HOCD; Test, symptoms, self-help and treatments How to recognise the symptoms, get self-help and treatment

What is HOCD?

Homosexual Obsessive Compulsive Disorder (HOCD) is a type of OCD where the person experiences obsessive thoughts and doubts about their previously taken-for-granted sexual orientation.

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.

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 actually feel attracted to people of the same sex.

The shared thoughts and behaviours associated with HOCD are difficulty setting aside thoughts about your sexual orientation, avoidance of people of the same sex, preoccupation with one’s level of arousal toward either sex and avoiding people who might make you question your orientation.
These thoughts can be incredibly distressing and lead to a great deal of anxiety and confusion. If you are experiencing these types of thoughts, it is essential to seek help from a therapist specialising in OCD treatment.

HOCD is not about your sexuality; it is about having intrusive thoughts about your sexuality, which is a crucial distinction.

What is HOCD?
- Signs of HOCD
- How do I know if I have HOCD?
  - HOCD test
  - Symptoms of HOCD
Diagnosis
What is it like to have HOCD?
- HOCD vs Sexual Fantasies
- Finding Members Of The Same-Sex Attractive
Questions and Myths
Treatments for HOCD
- Self-help course for HOCD

Signs of HOCD

Warning signs may include:

decreased attraction to people of the opposite sex,
increased attraction to those of your own sex,
preoccupation with the level of arousal you feel towards people of either gender,
construing any positive reaction as evidence that one is gay or straight,
and watching both gay and straight porn.

HOCD can be challenging to diagnose, so you must know the warning signs if you think you might have 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.

HOCD test

The following test is for informational purposes only 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. As mentioned at the beginning of this article, the literature assumed that some sub-themes, including sexualised themes, were Purely Obsessional. Still, we now understand that compulsions are there, albeit more covert.

OBSESSIONS

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 that your thoughts in your head, or the feelings and sensations you may get in your body, may mean that your sexual preferences have changed. If you are heterosexual (straight), you may be concerned about being gay.

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 living in denial of your sexuality.
Worrying if you cannot get an erection or are aroused if you are female could mean that 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 have mentioned before that people with HOCD may think that they have a form of Pure O, in that they only have thoughts but do not carry out compulsions, but they will be there, mainly hidden from view.

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.

Being aware of obsessions and compulsions is how to think about your HOCD. Rather than worrying whether you are gay, you can think, “oh, that thought was an overt compulsion.” Doing this can distance you from the thoughts, see them as HOCD symptoms, and not prove that you are gay or heterosexual.
You do the compulsions to make yourself feel better or try to ‘check out if you are gay’.

COVERT COMPULSIONS

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

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 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 make sense of what is happening to you.

OVERT COMPULSIONS
You are seeking reassurance. This reassurance-seeking could google HOCD Symptoms to get information to show you whether you are gay and ask current or previous partners questions to help you 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

Excessive Checking: This involves repeatedly checking one’s body for any signs that could be related to homosexuality. For example, someone with HOCD might constantly touch or look at their groin to see if they feel aroused.

Reassurance Seeking Behaviour: People with HOCD often seek reassurance from others that they are not gay. They may ask family members, friends, or even strangers if they think anything is “suspicious” about their behaviour or appearance.

Accepting that you are suffering from obsessions and compulsions instead of experiencing a change in your sexual preference is the first step towards recovery.

Diagnosis

You might want to get a diagnosis if you recognise yourself in some symptoms and compulsions unique to HOCD.

How Is It Diagnosed?
Neither Homosexual OCD nor Sexual Orientation OCD is diagnoses in their own right; instead, they fall under the umbrella of OCD.

OCD is a diagnosis in its own right because it has defining characteristics 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 consider it 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 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.

What is it like to have HOCD?

HOCD vs Sexual Fantasies

People with HOCD experience obsessions and compulsions around their sexuality.

People with HOCD have distressing thoughts rather than pleasurable ones, which set them apart from 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.

