What is HOCD?
HOCD stands for Homosexual Obsessive-Compulsive Disorder, also known as Sexual Orientation OCD, and is a form of OCD where the person experiences intrusive thoughts in relation to their sexual preference. These unwanted thoughts, which are known as obsessions, cause distress to the person and result in the compulsion to check that they are not attracted to the same sex. These obsessions and compulsions are typical of OCD.
Dr Elaine Ryan
The intrusive thoughts in relation to HOCD are not exclusive to heterosexual people obsessing that they are now gay or lesbian. Rather any person regardless of their sexual orientation can have intrusive thoughts about their sexual persuasion. Hence, I think the label Sexual Orientation OCD is more fitting.
Does having HOCD mean that you need to ‘come out’?
HOCD is not having thoughts about ‘coming out.’ Coming out is where you actively choose to think about your sexuality, knowing you are attracted to members of the same sex and are wanting to think about how to live your life authentically as gay or lesbian. The thoughts that arise in what is called HOCD, are symptoms of a mental health condition; OCD.
OCD is characterised by having continual doubt. For example, doubt about cleanliness and germs, doubt about doing something correctly, and in this case, doubt about sexuality. HOCD, in essence, has nothing to do with sexuality but has to do with the doubt and uncertainty that exist within OCD.
Table of contents
How is HOCD diagnosed?
Currently, neither Homosexual OCD or Sexual Orientation OCD are diagnoses in their own right; instead, they fall under the umbrella of OCD.
OCD is a diagnosis in its own right, in that it has defining characteristics that that can help form a diagnosis.
The Diagnostic and Statistical Manual for Mental Disorder, Fifth Edition (DSM-5); American Psychiatric Association [APA], 2013) does not list HOCD as a condition. I would suggest you think of it as a ‘label,’ that falls under the umbrella of Obsessive-Compulsive Disorder.
For a diagnosis of OCD to be made, the person needs to;
- have obsessions and/or compulsion that take up more than one hour per day, and
- cause distress or disruption to the person’s life in that they find it challenging to carry out day to day activity.
Why do they not have a separate diagnosis?
My answer to this will be because they are both OCD, or subcategories of OCD if you like.
The obsessions within OCD can cause the person to focus on;
- cleanliness
- religion
- relationships
- order
- as well as their sexual identity.
- Read more on Intrusive Thoughts
HOCD Treatment and Self Help
The main treatment for HOCD is Cognitive Behavioural Therapy, CBT, but I find that people tend to do better if they also use Mindfulness-Based approaches.
In all of the approaches, I shall explain below, if you want to overcome HOCD, the following is essential.
- You need to be able to, not only change your thought processes but stop reacting to them as if they are true
- You need to be able to stop reassurance-seeking behaviours
If you would like my help, All the things you need to overcome HOCD are including in my online course, which is available for you to start immediately,
My self-help course can be taken at home, in your own time, and follows the same format, as if you were to see me in person.
Dr Elaine Ryan
I understand that many people may not wish to meet with someone in person to discuss what is happening to them, but still want access to help; hence I made a course
Cognitive Behavioural Therapy, CBT for HOCD
CBT is a model of therapy that looks at the role of your thoughts and behaviours in HOCD. Put more simply, there will be things that you keep going over in your head (thoughts and doubts), and things that you do (maybe to look for reassurance) that are contributing to your experience of HOCD. CBT helps to take this apart for you, and change what needs changing.
You will learn to identify unhelpful thought patterns as well as unhelpful behaviours. If you can change how you think and change the things that you do, that are making it worse, that’s half the battle over. Think about it this way; if you were no longer stuck in your head with your worries, and no longer seeking out reassurance, your life would probably be back to normal.
Mindfulness for HOCD
I find mindfulness useful to help with HOCD; it takes the ‘sting’ out of your thought processes. Let me explain. Being human, we tend to react to most of our thought processes as if they are real. When I say react, I mean you feel it physically and psychologically.
Mindfulness will teach you that these are just thought processes and that you do not have to pay attention to every thought that pops into your head. Once you can do this, you are less likely to experience these type of thoughts in the future. The reason being is that your brain learns whatever you teach it, be it good or bad.
Read more on treatment
Psychologists understanding of HOCD
In the following part of the article I shall try to explain some points to you, that I would cover in session with clients.
Understanding how HOCD works
Most people who first experience unwanted thoughts about their sexual identity focus most of their attention on the fear that their sexual preference is changing. However, these thoughts about your sexuality are a symptom of OCD, and having an understanding of how OCD works, will help you negotiate your way through HOCD.
