Are you watching porn and checking out members of the same sex, to make sure you are not gay?
You could be experiencing intrusive thoughts about your sexual orientation – a key symptoms of Sexual Orientation OCD (SO-)CD), also known as HOCD.
People with HOCD constantly question their sexual preference and are troubled by obsessive thoughts that they might be gay, even when their past relationships and attractions have always aligned with being heterosexual. Before developing HOCD, you likely wouldn’t have given much thought to your sexual identity—it was simply a given.
But obsessive-compulsive disorder (OCD) thrives on doubt. Just as someone with health anxiety can’t stop thinking they might be sick, or someone with contamination OCD can’t stop worrying about germs, HOCD makes you obsessively question your sexuality—even when there’s no real reason to.
- Do you find yourself checking your feelings whenever you see someone of the same sex?
- Do you watch porn just to “test” your reaction?
- Are you mentally replaying past interactions to look for “signs”?
I’m a psychologist and have been working with OCD for 20 years and want to help you:
- Understand why these thoughts feel real (but aren’t proof of anything).
- Learn why checking, testing, and reassurance-seeking make it worse.
What is HOCD?
HOCD (Homosexual Obsessive-Compulsive Disorder) is an outdated term used to describe a type of OCD where you experience intrusive, unwanted thoughts about your sexual orientation.
It is not the same as questioning your sexuality or ‘coming out.’ Instead, HOCD is about obsessive doubt—a relentless need to be 100% certain about your orientation, even when nothing has changed.
If you’ve been heterosexual all your life, you are still heterosexual—it just feels like you might be gay and not know it. Likewise, if you’ve always been gay, you are still gay, but your OCD makes you doubt it. These thoughts are known as ego-dystonic, meaning they conflict with your true identity and values, which is why they feel so distressing.
MoodSmith’s Explainer Video on HOCD
Psychologists, like myself, now refer to this condition as Sexual Orientation OCD (SO-OCD), since it affects people of all orientations, not just heterosexual individuals. Research shows that, approximately 8% of individuals with OCD have obsessions related to sexual orientation making it a recognised subset of the disorder.
At its core, SO-OCD is not about sexuality—it’s about needing certainty. This desperate need for proof is what drives anxiety, not any real change in your orientation.
It’s crucial to remember that HOCD can affect anyone, regardless of their actual sexual orientation or gender identity. These intrusive thoughts are a symptom of OCD, not a reflection of your true feelings or desires.
Table of contents
- What is HOCD?
- Recognising the Symptoms of HOCD and SO-OCD
- How the Spotlight Effect Intensifies HOCD Symptoms
- Understanding the Causes of HOCD: Genetics, Brain, and Psychology
- Effective Treatment Options for HOCD and SO-OCD
- Real-life examples of HOCD Recovery
- Helpful Resources for HOCD Support and Recovery
Recognising the Symptoms of HOCD and SO-OCD
Recognising the symptoms of HOCD is the first step toward recovery. These symptoms fall into two categories: obsessions and compulsions.
Obsessions
Obsessions are intrusive, distressing thoughts or fears that are difficult to ignore. In the case of Sexual Orientation OCD (SO-OCD), these intrusive thoughts about sexuality often focus on doubts about one’s sexual orientation. Common examples include:
- Persistent fears such as, “What if I’m not who I thought I was?”
- Intrusive thoughts about being attracted to someone of the same or opposite sex.
- Doubting past interactions or relationships to find “proof” of one’s sexual orientation.
- Fear of acting on unwanted thoughts or “discovering” a different orientation.
- Noticing something attractive about a person of the same sex and interpreting it as evidence of being gay.
- Focusing on fleeting physical sensations (e.g., groinal response) and seeing them as confirmation of sexual orientation.
What is the groinal response?
Previously, I wrote an article on sexual arousal within HOCD, but I shall touch on it here again on my main page on HOCD. An unfortunate aspect of the condition is that not only are you actively searching for some sensation or feeling in your groin, which has been named ‘the groinal response’ but when you find it you take the sensation as some sort of evidence of sexual identity.
Like all forms of OCD, there are many physical sensations. most caused by the anxiety experienced by the condition, but one of the most difficult sensations people with HOCD have is the “groinal response.” It is simply a physical sensation in the groin area that can occur in response to intrusive thoughts.Individuals with HOCD often misinterpret this sensation as a sign of sexual attraction, which intensifies their anxiety. It’s important to understand that the groinal response is simply a physical reaction that can happen for many reasons and does not indicate actual sexual attraction. The heightened focus on this area due to OCD makes these sensations more noticeable, leading to more anxiety and confusion. This article from PsychologyToday concurs, that it is attentions that drives the sensation.
