Expert Perspectives
Expert Perspectives

Sexual Orientation OCD - Part 1: What is HOCD?

By Jon Hershfield, MA

Many people mistakenly think of Obsessive Compulsive Disorder (OCD) solely as a condition in which people wash their hands excessively or check door locks repeatedly.  There are actually many sub-types of OCD.  In this ongoing series, Jon Hershfield of the OCD Center of Los Angeles discusses Sexual Orientation OCD, also known as HOCD or Gay OCD.

So, Am I Gay or What?

I sat down to write this blog on Sexual Orientation OCD while my wife and I had started to watch a movie (It’s been suggested I work too much).  It’s either irony or personalization, but the opening scene of the movie involves a man kissing his lover… another man.  This is the second film in two weeks that I’ve rented which involve men and their male lovers, something I was not aware of when I selected the films.

Or was I?

Sexual orientation OCD is sometimes referred to as HOCD (an abbreviation for Homosexual Obsessive Compulsive Disorder) or Gay OCD.  This is an unfortunate abbreviation because it misses the true nature of this manifestation of OCD. 

Having gay thoughts is not the same as being gay.

First, it is not exclusive to heterosexuals.  Over the years, therapists here at OCD Center of Los Angeles have treated many homosexuals (male and female) who are plagued by obsessive fears of being “straight,” and who suffer equally when OCD attacks their sexual identity.  Furthermore, the fears that clients with this condition report have little to do with actually becoming gay (or straight).  At its core, Sexual Orientation OCD is the fear of not knowing for sure, paired with the fear of never being able to have a healthy, loving relationship with a partner to whom one feels genuinely attracted.

Similarly, someone with contamination fears may on the surface appear to be overly concerned with dirt, but this fear is indicative of an overwhelming fear of never feeling clean again.  “If I don’t wash my hands, I will feel this way forever and nothing will be right in the world.” For every cry of “does this mean I’m gay?”  there appears to be a louder cry of “does this mean I can’t be heterosexual anymore?”

In my experience with these clients, it also appears to have little to do with homophobia or bigotry.  On the contrary, these clients are often quite open-minded on issues related to sexual orientation.  In fact, it is their own lack of bigotry that often ends up being a fear trigger.  One notable exception is cultural bigotry in which part of their Sexual Orientation OCD is fueled by the broader societal beliefs of the sufferer’s culture of origin.  For simplicity’s sake, I will refer to “gay” throughout the rest of this article to describe any sexual orientation that is not one’s own.  For those who are homosexual but have obsessive fears of “straightness” please substitute the appropriate word.

One thing that has struck me as bizarrely consistent is that OCD sufferers who obsess about their sexual identity seem notably less “gay” than me.  Allow me to illustrate:

  • Picture a man who loves the arts, has no interest in sports, admires electronic music, doesn’t “pull chicks” at the bar and feels little discomfort in the presence of naked men in the gym locker room.  Obviously gay, right?  But then, that describes me, despite the fact that I am straight.
  • So what is the opposite of me?  A man who loves watching sweaty guys fight over a ball, admires music fronted by long-haired androgynous men singing about love, and showers at home to avoid naked guys… Well, this sounds pretty gay too.

So this is what happens when your OCD locks in on sexual orientation.  Whoever you are, whatever you do, suddenly seems gay.  Just as the selective abstraction found in Contamination OCD makes it appear that dirt is everywhere, so does this same distortion make gayness appear to be hunting you down.

When this form of the OCD is in full swing, sufferers tend to over-attend to any indication that their “sexual orientation of origin” may be compromised.  Since anxiety, distraction, and a lack of being “in the moment” are likely to make sexual experiences less gratifying, this often becomes a major trigger.  “If I don’t always want to have straight sex, I must be gay!” Interestingly, the idea that they might be asexual altogether doesn’t come up.  It’s the fear of the dark side, not the neutral one.  And the idea that their libido is actually compromised as a result of the anxiety and obsessions that they experience due to their OCD just sounds like an excuse, rather than a rational argument.  You simply cannot win when you play OCD’s game – OCD cheats.