The critical point to note with Sexual Orientation OCD is that the content of the obsessions is not as relevant as realising that you are suffering from obsessions that occur within OCD.
dr elaine ryan
Focusing on the content keeps your suffering going.
The content of thought is not important. In a psychologist’s mind helping someone with unwanted thoughts about their sexuality is the same as treating a person who is suffering from obsessions regarding, for example, contamination. They are both obsessions.
If you focus on the content, analysing every unwanted thought you have regarding your sexual identity, this does not solve your problem. Instead, it results in distress that makes you feel compelled to do something to check out what is happening to you. Your obsession results in a compulsion.
Further Reading: Compulsions make your intrusive thoughts worse
An important point to note is that it is not the content of the thoughts that are the problem, i.e. whether you are gay or not. The problem is what you do with the thoughts; the analysis, the checking, the need for certainty and reassurance is the problem; in other words, the compulsions. These are all characteristics of OCD.
Watch the video below to see if you recognise yourself in any of it.
Understanding obsessions and compulsions
HOCD Symptoms
I am going to split this into two groups
- Obsessions, and
- Compulsions
Obsessions
The obsessions are the unwanted thoughts that you get in your head, for example.
You worry that the thoughts you have in your head, or the feelings and sensations that you may get in your body, may mean that your sexual preferences have changed. In other words, if you are heterosexual (straight), you may now be concerned that you are gay.
You worry about things that may have occurred in the past, are some sort of proof that you are now gay.
Noticing something beautiful about members of the same sex may make you see this as evidence that you are gay.
Worried that you are indeed gay, and are somehow living in denial of your sexuality.
Worried if you cannot get an erection, or sexually aroused if you are female, that this could mean that you are gay.
When you get these obsessions, i.e. the thoughts about your sexuality that you do not like, like many other people, you probably do some things to help you decide if you are gay or not, or to reassure yourself that you are still straight. The things you do are known as compulsions.
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Compulsions
I shall divide the compulsions into two groups as I find that more helpful.
Covert – things that other people can’t see, for example, what goes in with your thought processes
Overt – something that other people could see you doing, for instance, watching porn to make sure you’re not gay.
Being aware of obsessions and compulsions is how to start thinking about your HOCD. Rather than worrying whether you are gay or not, you can think, “oh that thought was an overt compulsion.” Doing this can start to distance you from the thoughts, and see them as HOCD symptoms, and not proof that you are gay.
The compulsions are the things that you do to try to make yourself feel better or to try to ‘check out’ if you are gay or not.
Covert Compulsions
Going over in your mind, previous sexual encounters with members of the opposite sex, to reassure yourself that you are not gay.
On the other hand, you might try to imagine being with a member of the same sex, to check out your theory that you might be gay.
You might have remembered an event from your childhood that you now see as evidence that you are gay. Children can engage in a type of exploration play; you probably heard it called ‘doctors and nurses.’ If you recall this type of game, you may mentally go over it, matching it up with other pieces of ‘evidence’ to help you to make sense of what is happening to you.
Overt Compulsions
Seeking reassurance. This reassurance-seeking could be Googling HOCD Symptoms, to get information to show you whether you are gay or not. Asking current or previous partners questions to help you to decide about your sexuality.
Watching same-sex porn to see if you get aroused
Watching straight porn to see if you get aroused
Going to gay bars to see if you are attracted to anyone
Avoidance
Not being able to listen to or see anything, that might make you think about being gay.
This could be certain songs or artists that you associate with being gay, types of TV programs, magazines or books, that you might associate more with same sex couples.
You might avoid going out or mixing with same sex couple, or showing support in any way for same sex couples. There are many things that you may avoid, fearing that they could ‘trigger’ your HOCD and I shall give a list below.
- Avoiding men if your HOCD is concerned with being gay
- Avoiding women is your HOCD is related to feeling that you are lesbian
- Avoiding participating in things that you believe are too manly or too female
- Avoiding changing rooms where you will see members of your own sex dress and undress
- Not being able to make eye contact with members of the same sex, or avoid hanging out with them
- Any topics of conversation relating to sexual preference
- Movies where samesex actors may kiss or be romantically involved
Faulty Belief Systems
If you are like most people, you will not question the thoughts in your head (you will question all the HOCD thoughts), but will not question the validity of your own beliefs.
