Damián Ruiz

Obsessive-Compulsive Disorder has clear symptomatic components: mental or behavioural rituals, intrusive and/or irrational superstitious thoughts, continuous doubts and, at its core, very high levels of anxiety fuelled by fear and/or guilt.

However, OCD, which is a significant psychological disorder, cannot serve as a defence mechanism or a refuge from personal realities that cannot be accepted, nor should it be confused with obsessive personalities who have a particular “fixation” on orderliness or cleanliness.

Let us consider a few examples. If a person says they have sexual orientation OCD, one of the most common forms, but they have had pleasurable sexual experiences with someone of the same gender, have fallen in love with someone of the same gender, have experienced genuine sexual arousal (without self-stimulation) while thinking about or viewing erotic or pornographic images involving people of the same sex, then this is not OCD. This is egodystonic homosexuality (or bisexuality), that is, the non-acceptance or non-integration of one’s sexual orientation.

And I am not talking about theoretical assumptions but about facts.

Attempting to redefine this as OCD in order to relieve anxiety merely postpones and aggravates the potential resolution of the problem.

Because when would it be OCD?

When, despite repeated checking, the person is unable to experience genuine desire or arousal (the presence of a tingling sensation in the genital area or a slight increase in penile size is due to anxiety and nothing else), and when they have never experienced any form of attraction, either romantic or sexual, towards anyone of the same sex.

I would emphasise that we are all perfectly aware when someone of our own gender is attractive, but the aesthetic appreciation of beauty does not necessarily imply sexual desire.

In other words, for it to be OCD, doubt must remain permanently unresolved, because when it is a case of egodystonic homosexuality, the individual has usually already acted upon these experiences and found them satisfying, even if they find it difficult to integrate or acknowledge this reality.

Let us now turn to so-called relationship OCD or romantic OCD.

It is not always the case that when someone has stopped feeling attraction or desire towards their partner it is because they have relationship OCD or because they suddenly believe they may be homosexual. Sometimes the explanation is much simpler: the person no longer feels what they once felt but believes that this should not be the case.

This is where therapists come in: to distinguish one situation from the other and, through questions and answers, determine whether we are dealing with OCD or not.

I have said this on dozens of occasions: in my professional experience, nobody who has genuinely suffered from homosexual-content OCD has ultimately turned out to be homosexual. Why?

Because they displayed all the specific symptoms associated with this particular disorder.

When it is not OCD but rather egodystonic homosexuality, for all the reasons already mentioned, the work consists of helping the person integrate it and live it fully and authentically.

Homosexuality and bisexuality are, as I never tire of repeating, minority variations within the human species as well as within many other species. They are neither pathological nor something that requires treatment, because there is nothing to cure. — And those who question the normality of certain sexual practices should perhaps also reflect on other practices, equally heterosexual, that are statistically far less common within the animal kingdom and in the wild. —

It is the therapist, free from any form of prejudice, who must determine what constitutes OCD and what does not, and for it to be considered OCD the required symptomatology must be present.

And when it is not, the work must proceed in a different direction: that of the individual’s integration.

Barcelona, July 2026
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