Quick experiment; look at the tip of your index finger on your right hand. Really focus on it, just the very tip. Does it feel different to the rest of your finger, hand or body? Can you feel heat on the tip of your finger? More than likely, you feel something, and that is because you are bringing 100% of your awareness to one specific part of your body. Think about that the next time you are experiencing sensations in your groin. It is not evidence of anything but the fact that you are paying attention to it.
Compulsions
Compulsions are behaviours or mental acts that people with HOCD use to reduce their anxiety. They can be divided into two categories:
- Covert (Mental) Compulsions:
- Mentally reviewing past relationships to reassure oneself.
- Imagining scenarios with people of the same or opposite sex to “test” feelings of attraction.
- Analyzing childhood memories for signs of one’s sexual orientation.
- Overt (Visible) Compulsions:
- Watching porn (same-sex or opposite-sex) to check for arousal.
- Seeking reassurance from others about one’s sexual orientation.
- Avoiding LGBTQ+ media, same-sex spaces, or anything associated with the feared orientation.
Compulsions provide temporary relief but ultimately reinforce the OCD cycle, making it harder to break free. Intrusive thoughts in HOCD often follow specific patterns, such as:
- What if I’ve always been in denial about my true orientation?
- Does finding someone of the same sex attractive mean I’m gay/straight?
- Why did I feel a sensation when I saw that person?
- Am I lying to myself about my identity?
These thoughts often feel real because of the emotional charge behind them, but they are merely symptoms of OCD and I shall briefly explain why they feel like that now.
Do these symptoms sound familiar?
My online course offers step-by-step guidance to manage them.
Why HOCD Intrusive Thoughts Feel Real and How to Manage Them
Intrusive thoughts in SO-OCD feel real because they tap into deeply held fears and insecurities. The heightened focus on these thoughts intensifies their emotional impact, much like how someone with health anxiety may feel certain they’re ill. This phenomenon is known as “thought-action fusion”—mistaking thoughts for reality.
Here’s a helpful analogy: intrusive thoughts are like uninvited guests at a party. The more attention you give them, the louder they get. But when you stop engaging, they eventually quiet down and leave. Recognizing these thoughts as mental noise is the first step to regaining control. Learn more about why the thoughts in HOCD feel so real.
Can HOCD change my sexuality?
One of the most common fears people express in therapy is whether HOCD can change their sexuality. The answer is no—HOCD cannot change your sexual orientation. HOCD is a form of Obsessive Compulsive Disorder, where intrusive thoughts about sexuality create intense anxiety. These thoughts do not reflect reality and cannot alter your true sexual orientation. With proper treatment, including SO-OCD-focused therapy like CBT and ERP, these fears and obsessions can be managed, and their impact on your life will diminish.
I’ve found that many individuals with HOCD initially struggle to understand the nature of this condition. They often mistakenly believe it’s related to prejudice, political correctness, or even their own internalized homophobia, leading them to falsely believe in a fear of denial. However, it’s crucial to emphasize that HOCD has nothing to do with prejudice or a person’s actual sexual orientation.
What’s the difference between HOCD and being gay?
It’s straightforward, HOCD is Obsessive-Compulsive Disorder, and being gay is enjoying and wanting romantic relationships with members of the same sex. If you have HOCD, your thoughts are about being gay–not your actions. If you are gay, your actions and thoughts show you are gay; you want, seek and enjoy romantic relationships with the same sex.
The obsessions in HOCD stem from a fear that one’s long-standing sexual identity has changed. It’s an anxiety-driven condition focused on intrusive thoughts that contradict a person’s true nature.
How the Spotlight Effect Intensifies HOCD Symptoms
Before HOCD, you might have walked down the street without noticing who was around you. Now, you find yourself hyper-focused on how you walk, how others perceive you, and whether you’re giving off a “vibe.”
This heightened focus on yourself and others is known as the spotlight effect.
The spotlight effect occurs when your brain becomes primed to look for signs of something you fear. For example, someone with health anxiety may constantly scan their body for symptoms of illness. In HOCD, the spotlight effect causes you to look for “evidence” in your behaviour or interactions, even when no evidence exists. This hyper vigilance can make you misinterpret different things, for example;
What does it mean if I get aroused?
