HOCD is the abbreviation for homosexual obsessive-compulsive disorder. It’s also known as SO-OCD (sexual orientation) or “gay OCD.” It is a variant of OCD, and can have a profound impact on the lives of those living with it.
HOCD — The Basics
How Common Is It?
HOCD affects less than 1% of the population. OCD, the broader category in which HOCD falls, affects 1.2% of Americans — approximately 3.95 million people. Of those 3.95 million, estimates are that 8% of them have sexual orientation obsessions. So a reasonable estimate of the number of Americans suffering from sexual orientation-themed OCD would be 315,000. This a large number for such an infrequently discussed phenomenon! It’s similar to the numbers estimated for Americans living with multiple sclerosis, and more than the number of people living in Cincinnati, Ohio.
One factor that perhaps makes HOCD more torturous than other types of OCD is its relative obscurity. Therapists who specialize in OCD are typically familiar with HOCD, but most other therapists are not. If you ask most people what OCD is, their answers will likely involve a preoccupation with order, being excessively neat, or washing your hands. These can indeed be symptoms of OCD, but for some people, OCD can look completely different.
Is HOCD a Real Thing?
HOCD is poorly understood outside of the OCD community. For this reason, many people misunderstand it to be “repressed” homosexuality. Others mistakenly interpret it as an early part of the coming out process. HOCD has been around for a long time and, to those in the know, is an established and well-understood sub-type of OCD.
Note: HOCD can affect people of any sexual orientation. For simplicity’s sake, this article describes the experience of a straight person with obsessions about being gay. Everything written here can be applied to a gay person with obsessions about being straight; just swap the words “gay” and “straight.”
The Warning Signs of HOCD
The core symptoms of HOCD are intrusive thoughts about being gay. These can lead to any of the following:
- Difficulty setting aside thoughts about your sexual orientation
- Diminished attraction to the opposite sex
- Reviewing your day or week to feel sure that at no time did you feel attracted to someone of your own sex
- Preoccupation with one’s level of arousal toward either sex
- Avoidance of people of the same sex
- Construing any positive reaction to a member of the same sex as evidence of being gay
- Checking one’s response to opposite- or same-sex images of attractive people
- An urgent need to decide whether one is gay or straight
- Spending time in anxious rumination about one’s reaction to members of the same or opposite sex, looking for proof that one is gay/straight
- Looking at pornography, not because of enjoyment but because it is an opportunity to check one’s responses to men vs. women
Common Intrusive Thoughts in HOCD
- What if I’m gay?
- Did my noticing that man/woman just now mean I’m gay?
- Did my childhood interest in rugby/dance as a kid mean I’ve always been gay and missed the signs?
- Do my friends think I’m gay? If so, are they right?
- How can I continue in this relationship if I’m actually gay? That’s dishonest!
- What if these thoughts never go away?
- How much am I *really* enjoying this stereotypically straight man/woman activity? Maybe not enough!
- Why did I slow my pace a little when I walked by the LGBT community center the other day?
Compulsions in HOCD run the gamut from the unnoticeable and subtle all the way to the life-altering. People with HOCD feel a strong temptation to eliminate uncertainty about whether they are straight or gay. This has some parallels to Claire Weekes‘ metaphor of swimming rather than floating; you want the anxiety to go away, and assume that hard work is needed to make that happen. Paradoxically, the healthiest thing we can do in these situations is… nothing.
The Role of Tolerating Uncertainty
The more someone with HOCD seeks certainty, the more they weaken their innate ability to tolerate uncertainty. We all have the ability to tolerate uncertainty. We can tolerate not knowing what we’ll wear tomorrow, we can tolerate not knowing exactly where we’ll be in a year. So why are obsessive thoughts so hard to tolerate?
Partially, they’re hard to tolerate because they run counter to our well-rehearsed habits of eliminating that uncertainty. People with HOCD are tempted by the prospect of “figuring out” if they’re gay or straight, either by checking in some fashion or by mental exercise. There is no comparable temptation to “figure out” where we’ll be in a year because we know we can’t. That temptation makes the HOCD thought hard to tolerate.
For people with HOCD, tolerating anxiety around their sexual orientation is analogous to acquiring a taste for healthier foods if you’re used to eating junk food. If you’re used to pork chops and macaroni every day, your first taste of broccoli might not be appealing. However, the more you work it into your diet, the more you can tolerate it. You might even come to enjoy it!
Similarly, if someone with HOCD has never tried anxiety tolerance as a means of coping, it will be difficult at first. It may feel pointless, painful, and unproductive. Over time, however, with continued effort, it will feel easier and more natural.
There are two options for those who would like to improve their HOCD symptoms. You can work with a professional or try to make changes on your own.
