. (IN PRESS). Sexual orientation obsessions in obsessive-compulsive disorder: Prevalence and correlates. Psychiatry Research. doi:10.1016/j.psychres.2010.10.019
