HOCD is real and can cause sexual disorientation

In my practice, I sometimes encounter men who are so obsessively worried they may be gay or bisexual that it takes up such a significant amount of their daily life and thoughts and causes them nearly crippling anxiety. Sometimes they truly are gay or bisexual, and sometimes not at all.

Such a man constantly may think about if he is walking is too “girly,” or that he may appear gay if he crosses his legs at the knee like a woman. He may even avoid being alone with other men for fear of being attracted to them. He very well could be coping with homosexual obsessive compulsive disorder (HOCD), similar to obsessive compulsive disorder (OCD) but with the added worry of sexual orientation.

HOCD, also known as sexual orientation OCD, has not yet been recognized in the Diagnostic and Statistical Manual of Mental Disorders as a disorder, however, it does exist in both men and women. In this article, I will focus more on men dealing with HOCD.

In my clinical experience working with HOCD men, they find themselves obsessively looking at porn (gay or straight) to see if it sexually excites them. They also constantly may check out others’ reactions to their gestures or conversation to see if they get strange looks or signals that could imply homophobia. Sometimes, they even may go to extreme lengths to prove they are not gay or bisexual by having sex with men.

No matter what actions they take to disprove their sexual orientation, they will continue to live with anxiety-driven OCD. Doubt is their constant companion, and they show up in my office desperate for answers. They want the suffering and confusion to end.

Here are four questions I ask my clients to help them distinguish among gay, bisexual and straight:

1. Do you recall having sexual and romantic feelings for another boy during your childhood?
   • HOCD men always say no, while straight men with OCD never say yes.
2. How do you feel about gay people?
   • Closeted gay and bisexual men often are virulently anti-gay, where HOCD men are not.
3. At the beach, whom do you look at most?
   • Gay men will say women are in their way when trying to look at men, while straight men will only look at women. Bisexual men will say one or the other or both. The HOCD man is checking himself to determine his level of arousal while looking at men and women.
4. Whom do you want to come home to?
   • I call this their “home culture.” Gay men will say a man. Bisexual man will say one or the other or both. HOCD men will say a woman.

Of course, the whole question of sexual identity is exacerbated by societal pressures. Influenced by the heated atmosphere around sexual politics, and even the amount of media coverage around LGBTQ issues, some gays argue that in the coming-out process they went through much of the same confusion, and therefore believe that the HOCD person is simply experiencing the same thing.

They are not the same thing.

With HOCD individuals, their confusion will not be resolved by “coming out of the closet” because they are not gay or bisexual.

When I’m working with men experiencing HOCD, I recommend they also see a specialist who has training in OCD interventions. There aren’t a lot of therapists dually trained, however, as the incidence of HOCD continues to increase, we will see more therapists equipped to handle these patients without referrals.

To read my entire article on HOCD, click this link to Psychology Today: www.psychologytoday.com/us/blog/understanding-the-erotic-code/201804/homosexual-obsessive-compulsive-disorder-hocd

Worried you are HOCD? Take the self-test

The OCD Center of Los Angeles provides this questionnaire to help you get a better idea if you are exhibiting signs of gay OCD or HOCD. Please note: this questionnaire is not meant to replace a thorough evaluation by a trained and licensed mental health therapist. If you find yourself relating to a majority of these statements, you may want to speak with a licensed mental health therapist.

1. I often have unwanted thoughts and/or mental images related to my sexual orientation.
2. These thoughts and/or mental images cause me great distress, and I can’t get them out of my mind no matter how much I try.
3. I worry excessively that I will act on these thoughts.
4. I sometimes experience unwanted sensations in or near my sexual organs in unexpected situations (eg after seeing an attractive person of the same gender, or while watching a movie or TV show with a gay character), and I worry this is evidence that I am sexually aroused or that I am gay.
5. I often worry about acting in a manner that could be construed as “gay.”
6. I repeatedly worry about the possibility that I suddenly and inexplicably “turn” gay.
7. I worry that some childhood same-sex experimentation is “proof” that I actually am gay or that it somehow “made” me gay.
8. I fear the possibility that I am “living a lie” in terms of my sexual orientation.
9. I worry excessively that I do not really love, or am not really sexually attracted to, my spouse or partner, and that this is evidence that I am gay.
10. I prefer to avoid being around certain people, places or situations in an effort to ensure that I will not have unwanted thoughts about my sexual orientation (or unwanted sensations in or near my sexual organs).
11. I avoid certain movies, TV shows, books, magazines, news stories, performers, music or websites to avoid having unwanted thoughts about my sexual orientation.
12.  I sometimes read certain books, newspaper articles, magazines or websites (or watch certain TV shows or movies) to “test” if I am sexually aroused by “gay” subject matter.
13. I sometimes “test” myself by looking at gay pornography to see if I become sexually aroused.
14. I sometimes look at straight pornography for the main purpose of ensuring that I become sexually aroused by it.
15. I sometimes have sex or masturbate to prove to myself that I am straight or to get some sense of certainty about my sexual orientation.
16. I sometimes check myself (either physically or mentally) to see if I am sexually aroused in situations in which I don’t want to be aroused (eg, after seeing an attractive person of the same gender).
17. I often repeat certain ritualized behaviors, phrases or prayers to rid myself of unwanted thoughts about my sexual orientation or in an effort to ensure my sexual orientation will not change.
18. I sometimes ask others for reassurance about my sexual orientation.
19. I frequently analyze my personal behaviors or characteristics that I think might indicate that I am gay (eg speech patterns, how I dress, how I cross my legs, my musical preferences).
20. I am not comfortable with the idea of finding people of the same gender attractive.
21. I sometimes wash or shower or change my clothes to get rid of gay thoughts or feelings, or after exposure to gay people, places or situations.
22. I sometimes repeat routine behaviors (eg entering a room, turning off lights, reading a book) because I feel I need to do the behavior with a “straight” thought in my mind.
23. I avoid eating certain foods (eg bananas or cucumbers) that I associate with genitalia to avoid unwanted thoughts about sexual orientation.
24. I often am worried that I will have uncomfortable thoughts about my sexual orientation forever, and that this obsession ultimately will ruin my life.
25. I worry that if I am gay, I will be subject to public ridicule or be rejected by people who are important to me.
26. . I worry that if my sexual orientation is not as I think it should be, I will lose my sense of identity and that I will have to spend the rest of my life having sex that feels alien to who I am.
27. I worry that if my sexual orientation is not as I think it should be, I never again will be able to truly connect on a romantic level to another person.
28. My obsessive thoughts about my sexual orientation are interfering with my relationships and/or my academic or professional functioning.