What is HOCD?
Homosexual obsessive-compulsive disorder (HOCD) is not an official diagnostic term because it is not mentioned in the diagnostic manual (DSM-5)(1). Instead, HOCD refers to a sub-type of OCD where the person experiences obsessive thoughts about their sexual orientation. These obsessions can take the form of doubt, for example, a heterosexual male fearing they are gay, or vice versa, a gay man fearing that he is straight.
- You cannot be diagnosed with HOCD as it is not recorded as a distinct disorder in DMS-5. It is a label used to describe a particular set of obsessions and compulsions relating to sexual orientation.
- It has nothing to do with prejudice or homophobia—the obsessions related to a fear that long-standing sexual identity has changed.
- The name is misleading; homosexual OCD. The condition can affect anyone with any sexual preference. For example, it can affect a lesbian woman who suddenly fears that she should be with men. Hence the newer label of sexual orientation ocd may be more fitting.
- As with all forms of OCD, it has both obsessions and compulsions. Obsessions are distressing thoughts about sexual orientation, and compulsive behaviours can include checking out or testing your sexuality and seeking reassurance.
Table of contents
This is not an article about coming out.
It is essential to understand that HOCD is not about an individual’s sexuality but rather about their intrusive thoughts on sexuality.
A central feature of HOCD is intrusive thoughts about being gay rather than any actual attraction. People with HOCD often think they are gay or bisexual because of obsessive thoughts and self-doubt, not because they feel attracted to people of the same sex.
This can often include excessive checking for signs of homosexuality, questioning recent interactions with others and playing out potential scenarios.
When the condition first entered the public domain, it was labelled HOCD and, according to Bhatia & Kaur, 2015 (1), was marked by excessive fear of becoming or being homosexual. However, Sexual Orientation OCD or sexual-themed OCD is a more accurate and acceptable label, as the subtype is not confined to males doubting their heterosexuality.
How do I know if I have HOCD?
There are particular symptoms unique to HOCD, but to know for sure, getting a diagnosis from a licensed mental health professional is recommended. In my experience working as a psychologist for 20 years, it can be challenging to get a diagnosis.
As mentioned at the start of this article, neither Homosexual OCD nor Sexual Orientation OCD are diagnosed in their own right; instead, they fall under the umbrella of OCD.
For a diagnosis of OCD to be made, the person needs to;
- have obsessions and compulsions that take up over 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 activities.
I found the difficulty in getting the correct help lies in the skill of the therapist and their knowledge of OCD, as was noted in a case report where the authors mention the lack of tools to diagnose this type of OCD. This report details a case where the person noted repetitive thoughts since age four. This was not the case in my clinical practice, where all people I have worked with started having obsessive thoughts about their sexuality as adults, as seen in the case study below.
Paul was a 25-year-old man who referred himself for therapy. He stated that he wished to begin treatment because he believed he was suffering from anxiety which affected his ability to work.
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 that
- 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.
Symptoms of HOCD
As with all forms of OCD, HOCD has both obsessions and compulsions.
The word ‘obsession‘ comes from the Latin’ obsidere’, which means ‘to besiege’. Obsessions are the unwanted intrusive thoughts that you get in your head.
- You worry about things that may have occurred in the past, proving 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.
- You are worried you are indeed gay and are denying your sexuality.
- Worrying if you cannot get an erection or are aroused if you are female could mean you are gay.
Example obsessions you might have with HOCD
- I’m scared that I might be gay.
- I keep thinking about members of my own sex that I don’t want to have.
- I feel like I’m in denial, and if I come out as gay, it will ruin my life.
- I know deep down inside that I’m not straight, but how can I be sure?
- It feels like there’s something wrong with me because I can’t stop thinking about people of the same gender sexually.
When you get these obsessions, i.e., the thoughts about your sexuality that you dislike, like many other people, you do some things to help you decide if you are gay or reassure yourself that you are still straight. The things you do are known as compulsions.