Typically people with HOCD focus most of their attention on the fear that their sexual preference has changed. However, these thoughts about your sexuality are a symptom of OCD. Understanding 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.

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. The problem is what you do with the thoughts; the analysis, the checking, the need for certainty and reassurance is the problem; the compulsions. These are all characteristics of OCD.

Avoidance
People who have HOCD may avoid what they believe may trigger their symptoms.

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 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

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 that you want a physical and romantic relationship with them.

My Thoughts Mean Something About My Sexual Preference.

This is also a faulty belief system 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 a multi-millionaire, and it is not valid, as thoughts mean nothing. I shall contradict myself now; thoughts only have the meaning 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 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.

A term called selective attention can explain this. There are too many things 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 and scenery and pay attention to the road and the signs you need to read.

In your life before HOCD, you would have filtered out all the things 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 wonder 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
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 and affecting 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 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 questioned 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. Still, his intrusive thoughts were affecting the quality of his relationship. He had obsessed about 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 found out 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 take care of 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 that 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 it difficult to be intimate with his girlfriend, which made him question his sexuality.

We agreed to meet for six initial sessions to start treatment using CBT and Exposure Response Prevention.

Questions and Myths

I will answer some more common questions that I have been asked concerning HOCD below.

Does Having HOCD Mean You 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.

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 concerned 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.

After reading that, you could well think, but how do I know? How can I be sure that I am not gay and don’t know it? This 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; if you were wondering, 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 all the sessions, I have conducted over the years; this need to know for sure does not differ from someone needing to know that the surface they have just cleaned is clean; they always have doubt.

I am mentioning more familiar traits of OCD to help you think that what is happening to you is a symptom of HOCD instead of a change in your sexual choices.

This ‘needing to know for sure’ is a symptom of OCD, and it is helpful if you can see it as a symptom. For the rest of your life, you do not have this need for absolute certainty. You do not need to know for sure what you will do next Tuesday or need to be sure what something you did in the past meant (unless you associate it with HOCD.)

Until you thought you might have HOCD, you would not have needed to know for sure what your sexual preference was. Now, you 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 it is this ‘need to know and the things you do that help keep HOCD going.

What Maintains HOCD?

The doubt that I mentioned above, and the need to know for sure, leads you into the cycle of looking for reassurance, analysing everything, and carrying out compulsions. This keeps it all going; it has nothing to do with your sexuality at all!

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 gay and don’t know it.” I will explain to you what is happening, and it has a lot to do with ‘doubt.’

People who are gay, lesbian, or heterosexual know their sexual identity beyond any doubt. They do not spend hours analysing “how do I know.” They know. Just the way I know I am a woman and a psychologist, I don’t have to give it a second thought.

A gay man will enjoy and want relationships with other men; a man with HOCD has an obsession, doubt and compulsions. He has a subtype of OCD.

Doubt And The Denial Question

A nagging doubt characterises HOCD. The doubt arises because;
the ideas in your head are so foreign to who you are as a person, and
because you attach some significance to them, you believe 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 understand what is happening and therefore find it hard to dismiss thoughts relating to HOCD.

Homosexual OCD And Sexual Arousal

Suppose you have experienced sexual arousal while thinking about or watching members of the same sex. In that case, 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 past you in the street.
But the difference between you and me is that you would be selectively attended 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.

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.
Further Reading
Centreforanxietydisorders
NCBI

Treatments for HOCD

If you are struggling with HOCD, there are things you can do on your own that help.

First, it’s essential to understand that HOCD cannot change your sexual orientation- it is only a doubt, a symptom of the condition to know if you are gay or straight.

Second, try not to give the thoughts too much power by refusing to engage with them.

Many resources on MoodSmith contain psycho-educational material to help you.

Start by reading

Self-help course for HOCD

Please see my online course if you would like my help with HOCD.

View course

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.

Outlook.

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.

HOCD; Test, symptoms, self-help and treatments