Association Splitting of the Sexual Orientation-OCD-Relevant Semantic Network

Symptoms of obsessive-compulsive disorder (OCD) can manifest in various ways. One fascinating but understudied form of OCD is sexual orientation-OCD (SO-OCD). Individuals with SO-OCD experience obsessions and fears about their sexual orientation changing against their will. In response to their obsessions, individuals with SO-OCD may perform compulsive rituals that include checking for physical/sexual arousal around others. They may also excessively seek reassurance about their sexual orientation from their partners or close friends. They may even mentally review past interactions with others to determine that they were not feeling aroused in a way that would indicate a changing sexual orientation, or avoid situations in which such interactions might occur altogether. The predominant concern seems to be the feared inability to enjoy existing or potential romantic relationships in line with their sexual orientation.

Because very little research has been done to better understand and treat SO-OCD symptoms, we tested the efficacy of a novel self-help technique called association splitting in reducing such symptoms. This technique was developed by Steffen Moritz and colleagues at University Medical Center Hamburg – Eppendorf. Association splitting is based on the theory that obsessions are excessive activations of meaningful associations between concepts in one’s memory that are relevant to one’s OCD concerns. For example, for someone with contamination concerns, the core concepts could be ‘virus,’ ‘infection,’ and ‘germ.’ When encountering contaminated objects, these concepts become excessively activated via their associations, in essence triggering obsessions. Association splitting therefore helps to reduce obsessions by having the individual practice daily exercises in which they generate and rehearse creative, humorous, positive/neutral, and non-OCD-relevant associations to the concepts (e.g., ‘virus’ à ‘computer virus’; ‘infection’ à ‘infectious laughter’; ‘germ’ à ‘wheat germ’). In the same vein, for a heterosexual individual with SO-OCD who fears turning gay against his will, association splitting can be similarly helpful (e.g., ‘gay’ à ‘synonymous with being happy’; ‘straight’ à ‘third straight win’; ‘orientation’ à ‘North, South, East, West’). With constant practice, the old OCD-relevant associations (hence, obsessions) are weakened, and the new non-OCD-relevant associations are strengthened.

Results from our study with 120 heterosexual undergraduates (82 females, 38 males) randomly and equally assigned to either the association splitting group or a waitlist control group indicated there were reductions in SO-OCD-relevant associations four weeks later in the association splitting group. Additionally, there were reductions in SO-OCD symptoms, sexual obsessions, and thought suppression (i.e., maladaptive suppression of one’s thoughts) in the association splitting group. Furthermore, association splitting was well-received by participants. Association therefore appears to be an efficacious self-help technique in reducing SO-OCD symptoms, sexual obsessions, and thought suppression. Future longitudinal research should seek to replicate these findings with clinically diagnosed patient samples, as well as LGBTQ individuals who suffer from SO-OCD.

Read the full paper: Ching, T. H., & Williams, M. T. (2017). Association splitting of the sexual orientation-OCD-relevant semantic networkCognitive Behaviour Therapy, 1-17. doi:10.1080/16506073.2017.1343380

Terence Ching
Monnica Williams






Photo by: Alan Levine

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