How You Can Battle HOCD on Your Own
If you have HOCD, The good news is that there are a lot of things you can do to help yourself. Several strategies are listed below that have been helpful for many suffering from HOCD. One challenge in implementing them is that the obsessive thoughts are hard to shake, and feel very convincing.
The HOCD Thoughts Feel Real
People with HOCD are often thrown by their obsessions, and explain that the thoughts “feel so real.” Why is that?
The answer involves fear, repetition, and the power of mental habits. People with HOCD focus excessively on their reaction to men vs. women. The fearful intensity of that focus makes it impossible to distinguish between real desire and fear of real desire. (Similar phenomena happen in other anxiety disorders – for example, people who suffer from panic disorder also become very focused on a feared internal experience. In their case, it’s a sensation and not a desire, but the situations are similar.) When this inability to discern real sexual preferences repeatedly meets with fear and pessimism, there are consequences.
Sometimes people with HOCD go from being anxious because they’re unsure if they’re gay to being convinced that they’re gay. Instead of feeling horrified that they might have been wrong about being straight, they start to feel horrified that they are certainly wrong about being straight. This shift in thinking reduces the questioning of one’s sexual orientation; the belief that one has been masquerading as straight becomes strong and solid. This is sometimes referred to as overvalued ideation.
This is a difficult problem to address, but two strategies can be helpful: mindfulness and creating uncertainty.
The traditions of meditation and mindfulness offer a valuable perspective for those struggling with upsetting thoughts about one’s sexual orientation. From the mindfulness perspective, no thoughts are real, regardless of how they feel. They are all temporary experiences without any inherent substance or profound meaning.
Mindfulness practice helps us maintain a healthy relationship with thoughts (and emotions). It helps us remember that even beliefs we take for granted — e.g., that I’m reading an article on HOCD right now — are not reality. They may be factually based and accurate, but are still just beliefs. This is a useful perspective for someone with HOCD to have as they cope with thoughts and beliefs around their sexual orientation.
The “Lloyd Christmas” Technique
This is ideally used in the context of exposure and response prevention therapy, with the assistance of a trained therapist, but is presented here in the hopes that it might be useful to others.
Typically in OCD treatment, the emphasis is on learning to tolerate uncertainty. With the “Lloyd Christmas” technique, the person with HOCD strives to manufacture uncertainty. (Lloyd Christmas was the name of the character played by Jim Carrey in the film “Dumb and Dumber” who succeeded in creating doubt where there had been none — see video below.) This technique is appropriate for when you’re feeling completely convinced that you’re gay (or straight!). A therapist using the Lloyd Christmas technique helps an HOCD patient who is quite convinced that he or she is gay to create some doubt about their sexual orientation. You can try this on your own by briefly contemplating any of the following:
- past sexual relationships as possible evidence you might be straight
- hobbies or interests you have that are stereotypically heterosexual
- perhaps your friends think you’re straight
- past aversive reactions to same-sex flirting, touching, or erotic material
- past serious and long-lasting romantic relationships with someone of the opposite sex
Granted, none of the above factors prove that someone is straight or gay. However, they are not intended to convince you that you’re straight. Their job is to create some doubt! If you can see how one of the above factors might reduce the “odds” of your being gay from 100% to 80%, then this technique has been a success.
It’s important not to use this technique for too long. If one overindulges in it, it becomes simply a form of reassurance and can become compulsive. The key with the Lloyd Christmas technique is to only use it as long as needed to create some doubt, and then to stop.
How Can I Get Rid of HOCD Thoughts?
Understandably, the most common impulse of someone with HOCD is to try to get rid of the obsessive thoughts. In many ways, this impulse is the root of the problem.
The more we try not to think about something specific, the more it tends to crop up in our minds. The effect of the phenomenon is clear for those suffering from intrusive thoughts about sexual orientation or any other common obsessive topic. The more we try to get rid of an undesirable thought, the more it will come up! The lesson is clear: abandon efforts to get rid of the thoughts.
The 4-Step ERP Technique for HOCD Obsessions
When an intrusive thought strikes, be ready. The following four-step technique will help you practice precisely the skills necessary to reduce your HOCD symptoms. It’s based on the components of exposure and response prevention therapy, which is described below.
How to cope with HOCD thoughts when they arise:
- “Maybe I’m gay.”
Acknowledge to yourself the possibility that you may be gay. After all, nobody knows for 100% sure, and neither do you.
- “Maybe I’m not.”
Similarly, acknowledge that it’s also absolutely possible that you may be straight.
- “I don’t know.”
Admit to yourself that you just aren’t sure right now whether you’re gay or straight, and rest in that without trying to fix it.
