Homosexual obsessive compulsive disorder (HOCD) is a subtype of sexual orientation obsessive compulsive disorder (SO-OCD). Neither HOCD or SO-OCD are DSM-5 diagnoses, instead they’re terms used to describe subtypes of OCD that center around intrusive and recurring thoughts and ideas about sexual orientation and corresponding compulsions that often result in significant feelings of anxiety, shame, and confusion.
Anyone, with any sexual orientation, can experience HOCD and SO-OCD. The intensity, persistence, and cyclical nature of intrusive thoughts experienced by someone with HOCD or SO-OCD differs significantly from the passing, pleasant thoughts and fantasies most people have as they experience attraction and explore their sexual identity.
Symptoms of OCD can be highly distressing and can disrupt your everyday life and relationships. Fortunately, OCD can be effectively managed with psychotherapy, sometimes in conjunction with certain medications.
HOCD is a subtype of SO-OCD that involves recurring, unwanted sexual thoughts, images or attractions to people of the same sex.2 Sometimes called “gay OCD,” this condition causes people to question their sexuality and become excessively concerned that they are, will become, or will be perceived as gay.
In order to alleviate these concerns and doubts, people with HOCD may spend a lot of time monitoring their thoughts, checking for arousal, and doing tests and research on sexual identity.3,4,5,6 Those who are in committed heterosexual relationships may also exhibit signs of relationship OCD, a subtype that involves excessive doubts about their relationship or partner.
Common Thoughts & Behaviors in HOCD & SO-OCD
Like other OCD subtypes, HOCD obsessions and compulsions tend to center around a common theme. People with HOCD experience obsessions and compulsions that center around their sexuality.
Nine commonly reported symptoms of HOCD and SO-OCD include:1,4,6
- Unwanted sexual thoughts, images, and fantasies about people of the same sex
- Excessive fears or doubts about being or becoming gay
- Self-doubt and questioning about their sexuality, attraction, and sexual preference
- 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
- Feeling morally conflicted, guilty, or bad about homosexual thoughts
- Avoiding encounters with people of the same sex because of fear of attraction
- Avoiding contact with people who identity as gay or bisexual
- Watching both gay and straight porn to assess arousal and attraction
HOCD vs. Sexual Fantasies
Unlike a sexual fantasy, HOCD thoughts are upsetting, unpleasant, and distressing. People with HOCD rarely feel aroused by their sexual thoughts, and instead feel deeply distressed and bothered by them, while people with sexual fantasies experience pleasure from their sexual thoughts.14
HOCD vs. Being Gay or Bisexual
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 them.1,4 Their thoughts are usually explained by anxiety and self-doubt, rather than by their actual sexuality or sexual preference.3
Causes & Triggers of Sexual Orientation OCD
In some cases, SO-OCD and 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 additional fixation on their sexuality.
Examples of experiences that may lead a person to become overly concerned or fixated on their sexuality include:1
- Learning that someone close to them is gay and this news being shocking, upsetting, or unexpected, causing them to question their own sexual identity
- Being bullied, teased, or accused of being gay or not fitting in prescribed gender roles
- Sexual experimentation with people of the same sex and in some cases, sexual assault or trauma which 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, or sexual performance
- 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)
What It’s Like to Live With HOCD & SO-OCD
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 spending an excessive amount of time ruminating, worrying, and fixating on their sexual thoughts.
People with HOCD or SO-OCD 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/SO-OCD thoughts
- Feeling a lot of shame and guilt about their HOCD/SO-OCDthoughts
- Excessive self-doubt and anxiety about their sexuality
- Having trouble being intimate or sexual with their partner
- Changes in routine to avoid encountering HOCD/SO-OCD triggers
- Not being able to enjoy sex or intimacy
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:
Max
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.
Lisa
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.
Devin
Devin is a teenage boy enrolled in 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 to reform teens who believe they are gay. Now he is humiliated and deeply ashamed because his parents and pastor believe he is gay, and also worries about his friends finding out about it. He has become more withdrawn, 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.
SO-OCD & HOCD Treatment
OCD is highly treatable, and this includes SO-OCD and HOCD. People with this condition often benefit from therapy alone, but some need a combination of therapy and medication to manage their symptoms. Below are some of the effective treatments for OCD.6,8,9,10
Therapy for OCD
Therapy has shown promising results for people struggling with OCD.
Effective types of therapy for OCD include:
- Exposure and Response Prevention (or ERP) which involves exposing oneself to triggering thoughts and situations while learning to cope with these 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.
- Cognitive Behavioral Therapy (or CBT) is another effective form of therapy for OCD, and 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 (or ACT) is another form of therapy that 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.
Medications for OCD
People struggling with OCD can benefit from receiving medication, in addition to therapy.
Some of the most commonly used medications for people struggling with OCD include:
- SSRI medications, which are most often used to treat depression, but can also help reduce symptoms of OCD
- Antipsychotic medications that can help reduce repetitive sexual intrusive thoughts and obsessions in people with OCD
- Benzodiazepines are sometimes prescribed to people with OCD, and can help to reduce symptoms of severe anxiety, but these medications can also be addictive in nature and aren’t recommended for regular or long-term use
How to Get Help for HOCD or Sexual Orientation OCD
If you or someone you care about is struggling with HOCD or SO-OCD, getting professional help is the best first step to recovery. Many people begin their search for HOCD treatment online by conducting a Google search for a therapist or by using a free online therapist directory. These directories often provide people with options to narrow their search to find someone who specializes in OCD and is in-network with their insurance.
Because OCD and HOCD are widely misunderstood, it’s important to choose a therapist carefully, and select someone who has specialized knowledge and training in OCD. This will help to ensure that a person with SO-OCD 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.
HOCD Statistics
OCD is a relatively rare condition that impacts less than 3% of the population. Still, among those who have OCD, HOCD is not that uncommon.
Here are some statistics and facts about HOCD:1,8,9
- 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
- More than 50% of adults with OCD report being severely impacted by their symptoms
- Almost 35% of adults with OCD report being moderately impacted by their symptoms
- OCD is among the top 20 causes of disability worldwide for adults
Final Thoughts
HOCD or SO-OCD can be a debilitating condition that interferes with a person’s life, relationships, and ability to function. People with this condition often experience anxiety and self-doubt about their identity and sexuality, and this can become the central focus in their lives. With the help of a professional, it is often possible for people with HOCD to move past these concerns and begin living a more normal life.
HOCD Infographics