You can think of a belief system as being a set of rules you have to make sense of our world and your experiences, but many of them will not be correct or not helpful to you as a person.
For example, if you grew up thinking you had to please others in order to be liked; this is quite hard to maintain as an adult, and does not allow for the fact that people will like you regardless of whether or not you are doing things to please them!
I shall give a couple of examples below so you know what I am talking about.
- Finding members of the same sex attractive means that you are gay
- My thoughts mean something about my sexual preference
Finding members of the same sex attractive
If you notice that you find members of your own sex attractive, there are more things than faulty beliefs at play here. You are also more likely to, what I call, spotlight, this feeling of attraction. I’ll talk about the spotlight in a second.
If you hold a faulty belief (see above) that finding members of your own sex attractive, means that you must be gay, you are a victim of your belief system, as opposed to being gay.
Human beings find many things attractive. Houses, cars, people, gardens, and the list goes on. If you think of the word attractive as meaning ‘pleasing,’ you can find and appreciate many things as pleasing, this also includes appreciating the physical characteristics, or the personality of, someone who is the same sex as you. This does not mean that you want a physical and romantic relationship with them, but if you have a faulty belief system, it will certainly cause you difficulties.
My thoughts mean something about my sexual preference
This is also a faulty belief system as if you get an HOCD related thought; your belief system will guide you to think that it must mean that you are gay. Random thoughts mean nothing.
I can think I am 21 years old and multi-millionaire and sadly, it is not valid, as thoughts mean nothing. I shall contradict myself now; thoughts only have the meaning that you give to them, so be careful about any faulty beliefs you may hold.
HOCD in the Spotlight
You might have noticed that in your life before HOCD, you never questioned your sexual preference, took heterosexual relationships for granted, and never really noticed who was gay and who was straight. Now you have a radar, or a spotlight as I like to think of it, where everything you do, and everywhere you go, you seem to notice things that make you question your sexual preference.
This can be explained by a term call selective attention. There are too many things, at any given time in life, to focus on, so we can filter out the noise and focus on what is essential. Think about driving your car, you filter out the background noise, the scenery and pay attention to the road and the signs that you need to read.
In your life before HOCD, you would have filtered out all the things that are causing you distress now. If you were meeting friends for a coffee, you would have filtered out the people you walked past, how you were walking and focused on getting to the coffee shop and filtered out the background noise to enjoy your friend’s company.
Now you have a spotlight; you can selectively attend to everything you associate with being gay. You might be concerned about people on the street, how you appear to them, are you walking funny, should you have left the manbag at home? It could be challenging to pay attention and just enjoy being with your friends as you might be wondering if they think you are gay.
All of this does not mean that you are gay, it means that you are shining a spotlight on things that you associate with being gay, which brings me to an important point; what’s the difference between HOCD and being gay?
Case Study HOCD
Paul was a 25 year old man who referred himself for therapy. He stated his reason for wishing to commence treatment was that he believed he was suffering from anxiety and that it was affecting his ability to work.
I undertook an assessment and found that Paul was indeed anxious. No previous history of mental illness. He previously had a full social life and friends.
During our initial assessment, Paul did not say he was having intrusive thoughts or uncomfortable thoughts regarding his sexuality. This is not uncommon, many people who present for therapy, initially come because they have been feeling anxious or depressed, and it is up to the skill of the therapist to determine why.
During the assessment session, Paul made a ‘throw-away’ comment regarding his sexuality. I gently 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 that he has been heterosexual all his life, and would have no problem if he was in fact attracted to men, but 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. Approximately two months ago, he started having intrusive thoughts that he might be attracted to men.
Before the onset of the intrusive thoughts, his work colleagues teased him about his love of clothes and how he maintained both his physique and hair. He started comparing himself to other men in terms of their appearance and how well they kept themselves.
Paul stated that he noticed men more often when he was walking down the street as he was comparing himself to them in terms of ‘maintenance levels.’ He noted which men were attractive and which were not, and this is when he started to question the content of his thoughts.
Paul was clear that he did not wish to have a sexual or romantic relationship with a man, that he wanted to stay in his current relationship with his girlfriend, but his intrusive thoughts were affecting the quality of his relationship. He had started to obsess about his appearance and choice of clothes and how he appeared to other people. He also began to look at other men intentionally to test to see if he felt attraction.
During the session, I found out that Paul had mild OCD in his late teens. It explained that thought processes alone could not make a person’s sexuality change and that it would appear that he was experiencing unwanted intrusive thoughts about his sexuality that were both affecting his relationship, and making him anxious.
