Homosexual OCD (HOCD)
Homosexual OCD (HOCD)
What is HOCD?
Homosexual OCD – also known as sexual orientation OCD, is seen in individuals (straight, gay, or bisexual) who develop obsessive thoughts, plagued by an intense (unwarranted) fear and doubt over their long-standing sexual orientation. These individuals fear that they may be sexually attracted to the same sex (if they are heterosexual), or attracted to the opposite sex (if they are already gay), even though their sexual desires and underlying orientation indicate otherwise. Usually, their obsessive gay thoughts are followed with compulsive checking behaviours that allude any evidence as ‘proof’ that their thoughts and fears are in fact real.
As with other forms of OCD where individuals experience unwanted and intrusive thoughts that are contrived as irrational, and are usually accompanied by compulsive acts or urges – the obsessions individuals with HOCD experience are also unwanted thoughts, however these are focused mainly on the more realistic fear and uncertainty about their sexuality. The sexual obsessions involved in HOCD are typically associated with high levels of shame and guilt for the individual, and for this reason, are often kept hidden from others. Self-denial and confusion is also typical – subsequently creating an appropriate motive for not seeking appropriate help and treatment. Importantly, HOCD is not about homophobia – individuals with HOCD usually aren’t troubled by the concept of homosexuality in others, however the thought of themselves being gay (or straight if the person is gay), is extremely distressing. The main reason for this is the consequences of what it may mean for them. For example, a person who is in a loving committed relationship may experience the thought, “if these thoughts were true I would have to leave this relationship”. Therefore, their fear is not about being straight or gay – but more that they would lose the one they truly love. This article will help to explain some of the different forms of HOCD, and the common symptoms associated with each, including the various treatment approaches that can be taken.
What are the different types of HOCD?
It is important to acknowledge that HOCD involves obsessions, followed by urges (compulsions) that are geared toward doubts and fears surrounding their sexual orientation. The fears are ego-dystonic (separate from the self), not ego-syntonic (confusion about sexuality). Hence the categories of HOCD listed below are not conclusive, and those with HOCD may experience and identify with a number of these categories and many more.
- All or Nothing HOCD:
Individuals with this form of HOCD usually report of having been the same sexual orientation their whole life, or having never experienced gay fantasies or thoughts cross their mind before. Their fear usually begins with having one ‘gay’ thought or emotion pass over them, to which they payed extreme attention to and sought meaning for. Individuals with all or nothing HOCD, hold the distorted belief that having any gay thoughts must be an indication that they are in fact gay. In an attempt to ‘prove’ to themselves that they are straight, they may engage in various compulsive behaviours, such as, masturbation rituals to opposite sex fantasies, or extreme avoidance measures of objects or people of which the individual associates with homosexuality.
- Treatment involves CBT involves exposure therapy to the objects or people that trigger gay thoughts – in addition to resisting the compulsion to engage in ‘straight-proving’ behaviours
- Relationship HOCD:
Relationship OCD, (otherwise known as ROCD) is described when individuals blame their past relationship failures, on the belief that they ‘must be gay’ because they’re previous relationships just haven’t worked out. Common examples include not feeling sexually attracted to their sexual partner, or not having experienced love in their past romantic relationships. This concept is usually associated with individuals feeling as though they don’t relate to the opposite sex – using this as evidence that they are gay. In this case, individuals will usually over attend to their interactions with the same sex – evaluating them to be more understanding and more satisfying to spend time with. As a result, this causes the individual to fearfully question their sexuality.
- Treatment involves CBT based on exposure therapy to the individual’s sexually based fears, as well as being exposed to behaviours that demonstrate the normality of heterosexual relationship flaws.
- Self- Hating HOCD:
Individuals who develop this form of HOCD typically have little self- worth (which may have resulted from previous abusive relationships, traumatic experiences, or severe mistreatment in the past), and usually co-insides with depression. Those with self-hating HOCD typify their perceived wrongdoings, to the analogy that they are gay- wherein this association is directed as a form of self-insult (not as the actual fear of becoming their opposing sexual orientation). This therefore substantiates their distorted belief that they are in fact ‘unlovable’ and unattractive to their desired orientation.