- “I’m not going to try to figure it out right now.”
This is the “response prevention” step. Resolve to yourself that for the next few minutes, you will refrain from efforts to determine whether you’re gay or straight. Allow the question to remain unanswered.
Knowing Which Strategy to Use and When
Remember, it is possible to feel 100% certain of something and to be wrong about it. When symptoms are severe, some straight people with HOCD describe feeling 100% sure that they are gay. One helpful step in combatting HOCD anxiety is to ask yourself: how certain am I that I’m gay vs. straight?
If you’ve spent most of the past few days feeling certain that you are gay, then use the Lloyd Christmas technique described above. Then try to use the 4-step ERP technique.
If, on the other hand, HOCD symptoms have not dominated the past few days, then try the 4-step ERP technique. Go through those four steps each time an intrusive thought arises, and be prepared to do it a million times. Be relentlessly patient in your battle against OCD; be willing to use these techniques forever if necessary.
Generally speaking, it’s always helpful in battling HOCD to keep the following points in mind:
- Thoughts are just thoughts, they are not reality. The same goes for feelings. If you’re feeling completely sure at times that you’re gay, remember this quote from the movie Doubt: “Certainty is a feeling, not a fact.”
- If you’re able to confront the possibility that you may indeed be gay, but also may be straight, try to rest in that uncertainty without resolving the question. It’s not easy, but the more you can do that, the more you will weaken OCD.
HOCD Treatment With a Professional
The treatment of choice for sexual orientation obsessions is a form of cognitive-behavioral therapy called exposure and response prevention (ERP). Improving your ability to tolerate intrusive thoughts is an excellent way to reduce HOCD symptoms. Another way is to reevaluate the meaning you attribute to HOCD thoughts, images and impulses. ERP therapy helps you develop both of these skills.
What Does ERP Therapy Involve for HOCD?
The first stage of ERP is informational. You will learn about OCD and about how obsessions and compulsions work. Your therapist will teach you different ways of understanding the thoughts and feelings you’ve been having. (Check out our post with examples of how HOCD presents and how treatment can help.) This way of understanding your symptoms is a critical framework for what comes next.
Next, your therapist and you will develop a list of people, places, situations, images, etc. that trigger the anxiety that comes with HOCD thoughts. Your therapist will then teach you how to do exercises called exposures. In these exercises, you purposefully “expose” yourself to something that will evoke a little bit of HOCD anxiety. Following that, you practice responding differently than you have been; you refrain as best you can from efforts to seek reassurance about your sexual orientation. You also refrain from ruminating about the possibility that you might be gay. If you’re able to refrain from doing these things for a long enough time, you will weaken your HOCD.
Under the therapist’s guidance, the more you do the exposure exercises, the more you will improve.
Mindfulness as Part of HOCD Treatment
More and more psychotherapy (cognitive-behavioral and otherwise) in recent years has included an emphasis on mindfulness. Mindfulness derives from ancient traditions of meditation. Mindfulness is an awareness that we all have at times — an awareness that is relaxed, focused on the present, and not caught up in distracting thoughts. Some folks incorrectly think of mindfulness as a fad — in reality, mindfulness is an innate capacity of mind that we all have to one degree or another. By doing certain practices we can cultivate this awareness so that it becomes easier to access. This informs our experience of anxiety and other emotions, and in some cases, even how we live our lives.
Importantly for those with intrusive thoughts, mindfulness helps us relate to our thoughts as they actually are: insubstantial and much less important than they feel in the moment.
Does Traditional Therapy Help?
Traditional insight-oriented therapy is unlikely to help someone with HOCD. This type of therapy aims to — as the name suggests — produce insight. Typically, the desired insight is around the origin of the problem. However, for people with obsessive thoughts, the origin of the problem is 1) usually impossible to find and 2) not helpful even if you do find it. For these reasons, as well as the lack of emphasis on concrete strategies to navigate the symptoms, traditional therapy is typically unhelpful for HOCD.
This is a major problem in access to effective HOCD treatment in the United States. If you have HOCD and see a random therapist, you are not likely to find someone who recognizes and understands HOCD. Consider doing a consultation with an OCD specialist if at all possible.
Do Medications Help?
Medications can be part of the solution for someone suffering from intrusive thoughts about their sexual orientation.
Selective serotonin reuptake inhibitors (SSRIs) are often prescribed in high doses to address symptoms of OCD. Anafranil (clomipramine) is also used in some cases. These medications can help bring down the severity of the HOCD symptoms. However, in our experience, it is quite unusual for someone to make significant and lasting progress against HOCD without learning, to some extent, how to understand and cope with the intrusive thoughts.
HOCD Frequently Asked Questions
Let’s Hear From You
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