Call to Action: Recommendations for Justice-Based Treatment of Obsessive-Compulsive Disorder With Sexual Orientation and Gender Themes

• Published in: Behavior therapy 2022-03, Vol.53 (2), p.153-169
• Main Authors: Pinciotti, Caitlin M., Smith, Zachary, Singh, Sonia, Wetterneck, Chad T., Williams, Monnica T.
• Format: Article
• Language: English
• Subjects: exposure and ritual prevention; Female; Gender Identity; Humans; LGBTQ; Male; obsessive-compulsive disorder; Obsessive-Compulsive Disorder - therapy; Sexual and Gender Minorities; Sexual Behavior; SO-OCD; Social Justice; treatment recommendations
• ISSN: 0005-7894; 1878-1888
• DOI: 10.1016/j.beth.2021.11.001

•Historical treatment of SO- and gender-themed OCD perpetuates marginalization.•Updated CBT and ERP treatment recommendations for this presentation are provided.•Recommendations consider the intersection of treatment outcomes and social justice. Gender and sexual minorities are subjected to minority stress in the form of discrimination and violence that leads to vigilance; identity concealment and discomfort; and internalized homophobia, biphobia, and transphobia. These experiences are related to increased susceptibility to mental health concerns in this population. Historically, the behavioral treatment of sexual orientation (SO) and gender-themed obsessive-compulsive disorder (OCD) has inadvertently reinforced anti-lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) stigma and contributed to minority stress in clients, treatment providers, and society at large. We present updated recommendations for treatment of SO- and gender-themed OCD through a more equitable, justice-based lens, primarily through eliminating exposures that contribute to minority stress and replacing them with psychoeducation about LGBTQ+ identities, and exposures to neutral and positive stimuli, uncertainty, and core fears. We also present recommendations for equitable research on SO- and gender-themed OCD.