Sexual Orientation OCD (a.k.a. SO-OCD or HOCD)

In this blog series, I will predominantly be referring to the experience of self-identified heterosexuals with intrusive unwanted fears of being homosexual. This is the more common presentation, so I will generally reference “gay fears” as shorthand for fears of being an orientation other than one’s own. I will also predominantly use the shorthand of “HOCD” (formerly referred to as homosexual OCD) only because of its familiarity in online OCD communities. Having stated that, let me address two important points: 

1. OCD is not limited to any particular theme or person. A person historically attracted to the same sex could absolutely have an obsession about being attracted to the opposite sex or a fear of being in denial of their heterosexuality.
2. If you don’t suffer from this form of OCD, you may wonder why someone would fear a change in sexual orientation with the same intensity they might fear catching a disease or harming someone. In fact, it might appear offensive to some even putting such fears in the same category, given that one orientation or another is not intrinsically harmful. It’s important to remember that the person suffering from HOCD is no more or less homophobic than anyone else, but that the underlying fear of being or becoming another orientation is really a fear of losing one’s identity and living an inauthentic life of deception. People with HOCD often struggle with significant shame for the content of their obsessions especially because they harbor no particular ill-will towards the LGBTQ+ community, but nonetheless live in horror of being or becoming something they are not. The experience of living with any form of untreated OCD can be painfully devastating, regardless of the specific content of the obsession.

What is HOCD? 

It goes by many names. HOCD, SO-OCD, Gay OCD, Sexual Orientation OCD, or, if you suffer from it, your own personal nightmare. You know yourself to be of one orientation, but your mind starts telling you that you secretly belong to another. It’s not homophobia, it’s not denial, it’s a form of obsessive-compulsive disorder, an obsession with sexual orientation.

It follows the same rules as other forms of OCD of course. It has the obsession, an unwanted intrusive thought:

• the fear of becoming an orientation not your own
• the fear of being seen as having another orientation
• the fear of relationship issues being signs of sexual orientation issues
• the fear of being in denial of one’s sexual orientation or attractions
• the fear that intrusive thoughts will ruin your sexual performance and/or that difficulty performing sexually is a sign of your orientation changing
• the fear of losing your sexual identity

For those who struggle with this form of OCD, it’s not as simple as a self-identified heterosexual thinking, “what if I’m gay?” For many, if it were that easy, they could put it to rest with, “Well, I’ll be gay then and my gay self will be cool with it.” Rather, this obsession is a fear of being trapped, of losing one’s sense of self. It’s a fear of the historical “you” somehow getting lost in a metamorphosing body of another sexual orientation, never being able to return to that connection you once had with your sexuality and the people you were attracted to, and being held responsible for failing to realize it in time.

Like all obsessions, it has corresponding compulsions, many of them covert, easy to rationalize as just “figuring things out”, but no less ritualistic than counting to your favorite number while washing your hands in scalding water to ensure you are clean.

Physical Compulsions Common in HOCD:

• Avoiding all things you may associate with homosexuality – types of music or movies, gay neighborhoods, the gym, types of fashion, colors, cadences of speech, styles of singing or dancing…
• Physically checking of your groin to see if there is any sensation going on down there that you’ve deemed a “gay” response, hoping to find nothing. But because over-attending to any body part causes sensations, you inevitably find something and analyze why.
• Physical forms of reassurance seeking, such as compulsive masturbating to straight pornography while checking to be sure you like it, compulsively looking at gay pornography while checking to be sure you don’t like it.
• Staring at people you think you’re supposed to be attracted to and looking away from people you think you’re not supposed to be attracted to. Or staring at people you think you’re not supposed to be attracted to as a form of checking.
• Asking for reassurance to see if others think you’re gay or manipulating people into commenting on your “straightness.”

Mental Compulsions Common in HOCD:

• Neutralizing thoughts with self-reassurance (i.e. repeatedly saying “I’m not gay” or “gross, that’s not me”).
• Playing imaginary scenarios in your head to determine if you would or would not enjoy engaging in a gay behavior.
• Mentally reviewing your past sexual experiences to see if there were any signs or evidence of gayness. This may include over-analyzing any same-sex experiences you may have had to determine if they define your sexual orientation.
• Mentally reviewing recent interactions to see if you felt gay or if others saw you as gay.
• Praying or doing other mental activities in response to the presence of gay thoughts in an attempt to make them go away.
• Compulsive fantasizing about “straight behaviors.”
• Compulsive fantasizing about gay behaviors for the purpose of checking if you like them. 
• Ritualistically lamenting the presence of gay thoughts, devoting time to wishing they weren’t there, that you’d never thought them in the first place.

It is often underestimated how common a form of OCD this is. You may be afraid to call it OCD because in the throes of the obsession, it feels like that could just be an act of denial. If I call it OCD, how will I know for sure that I’m not also gay? You may be afraid to share your fears with friends, who may mock you or secretly pretend to “get it” when they really just think you’re gay and won’t admit it.

You may be afraid that your therapist will join you in the analytical pursuit of meaning, rather than help you, and then try to get you to accept a homosexuality in you that doesn’t really exist. It’s true that therapists who are not OCD specialists may feel pressure to view HOCD as an identity issue when it is not. It’s not even a sex issue. It’s an issue of obsessing over uncertainty and engaging in compulsions in the futile pursuit of that certainty. It’s about washing the sexual mind of perceived contaminants as someone else might wash their hands.

“I know I’m not gay, but this thing has made me lose confidence in knowing what I am, which means I could be gay, which means I can’t stop thinking about it until I prove I’m straight.”

Common things I hear from heterosexual clients who struggle with HOCD:

• Why do I keep getting intrusive thoughts of kissing my friend?

• Why do I notice members of the same sex at all?

• Isn’t calling this OCD just a way of avoiding calling it denial?

• I’m not as attracted to members of the opposite sex as I used to be.

• I’m not homophobic at all.  In fact, I’m a big supporter of gay rights. Does this mean something?

• If I were totally straight, this obsession wouldn’t keep coming back.

• There’s something happening in my groin and it means I’m reacting to members of the same sex and straight people don’t do that.

• If I don’t repeatedly read about HOCD, I won’t be able to handle the anxiety of thinking I could be gay.

• What if my therapist is just waiting for the right time to refer me to an LGBT specialist?

• Exposure therapy is going to make me feel ok with gay thoughts, which is going to make me gay.

• If I live in denial and wake up to being gay one day, everyone will think I’m so stupid for not having known and everyone will hate that I wasted their time knowing me.

Along with HOCD often comes brutal self-esteem hits, depression, and social anxiety. If you suffer from sexual orientation obsessions, it can feel like you don’t know who you are anymore, like your true self is locked away and this “other” is taking over your life. It can keep you from fully experiencing your romantic relationships, your friendships, and everything up to and including dreams. It may not seem like it, but all OCD is this way.

In the next installment, I’ll dive into treatment for HOCD.