HOCD: Homosexual OCD & Sexual Orientation OCD

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COMMENTS: This article has an active comments section with the doctor answering questions. Note that he avoids any discussion of Internet porn, even when it is brought up in the comment section. Employing exposure therapy to ones addiction (Internet porn) may be counterproductive.


On April 12, 2012, in OCD, Sexual Symptoms, “Pure-O” Symptoms, by Steven J. Seay, Ph.D.

Fear of Being Gay (Homosexual OCD / HOCD)

Emerging sexuality can be confusing for any teen or young adult, and gay teens face a variety of unique challenges over the course of adolescence.

In addition to learning to understand their own sexuality, gay teens must navigate complex situations and pressures that may not be relevant for straight teens. They must also deal with opinionated parents, friends, and others who sometimes hold differing views about sexuality. Anxiety, distress, and confusion are often part of this process.

This post is not about the anxiety associated with being gay or with “coming out” but instead discusses homosexual OCD (“HOCD”), an anxiety disorder that affects a small number of individuals. HOCD is not unique to teens but can occur at any age.

What is HOCD?

Homosexual OCD (“HOCD”) is a specific subtype of obsessive-compulsive disorder (OCD) that involves recurrent sexual obsessions and intrusive doubts about one’s sexual orientation.

Straight individuals with homosexual OCD experience obsessive fears about the possibility of being gay. Their HOCD obsessions often consist of unwanted thoughts, impulses, or images that uncontrollably pop into consciousness. To reduce the anxiety brought on by their obsessions, individuals with HOCD engage in a variety of rituals that focus on “proving their true sexuality” or reducing their perceived “vulnerability” to becoming gay.

Sexual obsessions can also affect gay men, lesbians, or bisexual individuals with OCD, who may become fearful about the possibility of becoming straight (“Straight OCD”). The common element that unites these seemingly opposite sexual obsessions is the fear of being attracted to something unwanted, taboo, or “unacceptable” based on one’s particular worldview. For the sake of simplicity, I’ll be using HOCD-centric language in this post. However, the same basic elements are directly applicable to all people with obsessive doubts about their sexual orientation.

People with HOCD worry that they might secretly be gay or might become gay, despite not questioning their sexuality in the past. Prior to the onset of HOCD, they might have had few doubts about their sexual orientation. Many people with homosexual OCD also have a history of having enjoyed heterosexual relationships in the past.  It was only after the first unwanted thought “popped” that they became overly concerned about the prospect of being gay. The occurrence of this unwanted thought then causes them to question their sexual identity and reanalyze previous experiences, in light of the possibility that they might possibly be gay.

Individuals with homosexual OCD want to know “for sure” that they are not gay and often go to great lengths to prove to themselves that they are straight.  However, due to the way OCD is strengthened and reinforced by rituals, these attempts ultimately backfire.  The result is that some people with HOCD become extremely disabled.  In order to avoid symptom triggers, it’s not uncommon for people with homosexual OCD to become depressed and drop out of school, quit their jobs, end relationships, or make other life-altering decisions that paradoxically make their symptoms worse.

In some cases, individuals with HOCD experiment with homosexual relationships or adopt gay lifestyles because of doubt about their heterosexuality. This doubt causes them to leave their current spouses/partners, “come out,” and begin to date same sex individuals. However, in contrast to lesbians and gay men who “come out” and find happiness, individuals with HOCD find their new lives distressing, confusing, and dissatisfying. Moreover, they continue to experience doubt and uncertainty about their sexuality.

HOCD Symptoms

Homosexual OCD typically has elements that parallel checking, contamination, and Pure-O OCD.  Some individuals with HOCD have a predominantly checking-related variant of OCD.  When around same sex individuals, they “check” their own bodies for signs of sexual arousal.  Other people with homosexual obsessions have a contamination-related variant of HOCD and worry that contact with gay men, lesbians, bisexual individuals, or effeminate/androgynous people is “contagious” or may somehow “activate” their latent homosexuality.  Still others worry about acting on unwanted sexual impulses.  They worry that if they’re around gay people or same sex individuals that they might lose control and act out sexually. Some people with HOCD worry that other people will think they’re gay, and they spend excessive time and energy trying to “act straight.” Many people with HOCD experience all of the symptoms above.