Psychological explanation for what was happening to Paul
We found that Paul had a faulty belief system that
- men who take care of themselves are effeminate.
- men should be rough
When teased about his appearance, this made Paul very aware of his choice of clothes, how he liked to use products for his hair and skin and this did not match up with faulty belief systems, that he did not know he held until he commenced therapy.
He actively focused on how he behaved, how he walked, how he talked (this is the spotlight of attention I mentioned above.)
Over time Paul started to avoid people and places that made him question his sexual identity. He found it difficult to be intimate with his girlfriend, which made him question his sexuality further.
We agreed to meet for an initial six sessions to start treatment using CBTand Exposure Response Prevention.
Questions about HOCD
I am going to answer some of the more common questions that I have been asked in relation to HOCD below.
Difference between HOCD and being gay
It’s straightforward, HOCD is a form of Obsessive-Compulsive Disorder, and being gay is enjoying and wanting romantic relationships with members of the same sex.
If you have HOCD, your thoughts processes are concerned about being gay – not your actions. If you are gay, your actions and your thoughts show that you are gay; you want, seek out and enjoy romantic relationships with the same sex.
After reading that you could well be thinking, but how do I know, how can I be sure that I am not gay and don’t know it? This in itself is a symptom of Obsessive-Compulsive Disorder – that need for certainty, which I shall talk to you about now.
HOCD and the need to ‘be sure.’
I don’t know how many times I have been asked “but how do I know for sure that I am not gay?” I’m the psychologist behind MoodSmith, in case you were wondering and this need for absolutes, reassurance and concrete evidence is a classic symptom of OCD. It’s what feeds the doubt, and leads you into the repetitive nature of carrying out compulsions.
Needing to know for sure is just a symptom of OCD
In my mind and in all the sessions I have conducted over the years, this need to know for sure is no different than someone needing to know for sure that the surface they have just cleaned is clean; they always have doubt. I am intentionally mentioning more familiar traits of OCD to help you to think that, what is happening to you is a symptom of HOCD as opposed to a change in your sexual choices.
This ‘needing to know for sure’ is a symptom of OCD, and it is helpful if you can start to see it as a symptom. In the rest of your life, you do not have this need for absolute certainty. You do not need to know for sure what you are going to do next Tuesday, or need to be sure what something you did or did not do in the past meant (unless you associate it with HOCD.)
Up until you started to think you might have HOCD, you would not have needed to know for sure what your sexual preference was. Now, you probably do not need to know for sure what your profession is – you take it for granted.
This ‘need for certainty’ is a symptom, but one that can cause you many hours of trying to find answers, and unfortunately it is this ‘need to know’ and the things you do that help to keep HOCD going.
What maintains HOCD?
It is the doubt that I mentioned above, and the need to know for sure, that leads you into the cycle of looking for reassurance, analysing everything and carrying out compulsions. This is what keeps it all going; it has nothing to do with your sexuality at all!
So what does this all mean?
If some of the things that I have written here makes sense to you, or you recognise yourself in it, it means that
whatever is happening to you is a symptom of HOCD, it does not mean that you are gay.
This doesn’t mean you are homophobic. It is, however, alarming if you suddenly start to question your sexuality, which you will have been taking as a ‘given’ for all of your life.
What causes Homosexual OCD?
Your brain is latching onto a thought and running wild with it.
The thought in itself is harmless. It does not have to originate from a thought; it can come from a feeling. You might have first thought
- Am I gay?
- Am I attracted to him?
- What would it be like to be with a guy?
- Am I not attracted to women anymore?
Or it can start with sensations such as getting aroused in a situation that you consider to be inappropriate or not like you.
But as I said, the thought or original feeling is harmless (and perfectly normal). It is what you do with the thought and/or feeling.
If you just ignored it, you probably wouldn’t be reading this post, as it would have just wandered in and out of your attention like all the other random thoughts.
If, however, it shocked you or alarmed you, as I am assuming it did, your brain will take note of it. As you are human and have the capacity for rational thought, you will naturally want to think about it, to try to make sense of it, and this is where you can get into trouble.
Having the capacity for thought is not always a good thing! You might want to reassure yourself that you are not gay and analyse every single male encounter you have had in your life to date.
You are trying to reassure yourself, but then start to find evidence that makes you doubt yourself.
It is here you get into dangerous territory. You put it to the test.
Before you know it, you are watching porn, and not like before just for the sake of it, but as some sort of experiment to make sure you are not gay.