If you are heterosexual, you have experienced sexual arousal while thinking about or watching members of the same sex. In that case, you can run into difficulty as you see this as evidence that you must be gay. This is a mistake. Ask yourself when you experience the arousal. Were you watching porn? For example, of course, you will feel arousal; we are sexual beings! But you could just be looking at a member of the same sex–but how are you looking at them? If I walked past you now in the street, I wouldn’t be thinking, do I feel anything? Am I getting aroused? I would just walk past you in the street. But the difference between you and me is that you would selectively attend to members of the same sex to check how you are doing. Your brain is actively searching them out; they might as well be walking about flying a flag to get your attention, and then you make the mistake of checking out how you feel in your genitals.
My thoughts must mean something
This is a faulty belief system. Random thoughts mean nothing, thinking that they must mean something is called thought action fusion.
Understanding the Causes of HOCD: Genetics, Brain, and Psychology
HOCD, like other forms of OCD, has complex origins. These may include genetic, neurological, and psychological factors.
Genetics
- Family History: If someone in your family has OCD, you might be more likely to have it too.
- Genetic Links: Certain genes might be linked to OCD, but research is still ongoing.
Brain Factors
- Differences in Brain Structure: Brain scans show differences in people with OCD compared to those without.
- Fear Centres: There may be a link between OCD and the brain’s fear centres.
- Chemical Imbalance: There could also be an imbalance in brain chemicals. Medicines like SSRIs help balance these and treat OCD.
Psychological Factors
- Complex Causes: HOCD and other types of OCD are complex, and no single reason explains why someone has it.
- Co-occurring Disorders: Although not technically a cause, clients with anxiety or mood disorders (co-occurring disorders) often find it more difficult to manage intrusive thoughts and compulsions. The heightened anxiety from these conditions can exacerbate OCD symptoms. It is therefore crucial that when getting treatment, you address anxiety or mood disorders alongside HOCD.
If you or someone you know might have HOCD, it’s essential to talk to a mental health expert. They can help diagnose and treat it.
Effective Treatment Options for HOCD and SO-OCD
HOCD, also referred to as SO-OCD, is highly treatable with a variety of evidence-based therapies. Effective SO-OCD treatments include Cognitive Behavioural Therapy (CBT), Exposure and Response Prevention (ERP), and in some cases, medication. These approaches focus on helping individuals manage intrusive thoughts about sexuality and reduce anxiety-driven compulsions.
Professional Help
Seeking help from a therapist specialising in OCD and sexual orientation issues is crucial. When speaking with clients over the years, many make the mistake of seeking a therapist that specialises in HOCD, when you should be looking for a therapist that is expert in treating OCD, (remember HOCD is OCD.) Specifically you should seek someone who is expertly trained in Cognitive Behavioural Therapy (CBT) as the recommended treatment for HOCD is CBT, particularly Exposure and Response Prevention (ERP). I am a psychologist and as such we do not prescribe medication but MayoClinic and NHS discusses more on medication for OCD. The National Institute for Health and Care Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) and Exposure and Response Prevention (ERP) as gold-standard treatments for OCD, including sexual orientation OCD
You might have heard psychologist like myself talk about evidence based treatment and I shall quickly explain that before talking properly about the therapy itself.
Evidence-based treatment refers to therapeutic approaches that have been rigorously studied and shown to be effective in treating specific conditions. For HOCD, the most effective treatments are rooted in cognitive behavioural therapy (CBT), particularly Exposure and Response Prevention (ERP) . These therapies have been extensively researched and proven to be successful in helping individuals with OCD manage their symptoms . Choosing evidence-based treatment is crucial because it ensures that individuals receive interventions that have been scientifically validated and are likely to produce positive outcomes .
In my podcast below, you can listen to how cognitive behavioural therapy and exposure response prevention can help you with HOCD
Types of Evidence-Based Treatment
Cognitive Behavioural Therapy (CBT)
Cognitive Behavioural Therapy (CBT) is a highly effective treatment for SO-OCD and other forms of OCD. CBT is a structured form of therapy that focuses on the interconnectedness of thoughts, feelings, and behaviours. It helps you identify and challenge negative thought patterns and develop healthier coping mechanisms. In the context of SO-OCD, CBT helps you
- Understanding Thought Patterns: CBT helps you understand how your thoughts and behaviours contribute to your experience of HOCD; in particular it helps you to understand cognitive patterns in HOCD.
- Coping Strategies: You’ll learn to correct your thought processes and relate to your thoughts differently. CBT focuses on teaching you how to understand and cope with intrusive thoughts without necessarily getting rid of them.
- Understand the OCD Cycle: CBT helps individuals recognize the cyclical nature of SO-OCD, where obsessions trigger anxiety, leading to compulsions that provide temporary relief but ultimately reinforce the cycle. By understanding this cycle, individuals can start to interrupt it and regain control. Understanding this is a necessary part of exposure and response prevention where you shall start to manage your thoughts without resorting to compulsions.
