HOCD: Symptoms & Treatments Options

What Is Homosexual OCD (HOCD)?

Homosexual OCD (HOCD) is a subtype of sexual orientation OCD (SO-OCD) where a person has sexually intrusive thoughts that cause them to doubt whether they are or are not attracted to the same sex. In order to alleviate the intrusive thoughts, someone with HOCD may struggle with compulsive behaviors such as spending a lot of time monitoring their thoughts, checking for arousal or groinal responses, and doing tests and research on sexual identity.^{3, 4, 5, 6}

It is important to note that anyone with any sexual orientation can experience HOCD and SO-OCD. It’s estimated that 11.9% of people with OCD struggle with HOCD. Most people with HOCD are males, accounting for 65% of all cases of HOCD.

HOCD Symptoms

People with HOCD experience obsessions and compulsions that center around their sexuality. Typical HOCD obsession involves endlessly questioning whether one is gay despite having no previous homosexual tendencies. These obsessive thoughts lead to intense anxiety and distress. Typical HOCD compulsions include checking for arousal when around people of the same gender or avoiding being alone with someone of the same sex.

HOCD Obsessions

Commonly reported obsessions of HOCD include:^{1, 4, 6}

• Spending a lot of time researching sexuality and sexual identity
• Checking for signs of arousal or attraction when exposed to people of the same sex
• Watching both gay and straight porn to assess arousal and attraction
• Unwanted sexual thoughts, images, and fantasies about people of the same sex
• Excessive fears or doubts about being or becoming gay

HOCD Compulsions

Commonly reported compulsions of HOCD include:^{1, 4, 6}

• Self-doubt and constant questioning and research about their sexuality, attraction, and sexual preference
• Feeling morally conflicted, guilty, or bad about homosexual thoughts and seeking reassurance about not being a bad person
• Avoiding encounters with people of the same sex because of fear of attraction
• Avoiding contact with people who identify as gay or bisexual
• Obsessively seeking reassurance from romantic partners, friends, and family about sexuality.

Is It HOCD or Denial?

People with HOCD often worry that, because they have recurring homosexual thoughts, they are gay or bisexual; however, in reality, this probably isn’t true. Most people with HOCD do not feel aroused or attracted to people of the same sex but instead feel disgusted, guilty, or bad about these thoughts.^{1, 4} Their thoughts are usually explained by anxiety and self-doubt rather than by their actual sexuality or sexual preference.³

Unlike individuals with HOCD, queer folk report that:

• Homosexual thoughts are enjoyable, even for someone hiding their sexual identity
• They have past sexual experiences with people of the same gender
• They often report having these feelings or feeling “different” from an early age

What Causes HOCD?

In some cases, HOCD may begin in response to specific experiences a person has had, which cause them to doubt or question their sexuality. In many instances, these are negative or upsetting experiences that have had a lasting impact on them. For teens with OCD, many have uncertainty around sexuality, which may also give way to an additional fixation on their sexuality.

Examples of experiences that may lead a person to become overly fixated on their sexuality include:¹

• Learning that someone close to them is gay and this news is shocking, upsetting, or unexpected causes them to question their own sexual identity
• Being bullied, teased, or accused of being gay or not fitting into prescribed gender roles or gender expression
• Sexual experimentation with people of the same sex and, in some cases, sexual assault or trauma caused them to question their sexuality
• Having a fleeting sexual thought about someone of the same sex, which snowballed into a deep-seated fear and doubt about their sexuality
• Having negative or failed relationships with people of the opposite sex or experiencing problems with intimacy, arousal non-concordance, or sexual performance anxiety
• Not having a lot of sexual experience or being overly anxious about dating, romantic relationships, or sexual intimacy
• Being around people or institutions that teach that homosexuality is wrong, bad, or immoral (i.e., certain religious teachings like those in purity culture, potentially leading to religious trauma

How Does HOCD Affect Someone’s Life?

People with OCD often experience a lot of distress related to their condition, and this includes people who have HOCD. Many find it difficult to function and interact normally with other people and report obsessively ruminating, worrying, and fixating on their sexual thoughts for an excessive amount of time.

People with HOCD often describe experiencing:^{1, 4, 5}

• Having trouble interacting with platonic friends of the same sex
• Avoiding social interactions with people of the same sex
• Being unable to focus and concentrate because of HOCD thoughts
• Questioning whether they are in the right relationship because of their sexuality
• Feeling a lot of shame and guilt about their OCD thoughts
• Excessive self-doubt and anxiety about their sexuality
• Having trouble being intimate or sexual with their partner
• Avoiding dating individuals of the opposite sex because they fear they are gay
• Changes in routine to avoid encountering HOCD triggers
• Not being able to enjoy sex or intimacy

HOCD can cause an individual to develop other subsets of OCD. For example, if someone is in a committed heterosexual relationship and has HOCD, they may develop relationship OCD because they have excessive doubts about whether they are attracted to their partner. Alternatively, if someone with HOCD comes from a religious background, they may develop scrupulosity OCD because they obsessively worry that they are sinning by having these sexually intrusive thoughts and compulsions.

When to Seek Professional Support

If you or someone you care about is struggling with HOCD, getting professional help is the best first step to recovery. OCD is highly treatable, and with the proper professional support, breaking out of the OCD cycle is doable. There are many different online OCD resources that make finding the help you need easy.

