HOCD: Thoughts, Symptoms, Causes, and Treatment

Caryn Gill

Caryn Gill

August 6, 2020

Disclaimer: This article deals with HOCD (also referred to as Homosexual OCD or Sexual Orientation OCD) and touches on potentially sensitive issues around identity. We want to be clear that HOCD is not about convincing someone that their sexuality is right or wrong or that a gay person “should” be straight (or vice versa). Instead, this article explains why it’s the constant cycle of obsessions, compulsions, and anxiety related to questioning one’s identity that can be overwhelming.

What is Homosexual OCD / HOCD?

Obsessive-Compulsive Disorder can pop up in every facet of life, from cleanliness and germs to people’s faiths and ideas of right and wrong. OCD can also appear in and around people’s relationships with others and their relationships with themselves – and that can include sexual orientation.

Homosexual OCD, or HOCD for short, is a particular subtype of OCD that is characterized by constant obsessions about one’s own sexual orientation. These obsessions may include intrusive thoughts, images, urges, or doubts, such as:

  • Fears that you are just in denial or somehow suppressing your feelings about the opposite sex;
  • Worries about losing your identity and “true self” if your sexual orientation is different than the one you identify with;
  • Concerns that you will “turn” gay or “turn” straight, and that your relationships will be ruined because of your sexual orientation;
  • Obsessions over your behavior and if you behaved or interacted with others in a “gay” or “straight” way;
  • A hyper-awareness of physical reactions, particularly the groinal response.

Just as with other OCD subtypes, these thoughts are unwanted and cause distress to the point of interfering with day-to-day life. Someone with HOCD may find these thoughts so distressing that it could affect their friendships, relationships, and ability to function at work or school.

And because the human mind is built to try to keep you safe, people with OCD will often engage in behaviors (also known as compulsions) to do away with the distress caused by these thoughts. Compulsions can take many forms, from mental or physical rituals to behavioral patterns like avoidance and reassurance-seeking. For people with HOCD, these compulsions may include:

  • Imagining sexual scenarios in order to gauge how aroused you are; 
  • Going through your behaviors and interactions to check for evidence that you acted “straight” or “gay”; 
  • Analyzing past interactions with others to see if you were attracted to them;
  • Watching pornography in order to evoke physical arousal as proof that you are not gay;
  • Watching gay pornography to check if you are aroused;
  • Avoiding people, places, things that you associate with being gay; 
  • Comparing your experiences to people who have come out to try to find certainty if you are alike or dissimilar;
  • Seeking reassurance about your sexuality by asking partners, friends, or family members;
  • Researching on the internet about what it is like to be gay to compare these experiences to your own.

Just as with other OCD subtypes, these thoughts are unwanted and cause distress to the point of interfering with day-to-day life. Someone with HOCD may find these thoughts so distressing that it could affect their friendships, relationships, and ability to function at work or school.

And because the human mind is built to try to keep you safe, people with OCD will often engage in behaviors (also known as compulsions) to do away with the distress caused by these thoughts. Compulsions can take many forms, from mental or physical rituals to behavioral patterns like avoidance and reassurance-seeking. For people with HOCD, these compulsions may include:

  • Imagining sexual scenarios in order to gauge how aroused you are;
  • Going through your behaviors and interactions to check for evidence that you acted “straight” or “gay”;
  • Analyzing past interactions with others to see if you were attracted to them;
  • Watching pornography in order to evoke physical arousal as proof that you are not gay;
  • Watching gay pornography to check if you are aroused;
  • Avoiding people, places, things that you associate with being gay;
  • Comparing your experiences to people who have come out to try to find certainty if you are alike or dissimilar;
  • Seeking reassurance about your sexuality by asking partners, friends, or family members;
  • Researching on the internet about what it is like to be gay to compare these experiences to your own.

HOCD can affect anyone, regardless of their sexual orientation. Here are two examples:

Example #1:

Joe is a straight man who starts to fear that he may be gay and is somehow in denial of his sexuality. The obsessive nature of his fears leads him to question his interactions with his male friends. In order to avoid feeling anxious about his sexuality, he starts to avoid spending time with his male friends.

Example #2:

Sarah is a lesbian who fears that she is too affectionate with her male friends. She begins to obsess about what that might mean about her “true” sexuality, and that she may actually be straight. She analyzes her physical experiences when she is around her male friends and spends hours scouring the internet for “proof” that her thoughts are normal and not a sign that she is straight.

Understanding the need for certainty

HOCD is actually not about a person’s sexual orientation, but rather, about the pervasive sense of doubt and the need for certainty – this is the one thread that ties all people with OCD together. In my work with individuals with HOCD, I’ve heard various forms of this expression: “I don’t even care if I’m gay or straight, I just want to know for sure.”

That quest for certainty is like fuel for these obsessions and compulsions.

In life, very little is 100% certain, and yet that quest for certainty over one’s sexuality and the idea of knowing oneself completely is, in many ways, the root of HOCD. The attempt to gain certainty is not, as Dr. Jonathan Hoffman describes it, a fixed point, so it is a faulty guide with which to navigate life.

Someone with HOCD might analyze and try to “think their way out” of their anxiety endlessly, at the expense of actually doing the things they love, like spending time with their partners and loved ones. They might feel short-term relief, but all those attempts to resolve their fears only serve to reinforce the idea that it is a question that needs an absolute answer in the first place.

So if compulsions don’t work, then what will?

Happy woman after HOCD treatment

HOCD Treatment

The most effective form of treatment for all forms of OCD is Exposure and Response Prevention (ERP).

ERP is an evidence-based treatment that helps individuals learn new ways of relating to their thoughts and feelings. It is a guided process that encourages people to confront their fears in order to get over them.

The response prevention part of the process is meant to help people learn to accept the presence of their intrusive thoughts without judgment or any attempt to change, fix, analyze, or solve them.

A therapist can help build tailored exposures based on a person’s unique experiences, triggers, obsessions, and compulsions. These exposures may involve scenarios like:

  • Looking at photographs of sexy men or women while resisting urges to make meaning out of their physical responses.
  • Consciously being friendlier than usual with their friends while resisting fears that they may “hitting” on them.

The true target of these exposures is not the possibility of being gay, necessarily – it is the possibility of not knowing one’s sexual identity, of not knowing one’s self.

Each time that these intrusive thoughts are denied a compulsive reinforcement, they begin to wither away into irrelevance, becoming quieter and less intrusive until they are nothing but background noise.

As an OCD therapist, I’m not inclined to give reassurance, but I do believe in instilling hope. Know that OCD is treatable. Using ERP, I’ve witnessed individuals change their behavioral responses to their anxiety and gain a better relationship with their thoughts.

Instead of believing that these thoughts must mean something about themselves, they come to learn that these thoughts are no more distressing than the thought of “what’s for dinner?” Instead of experiencing crippling fear when thinking about the mere possibility that they might be gay, these individuals learn that regardless of sexual orientation, they can accept themselves just the way they are.

And whether you are gay, straight, lesbian, bi, pan, ace, trans, cis, or queer – that’s something worth working towards.

If you’d like to work with me or another NOCD therapist, you can get started by scheduling a call with our care team.

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