- Challenge Distorted Thinking: SO-OCD often involves cognitive distortions, such as all-or-nothing thinking, overgeneralization, and catastrophizing. CBT helps individuals identify and challenge these distortions, replacing them with more realistic and balanced thoughts
- Understand the nature of their fears: CBT helps individuals understand the fears they associate with their thoughts and challenge the perceived necessity of rituals and compulsion
Cognitive Behavioural Therapy is a cornerstone of HOCD treatment. Discover how CBT for HOCD provides a structured path to recovery.
Exposure and Response Prevention (ERP)
ERP is a core component of CBT and is generally viewed as the first-line treatment for OCD . It involves gradually exposing yourself to the thoughts, images, objects, and situations that trigger your anxiety, while simultaneously stopping yourself from engaging in compulsive behaviours . ERP’s success lies in retraining the brain to respond differently to intrusive thoughts, making it a cornerstone of HOCD recovery. Read the rationale behind ERP and how it rewires the brain. For example, a person with HOCD might be set a homework to watch a program that has a same-sex relationship without engaging in checking behaviours or seeking reassurance. In the context of HOCD, this might involve:
- In Vivo Exposure: Directly confronting real-life situations that trigger anxiety. For example, going to LGBTQ+ friendly spaces or events, having conversations with LGBTQ+ individuals, or looking at pictures or videos depicting same-sex intimacy .
- Imaginal Exposure: Confronting feared thoughts and images in your mind. This can be helpful for addressing obsessions that are difficult to replicate in real life. Examples include visualising a scenario where you develop feelings for someone of the same sex or imagining yourself coming out as gay or lesbian . Learn more about ERP in relation to HOCD.
The response prevention aspect of ERP involves resisting the urge to engage in compulsions, such as seeking reassurance, checking for physical arousal, or engaging in mental rituals to neutralise thoughts . By repeatedly confronting anxiety-provoking stimuli without resorting to compulsions, the brain gradually learns that the feared situation is not actually dangerous, leading to a decrease in anxiety over time. I speak about this in my podcast (which is listed above) and it occurs through a process of habituation. The International OCD Foundation compares the ERP process to rewiring a home alarm system where alarm exist to alert you to danger but can be faulty and need rewiring. In a similar way, ERP helps to recalibrate the brain’s response to anxiety triggers, reducing the intensity of the alarm and allowing for a more measured response. You can learn more about ERP here
ERP is the gold standard treatment
my course is designed to walk you through it step by step. You’ll learn how to face intrusive thoughts without resorting to compulsions, building long-term resilience.
ERP has been shown to be highly effective in treating OCD, with research indicating that 80% of people with OCD who engage in ERP experience a significant reduction in their symptoms . It is considered the gold standard treatment for HOCD and is the most effective way to combat obsessions, intrusive thoughts, and compulsions .
Medication
Selective serotonin reuptake inhibitors (SSRIs) are often prescribed to reduce OCD symptoms. Medication can support therapy by lowering anxiety, making it easier to engage in CBT and ERP.
Self-Help
These self-help strategies can play a supportive role in managing intrusive thoughts about sexual orientation and reducing their impact on your daily life. While professional treatment, such as CBT and ERP, is the gold standard for SO-OCD, here are some additional strategies you can try:
- Practice mindfulness to observe your intrusive thoughts without judgment or engagement.
- Reduce compulsive behaviours like reassurance-seeking or checking.
- Educate yourself about SO-OCD to understand that these thoughts are a symptom of OCD, not a reflection of your true self.
For a step-by-step guide on how to stop intrusive thoughts about sexual orientation, you can read our detailed article on ERP techniques.
Would you like my help with HOCD?
All my materials are now online in a structured online course containing ERP and CBT. I’ve been working with OCD for 20 years and over 3000 people have taken this course.
Dr Ryan; MoodSmith
Acceptance and Commitment Therapy (ACT):
This model suggests that suffering arises from how we relate to our thoughts.
- Acceptance: ACT teaches you to accept your thoughts rather than trying to change or control them. Read more on how ACT helps with HOCD.
Mindfulness: This technique helps manage intrusive thoughts and reduce anxiety by being present in the moment and observing thoughts without judgment.
Real-life examples of HOCD Recovery
Case Study: Paul
Paul, a 25-year-old man, referred himself for therapy to address HOCD symptoms. Through structured HOCD treatment, including CBT and ERP, he was able to achieve significant progress in his recovery. His case highlights that HOCD recovery is possible with the right approach
I undertook an assessment and found that Paul was indeed anxious. No previous history of mental illness. He had a full social life and friends.