What maintains intrusive sexual obsessions? Like any form of OCD, symptoms of HOCD are maintained by faulty beliefs, rituals, and avoidance behaviors. Faulty beliefs about sexuality and sexual orientation perpetuate fear about the possible consequences of resisting OCD-related compulsions. This is harmful because every time an unwanted thought is avoided or neutralized, it is reinforced and becomes more likely to become activated again in the future. Avoidance and rituals thus prevent the occurrence of corrective learning experiences that would ultimately cause these unwanted thoughts to decrease in frequency and intensity.

Rituals associated with homosexual OCD include mental rituals and behavioral rituals.

Homosexual OCD Mental Rituals

 

  • Asking self, “Do I find that person attractive?” (often applied to both opposite sex and same sex individuals).
  • Asking self, “Am I currently aroused?”
  • Asking self, “Am I appropriately disgusted by this?” when seeing same sex couples.
  • Other questions like the above that are designed to “figure out” or determine one’s sexual orientation.
  • Re-analyzing previous romantic or sexual experiences to make sure that one is straight.
  • Trying to convince oneself definitively of one’s sexuality.
  • Reassuring self about one’s sexual orientation (“I’m definitely straight”).
  • Mentally comparing self to straight people vs. gay men (or lesbians).
  • Repeatedly redirecting attention away from same sex individuals to opposite sex individuals.
  • Other mental rituals designed to “reset” or neutralize unwanted thoughts (e.g., mental washing rituals).
  • Repeatedly telling yourself that you’re not gay.
  • Trying to figure out why previous relationships failed (to make sure it wasn’t related to your partner thinking you were gay).
  • Planning for and anticipating all the likely consequences of “coming out,” even though you have no desire to “come out” or have gay relationships.
  • Planning how to leave your spouse or significant other (when you don’t actually want to do this).
  • Neutralizing “gay thoughts” with “straight thoughts.”
  • Mentally picturing opposite sex genitals or heterosexual acts to reduce anxiety about intrusive thoughts.
  • Scanning the environment to identify people who might be gay.
  • “Magical” rituals designed to distance oneself from unwanted thoughts (e.g., imagining oneself getting sick or vomiting when having unwanted thoughts).
  • Escaping from unwanted thoughts by recalling/reviewing pleasant past sexual experiences.
  • Replacing unwanted gay thoughts with violent thoughts.

HOCD Rituals & Compulsions (Behavioral)

 

  • Checking one’s own body for physical signs of arousal (can also be a mental ritual).
  • Walking in an overly masculine (if a man) or feminine (if a woman) way in order to “appear straight.”
  • Interacting in a overly masculine or feminine way.
  • Talking only about “appropriately” masculine or feminine topics.
  • Washing rituals (hands, etc.) if one comes into contact with gay men, lesbians, or bisexual individuals.
  • Watching straight pornography in order to reassure self that your’re aroused by it.
  • Watching gay porn in order to “prove”  that your’re disgusted by it or not aroused by it.
  • Asking other people if they ever find same sex people attractive.
  • Asking other “Is it normal to…?”- type questions over and over again to obtain reassurance.
  • Asking other people for reassurance about your sexuality.
  • Repeatedly asking ex-girlfriends/boyfriends why your relationship ended.
  • Dating excessively to “prove” that one is straight and/or that one is attracted to the opposite sex.
  • Compulsive masturbation to straight pornography in order to “prove” that one is attracted to the opposite sex.
  • Interacting in a way that is aggressive, insulting, or disrespectful to gay people.
  • In some cases, adopting a gay lifestyle because it feels like it is inevitable (due to OCD doubt). However, finding this lifestyle distressing and unwanted.
  • In some cases, dating same sex individuals or engaging in homosexual acts to figure out the meaning of these experiences, but finding these activities distressing and unwanted.