Many people who suffer from Sexual Orientation OCD get stuck on the notion that they may or may not find someone attractive and that this may or may not mean something important about them sexually.  If they see a member of the same sex, they feel it is possible that the “seeing” was really intentional “looking” and that this intentional looking indicates a secret sexual desire.  They will often then attend to and monitor their genitalia to check for arousal in an attempt to prove or disprove the theory.  This often backfires since attention causes sensation.  This, by the way, is true of other body parts as well.  When you consider picking something up with your hands, the brain actually sends a priming impulse to the hand before you’ve even made a decision to move.

It is important to recognize the fundamental error in the line of thinking that pairs acknowledgment of attractiveness with sexual desire.  Attraction is a word we use to describe the feeling of being pulled into something, like a magnet.  We generally conceptualize this feeling of being pulled-in as evidence of our desire to be near someone or something.  This idea is troubling for the OCD sufferer who feels a strong need for certainty about the meaning of attraction, particularly when the false assumption is being made that all attraction is sexual attraction.

I often hear the question, “Am I attracted to this person?” from my clients.  I’m never quite sure how to answer it because it is a loaded question.  The words themselves only ask if the identified object is one they feel compelled to be near.  Furthermore, the reason for the attraction could be any number of things, positive or negative.  But the meaning my clients are hinting at is usually more along the lines of, “Do I desire to have sexual intercourse with this person?” The idea that I personally could even know what another person truly desires indicates an error in information processing.  What is more striking is the fact that their OCD does not allow them to consider the possibility of being attracted to someone, while concurrently not wanting to engage in sexual behavior with that person.

Every person is capable of identifying others as “attractive.”  This means that a person, regardless of gender, meets some set of criteria that is personally and culturally seen as attractive.  For Westerners, this may have something to do with musculature, bone structure, and/or facial symmetry.  But according to researchers, ancient Mayans apparently had a cultural preference for those who were cross-eyed and had flat foreheads.  In other words, “attractive” is not a fixed concept, and has different meaning for different people.

When we look at an attractive landscape in nature, we desire to be near it.  When we see an attractive person, this also compels us to linger.  In some cases it may be envy that draws us in.  Saying, for example, “I wish I had a body like that.”  But in many cases, it’s just giving a thumbs-up to the universe.  “Good one, Universe, you made an attractive person.”  But for the person suffering with Gay OCD, this triggers abject horror.

I often get asked the question, “Do you think I’m gay?”  After the usual therapist-speak of “Does my opinion matter?  Why do you want to know? And what would it mean to you if I thought you were?,” I suggest that my clients study the evidence with me.  The test is not very thorough.  It has one, simple question, with a few optional follow-ups:

“Do you like to have gay sex?”

That’s pretty much all we need to know in order to determine whether or not we should get busy with the work of treating their OCD.

I have seen clients with OCD who also happen to be gay.  They obsess about the same things that other OCD sufferers struggle with, except quite notably that they don’t obsess about their sexual orientation.  The only exceptions to this are gay clients who obsess about the possibility that they might actually be straight.  And I have never had a homosexual client tell me they weren’t sure if they liked homosexual sex.

On the other hand, for straight individuals with Gay OCD, their biggest fear is often that they will seek therapy for unwanted thoughts about their sexual orientation, and that the therapist will tell them that these thoughts indicate that they must actually be gay.  Unfortunately, this often happens when clients end up with ill-informed treatment providers who don’t understand what constitutes Obsessive Compulsive Disorder, and illuminates the importance of finding a therapist who thoroughly understands OCD and its appropriate treatment with Cognitive Behavioral Therapy (CBT).

To put it as simply as possible, gay thoughts are not unwanted by homosexuals.  For homosexuals, gay thoughts are what psychologists call ego-syntonic thoughts.  That’s just a fancy way of saying that their gay thoughts are in keeping with their true values and desires.  Conversely, for heterosexuals, gay thoughts are ego-dystonic, which simply means that the thoughts are in opposition to their true values and beliefs.  Furthermore, gay people like to have gay sex, while straight people with Sexual Orientation OCD are terrified of having gay sex.