Paul did not say he was having intrusive or uncomfortable thoughts regarding his sexuality during our initial assessment. This is not uncommon, as many people come for therapy because they feel anxious or depressed. It is up to the therapist’s skill to determine why.
Paul made a ‘throwaway’ comment regarding his sexuality during the assessment session. I explored this topic with him as I could see that he was feeling uncomfortable, and later, he informed me that this was the first time he had spoken about it. He stated he had been heterosexual all his life and would have no problem if he was attracted to men. Still, he could not understand what was happening to him.
Paul has been sexually active since he was 17, always with women, and has been in a long-term relationship with his girlfriend for three years. Two months ago, he started having intrusive thoughts that he might be attracted to men.
Before the intrusive thoughts, his work colleagues teased him about his love of clothes and how he maintained his physique and hair. He started comparing himself to other men regarding their appearance and how well they kept themselves.
Paul stated he noticed men more often when walking down the street as he compared himself to them in terms of ‘maintenance levels.’ He noted which men were attractive and which were not, and this is when he questioned the content of his thoughts.
Paul was clear that he did not wish to have a sexual or romantic relationship with a man and that he wanted to stay in his current relationship with his girlfriend. Still, his intrusive thoughts were affecting the quality of his relationship. He had obsessed with his appearance and choice of clothes and how he appeared to other people. He also looked at other men to test if he felt an attraction.
I discovered that Paul had mild OCD in his late teens during the session. I explained that thought processes alone could not change a person’s sexuality. It would appear that he was experiencing unwanted intrusive thoughts about his sexuality that affected his relationship and made him anxious.
The psychological explanation for what was happening to Paul
We found Paul had a faulty belief system
Quote from Paul
- men who care for themselves are effeminate.
- Men should be rough.
When teased about his appearance, Paul was very aware of his choice of clothes and how he liked to use products for his hair and skin. This did not match up with faulty belief systems he did not know he held until he began therapy.
He focused on how he behaved, walked, and talked (the spotlight of attention I mentioned above.)
Over time, Paul avoided people and places that made him question his sexual identity. He found being intimate with his girlfriend difficult, making him question his sexuality.
We agreed to meet for six initial sessions to start treatment using CBT and Exposure Response Prevention.
This case study shows the complexities of HOCD, and that having this condition is not about changes in your sexual orientation, but rather, the difference is in your thought processes in that you start to experience obsessive thoughts about your sexual orientation.
If you suspect you might have this form of OCD, the remainder of this article will detail what the obsessions and compulsions are like, and if you recognise yourself in some of the signs and symptoms, I will encourage you to discuss this with a mental health professional.
Remember, HOCD recovery is possible with the right treatment plan, whether through professional therapy or self-help strategies
Helpful Resources for HOCD Support and Recovery
Further Reading on MoodSmith
- Understand the connection between HOCD and arousal and its implications.
- Explore the nuances of Spectrum HOCD and its origins.
- Learn why wanting to stop HOCD thoughts makes it worse.
- Seek help from a therapist who specialises in HOCD for tailored guidance.
- International OCD Foundation. This is an excellent site where you can read articles as well as search for therapists.
- OCD-UK
- Anxiety and Depressional Association of America (ADAA).
Books that I recommend;
- Overcoming unwanted thoughts: A self-help guide using Cognitive-Behavioural Therapy by Sally Winston and Martin Seif.
- The last word
If you think you have HOCD, it is essential to understand that your sexual identity is not changing. Instead, you are suffering from the obsessions and compulsions within OCD, which can be treated.
Further Reading
Centreforanxietydisorders
NCBI - IOCDF
2 Sources
All content on MoodSmith is written and researched by Dr Elaine Ryan and uses only peer-reviewed research on journals, government bodies, universities and professional bodies to support the article.
FOOTNOTES
- HOCD is not a diagnosis that can be found in the Diagnostic and statistical manual of mental health disorders; DSM. DSM is used by mental health professionals to diagnose conditions. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
- Bhatia & Kaur J. Homosexual Obsessive Compulsive Disorder (HOCD): A Rare Case Report. J Clin Diagn Res. 2015;9(1):VD01-VD02. doi:10.7860/JCDR/2015/10773.5377
- Williams MT, Farris SG, Turkheimer E, Pinto A, Ozanick K, Franklin ME, Liebowitz M, Simpson HB, Foa EB: The myth of the pure obsessional type in obsessive-compulsive disorder. Depress Anxiety 2011;28:495-500.