I shall divide the compulsions into two groups, which is more helpful.
Covert–things that other people can’t see, for example, what goes on with your thought processes
Overt–something other people could see you doing, for instance, watching porn to ensure you’re not gay.
You are going over previous sexual encounters with members of the opposite sex to reassure yourself that you are not gay.
|Watching same-sex porn to see if you get aroused|
Watching straight porn to see if you get aroused
You might try to imagine being with a member of the same sex to check out your theory that you might be gay.
|Going to gay bars to see if you are attracted to anyone|
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 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 understand what is happening to you.
|Excessive Checking: This involves repeatedly checking one’s body for any signs related to homosexuality. For example, someone with HOCD might constantly touch or look at their groin to see if they feel aroused.|
If you avoid things as you are afraid they may trigger your HOCD, this can be a compulsion in that you are changing your behaviour in response to thoughts in your head.
This could be certain songs or artists 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, mixing with a same-sex couple, or showing support for same-sex couples. You may avoid many things, 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 if your HOCD is related to the feeling that you are lesbian
- Avoiding taking part in things that you believe are too manly or too female
- Avoiding changing rooms where you will see members of your 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 same-sex actors may kiss or be romantically involved
Treatments for HOCD
If you are struggling with HOCD, there are things you can do on your own that help. Many resources on MoodSmith contain psycho-educational material to help you.
Start by reading
I recommend you start with self-help and have made a video to allow you to look inside MoodSmith’s online course for HOCD.
HOCD treatment with a therapist
Therapy has shown promising results for people struggling with HOCD. There are a few different types of treatment that can be helpful, including ERP and CBT.
Exposure Response Prevention.
Exposure and response prevention ERP involves gradually exposing someone to what they’re afraid of, then preventing them from rituals or behaviours that usually relieve the anxiety caused by the fear.
If you have tried therapy before, please do not be discouraged. ERP is designed to eliminate compulsions. Suppose your therapist was not well versed in sexual-themed OCD. In that case, they might have missed helping you uncover mental compulsions or reassurance-seeking behaviours because they can be easily overlooked, according to Wiilliams et al. (2011) 2.
Cognitive Behavioural Therapy.
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 you keep going over in your head (thoughts and doubts) and things that you do (maybe to look for reassurance) that contribute to your experience of HOCD. CBT helps to take this apart for you and change what needs changing.
In this last section, I shall answer some of the questions I have been asked while working as a psychologist. In doing so, I shall hopefully dispel some myths.
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.
What about sexual fantasies?
Unlike fantasies, people with HOCD feel distressed by their thoughts – not aroused by them – which is the opposite of what typically happens during a sexual fantasy. This means that people with HOCD are not getting the same pleasure from their thoughts as those who do not have OCD.
What about finding members of the same sex attractive?
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 respecting the physical characteristics of the personality of someone the same sex as you.
This does not mean you want a physical and romantic relationship with them.
What about getting 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.
You can read more about sexual arousal here.
How do I know I’m not just in denial?
This is the question I get asked the most. “How do I know that this is HOCD and that I am not gay and don’t know it.” I will explain to you what is happening, and it has a lot to do with ‘doubt.’
My thoughts must mean something.
This is a faulty belief system if you get an HOCD-related thought. Random thoughts mean nothing.
I can think I am 21 years old and a multi-millionaire, and it is not valid, as thoughts mean nothing. Thinking that they must mean something about your sexuality is, in fact, thought-action fusion, and you read more about that here.
Do I need to come out?
HOCD is not having thoughts about ‘coming out.’ Coming out is where you choose to think about your sexuality, knowing you are attracted to members of the same sex and want to think about how to live your life as gay or lesbian. The thoughts in 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 has nothing to do with sexuality but with the doubt and uncertainty that exist within OCD.
Hopefully, this last section helped answer some questions and dispel some myths.
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.
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.
- 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.