- For Self-Hating HOCD, depending on the severity of the individual’s symptoms, it may be more effective for treatment to address any underlying depression symptoms first. Following this, engaging in cognitive behavioural therapy is recommended –helping the individual to identify and challenge their negative thoughts about their identity, and work towards reframing these as irrelevant to their sexuality.
- Masculine / Feminine HOCD
This form of HOCD is generally associated with the individual’s perception of stereotypical expectations that are placed upon masculinity and femininity within society. Generally speaking, the individual believes that any incongruence (with their thoughts or behaviours) of their expected gender role, is a sign of gender ‘weakness’ and therefore an (unwarranted) indication of their sexual orientation. For example, a male who finds another male as attractive, may fear that ‘real men’ only think women are attractive – this therefore invokes their though: ‘I must be gay’
- CBT therapy involves gradual exposure to the objects, people, or activities that they associate with their distorted beliefs around their gender (eg: exposure to images or film associated with identifiable homosexuals, attending theatre or ballet, and engaging in activities perceived as masculine for females or feminine for males)
- Groinal response HOCD
This form of HOCD is when individuals experience sexual arousal / groinal responses, in situations that do not conform to what they believe to be appropriate circumstances in line with their sexual preference. As these individuals begin to place more awareness on their groinal areas it only heightens their sensitivity, working to actually provoke increased sensation in this area. Individuals with groinal response HOCD believe that any groinal response or feeling of sexual arousal, in circumstances conflicting with their orientation, must be proof that they are gay – regardless of the fact that they have no desire for sex with the same gender.
- CBT treatment involves educating individuals on being able to detect and challenge their distorted beliefs around groinal responses, involving gradual exposure therapy to situations that they fear may invoke arousal.
What are the symptoms of HOCD?
- Feeling disgusted with the thought of their feared sexual orientation becoming true
- Feeling no sense of sexual arousal and desire for their feared sexual orientation
- Looking for and finding any evidence as (false) ‘proof’ that their intrusive thoughts ‘must’ be real
- Ruminating on their doubtful thoughts and fears surrounding their sexual orientation
- Engaging in various checking behaviours to prove themselves to be either straight or gay
- Mistaking imagined scenarios of gay (or straight) thoughts as defining their sexual orientation
- Rationalising that their past unsuccessful or unsatisfying romantic relationships is evidence that proves their sexual oriented fears to be true
- Avoiding all people, objects, or places that may be associated or act as a trigger to provoke their distorted thoughts and subsequent compulsive behaviours.
What are the causes?
While there is no definitive reason why individuals develop HOCD, there are various factors that may come into play for contributing to it,/ that have been thought to contribute to it, some common themes in individuals include those who may have:
- Poor self- esteem
- Not been able to sustain past romantic relationships
- Suffered from a traumatic break up
- Experienced an abusive relationship
- Experienced multiple unsatisfactory dates
- Unsatisfying sex
- Unable to attain dates
- Associating virginity with a particular sexual orientation
What does treatment involve?
Treatment for HOCD involves Cognitive Behavioural Therapy (CBT), including gradual exposure therapy to the individual’s irrational homosexual thoughts and fears. It is important to acknowledge that the exposure component involved in treatment does not involve encouraging the individual to engage in homosexual activities, but instead, to instances that invoke their obsessive thoughts and compulsions.
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What is your experience?
- Clinical Director of Anxiety House and OCD Clinicsince 2010
- Ten years’ experience with clients with OCD and anxiety
- Clinical supervisor and STAP trained
- Worked in public and private sectors for many years
- Worked in acute inpatient and outpatients units
- Regular speaker on radio and social media
- Researcher and presenter at international conferences
Sophie Lucas is our Anxiety House blogger and is studying Bachelor of Communications at UQ. Sophie is passionate about anxiety recovery and loves to write about research and provide EDUCATION about anxiety. Sophie and Director Dr Emily O’Leary carefully think about each topic and try and provide the most up to date information. We have a number of scheduled blogs coming up, but we really want to hear your IDEAS! What topics would YOU like to know more about?
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