HOCD - 30 Things You Need To Know - 300

HOCD is a misunderstood and under-recognized variant of Pure Obsessional OCD (Pure O).

HOCD (Homosexual OCD) is ostensibly a variant of OCD in which the sufferer obsesses about being gay. Of course, like most subtypes of OCD, it’s a lot more complicated than that. Unfortunately, the numerous myths and misconceptions surrounding HOCD lead to this condition being poorly understood, under-reported, and ineffectively treated. Here are 30 things you should know about HOCD and its treatment:

1. The term HOCD is not a formal diagnostic term. It is simply a slang term for OCD in which the sufferer’s obsessions focus on their sexual orientation. Some naysayers claim that HOCD doesn’t really exist simply because it is not a formal diagnosis that can be found in the Diagnostic and Statistical Manual of Mental Disorders. That’s a lot like saying broccoli is not really food because it’s not listed as a category of food by the USDA. Broccoli is a type of food and HOCD is a type of OCD.

2. The term HOCD is a bit misleading. While most people with HOCD obsess about secretly being gay, a significant number of gay people who struggle with OCD obsess that they are secretly straight. This is why some people prefer to call HOCD “Sexual Orientation OCD”. The bottom line is that, no matter what you call it, the core obsession in this variant of OCD is the fear that one is secretly not living in accordance with what they see as their their “true” sexuality.

3. Similarly, some people obsess that they are secretly bisexual, or that they are secretly transsexual or transgendered. Basically, people can and do obsess about almost anything, especially when it comes to their sexuality.

4. While HOCD is extremely common, it is not well known by the public. Many people mistakenly think that OCD consists entirely of compulsive hand washing, door checking and stove knob checking.

5. HOCD is under-reported, mostly because people who experience it have so much shame about having thoughts about being gay. This under-reporting is also a function of people simply not knowing HOCD exists. This is further complicated by the fact that so many mental health professionals are utterly clueless about HOCD.

6. Most people with HOCD are not particularly homophobic. In fact, many are quite open-minded when it comes to issues of gender and sexual orientation. They just feel a tremendous amount of concern that they may secretly want to be gay, mostly because they see themselves as straight. The same goes for those who are gay who obsess that they are secretly straight (sometimes called “Straight OCD”).

7. Thoughts are just thoughts, and having gay thoughts does not automatically mean you are gay. Most people at some time in their life have at least some passing curiosity about sex with the same gender. Curiosity about all sorts of things is a normal part of the human experience, and curiosity about sexual matters is healthy and predictable.

8. Additionally, having sexual fantasies about the same gender does not automatically mean you are gay. Everybody has sexual fantasies, and everybody has sexual fantasies about things they are unlikely to actually do. Humans really, really like to fantasize about things that are taboo. We are naturally curious about sex, and that includes sex that is “forbidden” or outside of our normal sexual menu. Again, curiosity about sexuality is normal and healthy.

9. A history of experimenting with same-sex behavior when you were young does not automatically mean you are gay. Sexual experimentation is an extremely common part of growing up, and many children, adolescents, and young adults do all sorts of things that their parents would be appalled by.

10. Likewise, a history of being sexually abused as a child does not mean you will automatically become gay. The great majority of people who were sexually abused as children are not gay (including most of those who were abused by a person of the same gender).

11. If you are straight and a gay person expresses romantic/sexual interest in you, that does not mean you are gay – it means they are gay. Gay people come on to people for the exact same reason that straight come on to people – because they are hoping that the other person will respond favorably. Their interest in you is based on what they want, not on what you want, and what they want is based on your gender, not your sexual orientation. There is no reason to assume that their interest means anything more than that they find you attractive, and the most appropriate response is to be flattered, not to assume that you are gay.

12. You do not need to ”know” your sexual orientation with 100% certainty, any more than you need to know with certainty what you are having for lunch next Tuesday or what color socks you were wearing on New Years Eve. HOCD is not really about sexual orientation at all – it’s about having an exaggerated need for absolute certainty about sexual orientation. But absolute certainty is not possible. It doesn’t exist! Nobody on the planet can guarantee with 100% certainty that they will always be gay or straight or bi or whatever. Certainty is not required, and searching for it is a compulsive waste of your time and energy.

13. Many people with HOCD obsess about experiencing a groinal response that they have in reaction to anything they perceive as being potentially “gay”, such as:

• Exposure to attractive people of the same gender.
• Exposure to overtly gay people.
• Exposure to gay music, gay TV characters, or gay themed films and books.

This groinal response is almost always a function of the HOCD sufferer paying way too much attention to their groin. The simple fact is that people without HOCD spend virtually no time whatsoever analyzing their groin for signs of arousal.