Because OCD and HOCD are widely misunderstood, it’s important to work with a therapist who has specialized knowledge and training in OCD. This will help to ensure that a person with HOCD gets the help they need and doesn’t see someone who mistakes their symptoms as a sexual identity crisis or a sign of sexual preference. Services such as NOCD are focused on treating OCD solely and are dedicated to providing the most specialized and effective care.

Getting an HOCD Diagnosis

It is not possible to be diagnosed specifically with HOCD because it is not an official diagnosis according to the DSM-5. Rather, if an individual has HOCD, a therapist and/or psychiatrist will diagnose them with OCD. They will then be given an informal label of HOCD to describe their unique set of obsessions and compulsions revolving around questioning one’s sexuality.

HOCD Treatment

Exposure response prevention (ERP) is the gold-standard treatment for OCD and is most doctors’ first recommendation. Many individuals with HOCD condition often benefit from therapy alone, but some may need a combination of therapy and medication to manage their symptoms.^{6, 7, 8}

Effective types of therapy for HOCD include:

• Exposure and response prevention (ERP): ERP for OCD involves exposing oneself to triggering thoughts and situations while learning skills to cope with their OCD without using compulsive behaviors or mental acts. For example, a person receiving ERP for SO-OCD may be taught to sit with upsetting sexual thoughts and images without researching, checking, or coming up with past examples.
• Medication: People struggling with HOCD may benefit from taking OCD medication in addition to therapy. The most commonly used medications for OCD are SSRIs to reduce the anxiety caused by intrusive thoughts. Antipsychotic medications are sometimes specifically prescribed to individuals with HOCD because they can help reduce repetitive sexual intrusive thoughts and obsessions.
• Cognitive behavioral therapy (CBT): CBT for OCD involves learning to “reframe” or “rethink” unhelpful and upsetting thoughts and respond differently when they come up. For example, a person with HOCD may be asked to try thinking, “It’s not important that I had a random sexual thought” or, “This thought doesn’t mean anything about my sexuality.” They may also be taught other methods of coping with anxiety and difficult thoughts, like coming up with other activities they can focus on when these unwanted thoughts come up.
• Acceptance and commitment therapy (ACT): ACT for OCD has shown promising results for people struggling with OCD. This kind of therapy involves learning how to sit with difficult thoughts and feelings by using mindfulness and acceptance skills while not acting on them. People who receive ACT also learn how to use these skills to get some distance from their thoughts and feelings rather than confusing them to mean something about their identity.

Mindfulness as Part of Treating HOCD

Mindfulness can be an effective addition to any OCD treatment. With mindfulness and meditation for OCD, a person works to identify, understand, and accept their thoughts without having excessive judgment. This can help a person with HOCD to not let their obsessive thoughts turn into an existential identity crisis. Instead, they can let the thoughts come and go and separate the emotions from the thoughts.

Examples of HOCD

Many people with HOCD find comfort in hearing stories of other people who struggle with this same issue. This information can be reassuring to them because it helps them better understand where their thoughts, feelings, and doubts are coming from instead of attributing them to their sexuality.

Here are three examples of people who struggle with HOCD:

Constant Research & Checking Regarding Sexuality

Max, a 20-year-old male, takes a college course on sexuality. In the course, the instructor teaches that sexuality is a spectrum and that no one is either completely straight or completely gay. Because of this, he begins to question his sexuality, as he had always considered himself 100% straight. This causes him to obsess over past interactions, replaying times when he had trouble being intimate with girls and times when he was bullied and called gay in middle school.

As a result of these doubts, he spends hours reading Reddit and doing self-assessments on homosexuality to determine whether or not he is gay. He stops hanging out with some of his male friends and drops out of sports because he feels so uncomfortable being around other men when showering and changing. When he is around men, he finds himself constantly focusing on his groin to check for any signs of arousal.

Anxiety After a Friend Came Out

As a recently married woman, Lisa begins to question her sexuality after having one of her close friends from college announce she is gay. Her friend had also recently gotten married to a man but ended up having an affair with a female coworker and leaving her husband as a result. As a result of learning the shocking news about her friend, she begins to wonder whether the same thing might happen to her. It begins as a passing thought but becomes more and more obsessive over time.

Lisa’s husband is complaining that they have not been intimate in weeks and that she seems “distant,” but she is terrified to admit to him what is going on. She worries that as soon as she states her fears out loud, they will come true. Instead, she secretly spends hours of her time writing down all of her past sexual experiences, watching both gay and straight porn to see what arouses her, and rehearsing how she would come out to her husband, friends, and family. She begins to believe that she must be gay if she is spending this much time thinking these things.

Fear of Being Gay Due to Religious Teachings

Devin is a teenage boy enrolled in a Catholic school. He begins to worry that he is gay after hearing his teachers and pastor give talks about the growing threat of homosexuality, transgender people, and the sin of same-sex intercourse. He is convinced that people who are gay go straight to hell and worries that it’s possible for him to “turn gay.”

Devin begins having sexual dreams about boys and men and believes that the devil is trying to corrupt him and turn him gay. He admitted his dreams to his pastor, who then told his parents about it and recommended that he attend a specific Christian camp that can help reform teens who believe they are gay. Now, he is humiliated and deeply ashamed because his parents and pastor believe he is gay, and he also worries about his friends finding out about it. He has become more withdrawn and depressed and has stopped seeing friends or doing the things he enjoys. Instead, he spends most of his free time reading the bible and praying to God to help him become straight again.