Homosexual OCD Avoidance Behaviors

 

  • Avoiding gay men, lesbians, and bisexual people.
  • Avoiding things that have been touched by gay men, lesbians, or bisexual people.
  • Avoiding physical contact with same sex individuals (handshaking, hugs).
  • Avoiding being alone with same sex individuals.
  • Avoiding conversations with same sex individuals.
  • Avoiding places frequented by gay people.
  • Avoiding public restrooms, locker rooms, and other situations potentially involving same sex nudity.
  • Avoiding attractive same sex individuals or pictures/movies featuring attractive same sex individuals.
  • Avoiding activities that aren’t stereotypically masculine (if a man) or feminine (if a woman).
  • Dressing in a stereotypically masculine or feminine way (e.g., wearing pink [for men]).
  • Avoiding music by gay individuals or movies featuring gay actors or characters.
  • Avoiding romantic relationships and sexual activity for fear of unwanted thoughts “popping in” during sex.
  • Avoiding eye contact with same sex individuals.
  • When in public, trying to avoid looking at the groin, backside, or chest areas of same sex individuals.
  • Avoiding masturbation due to fear about an unwanted thought occurring.
  • Avoiding TV shows with gay characters or gay themes.
  • Avoiding purple items, rainbows, and other symbols associated with homosexuality.
  • Avoiding androgynous or flamboyant clothing.
  • Manipulating your voice so that it sounds more masculine or feminine.
  • Not eating in public (in case food was prepared by a gay person).

Homosexual OCD Maladaptive Beliefs

 

  • Straight individuals shouldn’t find same sex people attractive.
  • Straight people shouldn’t have any doubts about their sexuality.
  • Every thought means something. I wouldn’t be having these thoughts over and over again if they weren’t meaningful.
  • If I turned out to be gay, it would ruin my life.
  • Straight people should only have straight thoughts. Gay people should only have gay thoughts.
  • If I’m not 100% straight, it means I’m gay.
  • If I have a thought that’s inconsistent with my desired orientation, it means I’ve “crossed over.”
  • Sexuality can be contagious.
  • Every time I feel sexually aroused, there must be a reason for it.
  • Feeling sexual arousal must mean that I want to have sex with this person.
  • If my current partner found out I was having these thoughts, s/he’d leave me.
  • If I keep having this thought, I’m going to have to act on it eventually.
  • Maybe the only way I can be free of these thoughts is to act on them.

Treatment of HOCD (Homosexual OCD)

“What if this isn’t OCD? What if I’m really gay?” These are important questions that you might wish to discuss with your therapist. If you have HOCD, doubt about your sexuality reflects an OCD-related “false alarm” that has nothing to do with your actual sexual orientation. If you are gay, your gay thoughts will be associated with pleasure rather than with fear (although you might experience anxiety about the social repercussions of “coming out”).

If you have homosexual OCD, what-if questions about sexuality are ultimately unanswerable in the way that OCD demands they be answered. In my South Florida (Palm Beach County) psychological practice, people seeking HOCD treatment are preoccupied with attempts to know the unknowable.  Unfortunately, there simply is no objective way to determine your “true” sexuality.  If there was a simple solution, you would’ve found it by now.

Because there is no objective way to prove your “true” sexuality to your OCD (it will always ask, “What if…?” and “How do you know for sure…?” questions), your HOCD treatment must focus on the goal of learning to live with the doubt. In other words, treatment should not focus on “proving” whether or not you are straight or gay but rather focus on providing you with better skills for tolerating the unknowable. Remember that HOCD operates just like other versions of Pure-O OCD: the more you analyze your thoughts and body to try to “figure out the truth”, the more likely you are to unknowingly reinforce your symptoms.

The best strategy for reducing your symptoms will be based on exposure and response prevention for HOCD. Exposures for HOCD are built around purposefully seeking out situations you avoid and then resisting mental and behavioral rituals. Developing a good exposure hierarchy can be confusing, so find a good HOCD therapist to guide you. Moreover, your HOCD therapist will also help you stay consistent in the goal of learning to live with uncertainty. Because you have probably spent significant amounts of time trying to prove your sexual orientation once and for all, it’s easy to fall back into this unhelpful goal.

If you’re interviewing potential therapists and one suggests that they can “cure you of your gay thoughts” or help you “know for sure that you’re straight”, consider this a red flag. That person is not an HOCD specialist. These types of promises are inconsistent with how effective HOCD treatment actually works. Although everyone with HOCD wants to get rid of their gay thoughts, thought suppression techniques will be ineffective in the long-run.

To understand why, or to read more about my general treatment approach in my South Florida (Palm Beach) psychological practice, see my posts on sexual obsessions, thought control and thought suppression. Overcoming symptoms of HOCD requires hard work, but people recover from this challenging form of OCD every day.

Questions? Comments? Living with HOCD or another sexual orientation obsession? Sound off below.