14. Many people with HOCD are extremely concerned with the fact that they notice people of the same gender who are attractive. And just as with the groinal response, this problem is almost always a function of over-attending. Most people who don’t have HOCD do not spend a whole lot of time analyzing whether or not they find people of the same gender attractive. That said, it is completely normal to notice that some people of the same gender are attractive. There are lots of attractive people in the world – why shouldn’t you notice them? Recognizing that a person of your gender is attractive does not mean you are gay – it means you have functioning eyeballs.

15. If the idea of sex with a person of the same gender sounds awful to you, then you probably are not gay. Gay people like the idea of sex with people of the same gender. Likewise, if the idea of sex with the opposite gender sounds awful to you, you are probably not straight.

16. Sexual orientation exists on a spectrum ranging from really, really straight to really, really gay, and people can exist anywhere on that spectrum. Furthermore, one’s sexual orientation may vacillate over time. Everybody knows people who have “experimented” with same-gender sexuality, or who have been straight sometimes and gay at other times. The bottom line is that you are not obligated to fit perfectly and permanently into a category of “straight” or “gay” or “bi” or whatever flavor of sex currently turns you on. There are no rules about your sexual orientation. You can be whatever you want, whenever you want.

17. HOCD is not curable, but it is treatable. Research has consistently found that the most effective treatment for all forms of OCD is Cognitive Behavioral Therapy (CBT), with an emphasis on a specific CBT technique called Exposure and Response Prevention (ERP).

18. Challenging your distorted thoughts about your sexuality and your sexual obsessions is called Cognitive Restructuring. This is the “C” part of CBT, and for many, this is a very valuable aspect of treatment.

19. Exposure and Response Prevention (ERP) is the “B” part of CBT, and is the key ingredient to treating all forms of OCD. Using ERP, the HOCD sufferer learns to challenge and change the compulsive behaviors that they have been doing in response to their anxiety-provoking obsessions about their sexual orientation. These behaviors tend to fall into four categories:

• Overt compulsions (e.g., washing your hands or changing your clothes after spending time with a gay person).
• Avoidant compulsions (e.g., not going to gay neighborhoods or watching gay themed TV shows).
• Reassurance-seeking compulsions (e.g., asking friends and family to confirm that you are not gay, or that you are not acting in a manner that could be construed as gay).
• Mental Compulsions (e.g., repeatedly analyzing your thoughts or actions in an effort to prove to yourself that you are not gay).

20. A key part of ERP for HOCD is Imaginal Exposure. This technique involves writing short stories based on your obsession and then repeatedly reading those stories until they become boring and non-triggering. For many people struggling with HOCD, imaginal exposure is one of the most effective components of treatment.

21. Mindfulness and acceptance based treatments are great adjuncts to CBT / ERP, and are considered the “third wave” of CBT (cognitive and behavioral therapies being the first two waves).

22. Some people struggling with HOCD worry that treatment will ultimately make them become gay. Treatment with CBT / ERP cannot “turn you gay”. Simply put, therapists are not that powerful. Likewise, therapists cannot make a gay person become straight (which is why conversion therapy is a crock).

23. Likewise, many people with HOCD are extremely concerned that treatment will result in them discovering that they are in fact secretly gay, and that they have been “in denial” all along. When it comes to HOCD, the concept of gay denial is utter nonsense.

24. Treatment with CBT / ERP does not include having gay sex to “prove” whether you are straight or gay. Out of sheer desperation, some people with HOCD try to prove to themselves that they are straight by “testing” whether they like having gay sex. This always backfires, resulting in the sufferer feeling more confused and tortured than ever.

25. Conversely, treatment for HOCD is focused on helping the sufferer learn to accept the presence of intrusive, unwanted sexual thoughts, without taking those thoughts so seriously, and without demanding that they have 100% certainty about their sexual orientation. Again, thoughts are just thoughts, and absolute certainty is not possible.

26. We have treated hundreds of people with HOCD, and not one has been able to articulate why it is so important that they have absolute certainty about their sexual orientation…because it is not imperative to “know” your sexual orientation with 100% certainty.

27. Sometimes, when a person with HOCD starts to see significant improvement during treatment, they then start to obsess that their reduced anxiety about being gay is really just further evidence that they actually are gay. This is called a “backdoor spike” – just as they are getting relief, their HOCD finds a new avenue to torture them. The best response to a backdoor spike is to realize that it is just a new twist on the same old intrusive, unwanted thought, and to accept its existence without paying it any special attention.

28. Many people with HOCD also experience other subtypes of OCD, especially other variants of Pure Obsessional OCD (“Pure O”). It is particularly common for people with HOCD to also struggle with a variant of Pure O known as Relationship OCD (ROCD).

29. Still not sure if you have HOCD? You can click here to take our free online test for HOCD.

30. Want to learn more about this misunderstood and under-recognized variant of OCD? You can click here to read our four-part series about HOCD.

•Tom Corboy, MFT is the founder and executive director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related anxiety based conditions.  In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.