This article is part one of a two part series on HOCD and HOCD symptoms. To read part two, please click here.
Homosexual OCD, Sexual Orientation OCD (SO-OCD), Gay OCD, or more commonly HOCD, is an Obsessive Compulsive Disorder (OCD) subtype centered around persistent doubt and fear about the sufferer’s sexual orientation. Just like any other manifestation of OCD, HOCD can appear at any time in one’s life and tends to focus on a specific core fear that one is gay, will become gay, want to be gay, should be gay, is somewhere on the LGBTQ+ spectrum, or doesn’t fully know their sexual orientation. Needless to say, to the HOCD sufferer this ambiguity is highly distressing.
HOCD (SO-OCD) obsessions consist of a feared story, but just a story nonetheless. When OCD tells this story, it can cause an overwhelming amount of concern that the story may actually be true!
Feared stories (obsessions) can include, but are not limited to:
- If I watch Brokeback Mountain and like the movie, I might start to think I should have a gay relationship.
- What if I thought that guy was attractive?
- I like spending time with my female friends more than my male friends. What if that means I’m a lesbian?
- I noticed that guy was attractive last week, and looked at him for a while, I must be gay.
- I “experimented” with someone when I was a young boy, I must have gay leanings.
- I noticed a twinge in my groin around my buddies last week, does that mean I’m gay?
- I can’t stop thinking about women’s body parts and thinking “I’m gay.” What if it’s true?!
In order to get rid of these thoughts, reaffirm their heterosexual identity, or at least feel better, the sufferer might give into a compulsion of reassurance, neutralization, or avoidance. At their core, compulsions are misguided attempts to manage distorted thoughts and unwanted feelings.
Common HOCD compulsions include, but are not limited to:
- Avoiding making eye contact with people of the same sex
- Avoiding any physical contact other than necessary handshakes.
- Avoiding gay neighborhoods, or media with gay themes or actors
- Mentally reviewing previous attractions to people of the opposite sex
- Asking one’s partner or friends if they’ve ever or currently thought they are gay, or have questioned their sexual orientation.
- Looking at sexually explicit images of opposite sex people to check for arousal, or to look at sexually explicit images of same sex people to ensure they are not aroused
- Noticing a person of the same sex is attractive and quickly moving eyes to a person of the opposite sex
- If a gay thought comes in mind, replacing it with a heterosexual thought
- Saying phrases like “I’m not gay or anything” when commenting positively on a same sex person or something related to homosexuality.
HOCD is not limited to people simply questioning one’s sexuality, nor is it limited to only straight identified people. So called “Straight HOCD” is another expression of HOCD in which a gay identified person, who has gone through their coming out process, fears they are actually straight, have been lying to themselves about their sexuality, or will eventually become straight despite their identity as a gay man, lesbian woman, or anywhere else on the LGBTQ+ spectrum. Often this comes with fears of how it will change their status among others in the gay community, or whether they fully or truly know themselves. Furthermore, Transgender OCD is focused on whether the individual is, wants to be, will be, or will want to be the opposite gender. This can come with or without traditional sexual orientation OCD, but is all ultimately OCD that should be treated as OCD.
HOCD Is Not Sexual Orientation Suppression
To be clear, HOCD obsession is not the same as someone genuinely questioning their sexuality, nor is it internalized homophobia or suppressing one’s sexual orientation. HOCD receives undue criticism from people who misunderstand this subtype. At its core, it is nothing more than Obsessive Compulsive Disorder revolving around a specific fear. Someone experiencing HOCD related obsessions perceive the thoughts as being at odds with their desires, wants, and character. The intrusive thoughts are run counter to who they feel they truly are and differ from their genuine opposite sex attraction. Understandably, this experience makes the obsessions feel so threatening, alien, and inconsistent. Furthermore, most people with HOCD are not homophobic and often are LGBTQ+ allies and supporters.
Conversely, internalized homophobia and suppressing one’s sexual orientation occurs when the individual recognizes personally genuine same sex attraction but electively chooses to suppress it in order to desperately maintain a heterosexual identity. This is a subtle, but crucial difference between the two. Someone suppressing their sexual orientation, sometimes due to internalized homophobia, resists accepting their genuine and honestly felt sexual attractions because they fear it will threaten their public and personal identity. For example, their religious identity, family membership, or social status. On the other hand, HOCD is the experience of non-genuine and unwanted feelings and thoughts that threaten the individual’s genuinely felt identity and sexual orientation.
Treatment for SO-OCD includes Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and mindfulness-based treatment. CBT works to help the client challenge distorted thoughts about themselves, confront distorted thoughts about their sexual orientation and to develop a more balanced, reality-based understanding of their thoughts and feelings. With this firmer grounding in rational thought, ERP helps clients face their fears and work toward reducing and tolerating anxiety-riddled thoughts and unwanted physical sensations. Lastly, mindfulness-based approaches, such as Acceptance and Commitment Therapy (ACT), help you develop a greater willingness to confidently stand in the present moment with feared thoughts, feelings, and situations. The end result is greater freedom of thought and of action. Additionally, clients learn that they are in control of their responses and can withstand the discomfort of fleeting, unwanted thoughts and feelings.
To read part two of this series on HOCD, please click here
For more information about HOCD, to discuss HOCD teletherapy or in-office treatment at the Fullerton, Orange County location, or to schedule an assessment and begin treatment, please contact me.
FearCast Podcast episodes about HOCD:
The California OCD and Anxiety Treatment Center offers specialized therapy for HOCD (Sexual Orientation OCD) in its Fullerton offices. In addition to serving North Orange County, Los Angeles, and the Inland Empire, CalOCD offers online therapy, group therapy, and Intensive Out-Patient treatment.