HOCD: What It Is, How to Cope, and Get Help from Chartered Psychologist Dr. Elaine Ryan

Homosexual Obsessive-Compulsive Disorder (HOCD) is a type of OCD that causes people to have intrusive thoughts about their sexuality. People with HOCD may worry that they are gay or lesbian, even if they do not identify as such. They may also have compulsions, such as checking to see if they are attracted to people of the same sex or avoiding situations that trigger their HOCD thoughts.

HOCD is a treatable condition. There are a variety of therapies that can help people to manage their symptoms and live normal lives.

This page on HOCD is written by myself, a psychologist, to help you understand Homosexual Obsessive Compulsive Disorder. I have a particular interest in HOCD and have helped over 1000 people with HOCD over the years both in my clinical practice and through my self-help material. If you are looking for my help, you can find my self-help course here.

I update this page regularly to ensure what you read is both accurate and up-to-date and I hope you find it useful.

Dr Elaine Ryan

What is HOCD?

It is essential to understand that HOCD is not about an individual’s sexuality but rather HOCD refers to the obsessive thoughts a person has about their 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.

It has nothing to do with prejudice or homophobia—the obsessions related to a fear that long-standing sexual identity has changed.

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. I shall expand on this below in what I loosely call types of HOCD.

Types of HOCD

I choose to write briefly about types, as people had emailed to say, for example, that they are in a same-sex relationship but think they have obsessive fears that they are attracted to the opposite sex. HOCD is about having any obsessive thought or fear surrounding your sexual identity.

HOCD about Sexual Orientation (SO-OCD)

• Obsessions: Doubts and intrusive thoughts about one’s own sexual orientation. A straight individual might fear they are actually gay or vice versa, even when they have no actual desire for that particular sexual orientation.
• Compulsions: Seeking reassurance, checking reactions when looking at people of the same or opposite sex, avoiding certain situations or people that might trigger these thoughts, etc.
• Note: This type of OCD is not about repressed homosexuality. It’s about the fear and doubt about one’s orientation, irrespective of what that orientation might be.

HOCD about Gender Identity (GI-OCD)

• Obsessions: Doubts and intrusive thoughts about one’s gender identity. Someone who is cisgender (identifies with the gender they were assigned at birth) might obsessively worry that they are actually transgender, even if they have no genuine desire to live as another gender.
• Compulsions: Seeking reassurance, checking one’s reactions to gender-specific situations, avoiding situations that might trigger these thoughts, etc.
• Note: This is not about repressed transgender feelings. It’s about the obsessive worry over one’s gender identity.

What causes HOCD?

Genetics

• If someone in your family has OCD, you might be more likely to have it too.
• Certain genes might be linked to OCD, but we’re still learning about this.

Brain Factors

• Brain scans show that people with OCD have some differences in their brain.
• There might be a link between OCD and the brain’s fear centers.
• There could also be an imbalance in brain chemicals. Medicines like SSRIs help balance these out and treat OCD.

Psychological Factors

In Summary:

• HOCD and other types of OCD are complex. No single reason explains why someone has it.
• 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.

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.

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.

Case Study: Paul 

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

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.

HOCD test

The following test is for informational purposes and is not a substitute for meeting with a licensed mental health professional.

Go to test

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. 

Intrusive thoughts about being gay or lesbian

• 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.

Fear of being attracted to people of the same sex

• 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.

• You might try to imagine being with a member of the same sex to check out your theory that you might be gay.

• You are going over previous sexual encounters with members of the opposite sex to reassure yourself that you are not 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 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.

Compulsive checking to see if you are attracted to people of the same sex

• Looking at members of your own sex to check if you feel attraction or not
• Actively seeking out same-sex couples to see if you ‘feel anything.’
• This involves repeatedly checking your 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.
• Going to gay bars to see if you are attracted to anyone
• Watching same-sex porn to see if you get aroused
  Watching straight porn to see if you get aroused

Avoidance of situations or people that trigger your HOCD thoughts

• Turning off television programmes, when you see a same-sex couple
• avoiding gay friends

Other common symptoms of HOCD

• Difficulty concentrating
• Feeling anxious
• Feeling like you are not like your old self

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.

Avoidance

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

• this introductory series on intrusive thoughts.
• Learn how to do ERP yourself in this article ERP for intrusive thoughts.

I recommend you start with self-help and have made a video to allow you to look inside MoodSmith’s online course for HOCD.

Self-help

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.

FAQs

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.

Resources for people with HOCD

• 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

Glossary

• Obsessive-compulsive disorder (OCD): A mental health condition that causes people to have unwanted thoughts, images, or urges (obsessions) and repetitive behaviours or mental acts (compulsions).
• Homosexual obsessive-compulsive disorder (HOCD): A subtype of OCD in which people have unwanted and intrusive thoughts about their sexual orientation.
• Obsessions: Unwanted and intrusive thoughts, images, or urges that cause distress or anxiety.
• Compulsions: Repetitive behaviours or mental acts that people feel driven to perform to reduce anxiety or prevent some feared consequence.
• Cognitive distortions: Unhelpful ways of thinking that can lead to negative emotions and behaviours.
• Exposure and response prevention (ERP): A type of therapy that helps people with OCD to face their fears and resist their compulsions.

• Rumination: Repeatedly thinking about the same negative thoughts or experiences.
• Reassurance seeking: Seeking reassurance from others about one’s thoughts, feelings, or behaviours.
• Safety behaviours: Avoiding things that trigger obsessions or compulsions.
• Pure O: A type of OCD in which people have obsessions but no compulsions.
• Acceptance and commitment therapy (ACT): A type of therapy that helps people to accept their thoughts and feelings, and to commit to living a meaningful life, even in the presence of discomfort.
• Anxiety: A feeling of worry, nervousness, or unease.
• Intrusive thoughts: Unwanted thoughts that pop into a person’s mind without their control.
• Cognitive fusion: The belief that one’s thoughts are true and accurate, even when they are not.
• Thought-action fusion: The belief that thinking about something makes it more likely to happen.
• Urge: A strong desire to do something.
• Reassurance-seeking: Asking others for reassurance about one’s thoughts, feelings, or behaviours.

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

1. 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.). 
2. 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
3. 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.