But it is not like before. In the past you would have been relaxed, maybe having a few beers. The perfect environment for everything to be in working order.
This time, the porn is an experiment, and you are probably stressed to the high heavens, and when you don’t get an erection, you take that as evidence you must be gay.
Let me tell you, if you are stressed, nothing down there works very well!
It is only a matter of time before these thoughts are running your life.
You can’t even walk down the street without thinking you are checking out guys or looking at them differently.
Maybe you are giving off some sort of a gay vibe and never knew it!
If any of this is familiar to you, it screams of intrusive thoughts. You will not be gay. You are just afraid you might be and are reacting to the thought as if it is reality.
If you were gay, it wouldn’t be causing you a thought.
HOCD or denial?
This is the question I get asked the most. “How do I know that this is HOCD and that I am not secretly gay and don’t know it.” Trust me, you would know. I am going to explain to you what is happening, and it has a lot to do with ‘doubt.’
Doubt and the denial question
Forget the denial question for a minute. HOCD is characterised by a nagging doubt. The doubt arises because
the thoughts in your head are so foreign to who you are as a person, and
because you attach some significance to the thoughts, you start to believe that they must mean something.
Being human, you have the capacity for thought; it’s both a gift and a curse. Without having a good understanding of how your brain works, you might not fully understand what is happening and therefore find it hard to dismiss thoughts relating to HOCD.
Your brain is wired to keep you out of harm’s way, which means that it shall pay more attention to the bad things than the good experiences in your life – your brain does not need to protect you from good things.
Now here’s the thing. Your brain does not differentiate between ‘bad things’ – threats. A threat could be real, such as approaching a poisonous snake, or threats that are specific to you – things that disturb you.
If you are anxious about the thoughts in your head relating to HOCD, your brain may pick up on this and very loosely speaking, mark them as a threat. Once that happens, your mind pays more attention to them, sort of, seeking them out to draw your attention to them.
Now that they are in your head more often, you can use your ability to think and try to analyse what is happening to you. You can start to question your sexuality, looking for evidence both in your life at the moment, and going into the past to see if you are somehow in denial and didn’t know it.
Initially, I said to forget the denial question at the moment, and I did that for a reason. If you did my job (I’m a psychologist) you would see that this constant analysis and need to know ‘the truth’ occurs in all forms of OCD and Intrusive Thoughts.
This is very important – the content of your thoughts are not important; it is what you do with your thought processes that are important.
For example, it doesn’t matter is someone is seeking the ‘truth’ over
am I gay or in denial?
How do I know I won’t act on my thoughts?
how do I know something is clean and free from germs
Instead, it is about recognising that this is something that happens – a pattern if you like – that occurs not only in HOCD but in all forms of intrusive thoughts. This is where acceptance and commitment therapy can help.
People who are gay, know this, beyond a shadow of a doubt. They do not spend hours analysing “how do I know.” They just know. Just the way I know I am a woman, and a psychologist, I don’t have to give it a second thought.
You however, if you are reading this page, I am guessing are plagued by that nagging doubt, which is just a symptom of HOCD.
Homosexual OCD and sexual arousal
If you have experienced sexual arousal while thinking about or watching members of the same sex, this is where you can run into difficulty as you see this as evidence that you must be gay.
This is a mistake. Ask yourself where you experience the arousal, are 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 passed you in the street.
<>But the difference between you and me is that you would be selectively attending 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.
You can read more about sexual arousal here.
How to overcome HOCD
I shall go through some treatment options to help you decide what is best for you.
You have a couple of options open to you.
You can attend a psychologist, for face to face therapy, or
You can undertake self-help.
Regardless of whether you attend in person or use self-help, you need to undertake, in my option, both CBT (Cognitive Behavioural Therapy) and Mindfulness-Based Approaches. I favour CBT, with Acceptance and Commitment Therapy in addition to explaining to you about your brain.
If you would like more help on this area, you don’t need to come to see someone like myself (a psychologist) in person, as I have a course you can take in the privacy of your own home, and your confidentiality is assured.
Let me start by introducing myself, I am a psychologist, and you can read more about me here. If you want to overcome HOCD but do not want to meet with someone in person, I shall go over all your treatment options.
First things first, if you have been searching for information on HOCD treatment, you have probably noticed that most information refers to OCD. There is a reason for this. HOCD, in itself, is not recognised as such, in tools we use to diagnose conditions. It is useful for you to think of it as coming under the umbrella term of OCD.
Further Reading
