OCD Subtypes

HOCD: Understanding homosexual obsessive-compulsive disorder

People with HOCD, also known as homosexual obsessive-compulsive disorder, fear that they might be homosexual even though they are not attracted to their own gender.

Those with this subtype are plagued by unwanted thoughts, images, urges, feelings, and sensations that make them fearful and uncertain about their sexuality.

The common misconception about those with HOCD is that they are homophobic.

For some, this adds an extra layer of guilt or shame because on top of their fears is the feeling that they’re a bad person.

But this couldn’t be further from the truth.

Having HOCD does not mean that you are homophobic. As with all OCD, the individual finds themselves trapped in an uncertainty spiral. The sufferer feels unable to cope with the anxiety of not knowing whether their intrusive thoughts mean something about their sexuality.

For many, it isn’t about ‘making sure that I’m not gay’ but about knowing either way.

Likewise, for those who do not find themselves attracted to the same sex, these unwanted thoughts are confusing and make them doubt who they believe themselves to be. The thoughts appear jarring and unaligned with who they are and this is what disturbs them.

This article will explore the ins and outs of HOCD and guide you toward treatment options that can help you break the OCD cycle and no longer live in fear of homosexual intrusive thoughts.

OCD: The Basics

Obsessive-compulsive disorder is a common mental health condition that ranks in the Top 10 of the world’s most debilitating health conditions, according to the WHO (World Health Organization).

OCD has two core characteristics, obsessions and compulsions.

Let’s take a look at both of them individually… 

Obsessions

Obsessions are unwanted and intrusive thoughts, images, urges, feelings, or sensations that cause torturous degrees of uncertainty and anxiety.

This is why OCD is also known as the ‘doubting disease’. 

Because it is the uncertainty that causes the sufferer such distress. Our brains naturally seek certainty because we believe certainty equates to safety. And so we like to know, for sure, that what we know and believe is correct.

When an individual with OCD experiences these obsessions, the brain goes into fight, flight, or freeze response. The obsessions in this case are believed to be a source of danger.

We experience a hefty dose of adrenaline and cortisol that gets our heart pumping, palms sweating, muscles aching, and minds racing. This is called the anxious response.

When we feel this anxiety, we instinctively feel like we must respond to this immediate threat urgently. 

The OCD cycle has been set in motion…

Compulsions

Those with OCD have one goal, to get rid of those anxious feelings as soon as possible.

The fear that accompanies those obsessions can be so severe and uncomfortable, that we engage in ritualistic safety behaviors  – known as compulsions – to find quick relief.

Physical and mental compulsions can appear in the form of checking, reassurance-seeking, avoiding, counting, praying, ruminating, and much more.

What is important to understand is this…

Someone with OCD performs compulsions to alleviate the uncertainty and anxiety brought on by their obsessions.  Sometimes these compulsions seem logical, for example, “If I avoid being near my child then I can’t harm her”. Sometimes they appear illogical, for example, “If I put the TV on volume 9 today we won’t get robbed in our sleep”.

Regardless, the aim is to ‘get rid’ of those uncomfortable feelings.

But in doing so, the sufferer inadvertently keeps the OCD cycle in motion. By engaging in these compulsions we teach the brain that we need them in order to tolerate anxiety and uncertainty.

Instead, we want to teach our brains that we are capable of managing the discomfort without those safety behaviors. Then we can begin to break the cycle.

What is HOCD?

Homosexual obsessive-compulsive disorder at a basic level is when a person agonizes over whether or not they are attracted to the same sex.

As with all OCD subtypes, the sufferer feels tortured by unrelenting and severe doubt. In the case of those with HOCD, this doubt focuses on their sexuality.

Interestingly, a person does not need to have experienced any heterosexual or homosexual encounters to have HOCD. In fact, they do not need to have had any sexual encounters at all.

A study of 171 students found that 84% of them experienced sexual intrusive thoughts that caused high degrees of distress. Children, adolescents, and adults alike can suffer from this subtype. One report from the National Institute of Mental Health showed that approximately 4% of the children had concerning sexual thoughts.

Type of SO-OCD

HOCD is now commonly referred to as SO-OCD (sexual orientation OCD). HOCD is specific to an individual who is heterosexual in nature and has fears and doubts about being homosexual.

The truth is, this doesn’t quite encapsulate the array of fears an individual can experience about their sexuality.

A person may just as equally fear being straight. They may fear not knowing what sexual orientation they are. They may have fears that they are attracted to anyone of any gender or sexual persuasion. 

In recent years, it has become more politically correct to incorporate this into SO-OCD.

The reason is that people of all sexual orientations can experience unwanted intrusive thoughts that make them doubt their sexuality.

SO-OCD is therefore more inclusive of the vast variety of ways in which these painful obsessions can arise. For the sake of simplicity, this article focuses solely on homosexual OCD. But you can read more about SO-OCD here if you wish to have a wider view.

The need for certainty in HOCD

It’s important to understand that someone with HOCD views their thoughts as intrusive and anxiety-inducing and does not wish to act on them.

This is why their thoughts and obsessions are so disturbing to them. They are quite different to fantasies where a person gains a sense of pleasure. Instead, they can be left with feelings of confusion and uncertainty. 

In classic OCD fashion, what if intrusive thoughts or vivid sexual images may flash across their mind and cause a desperate plea to know for certain…

WHY AM I HAVING THESE THOUGHTS?

WHAT DO THEY MEAN?

The torture lies within the uncertainty of not knowing the answers to those questions.

Signs and Symptoms of HOCD

The symptoms of HOCD appear in the form of obsessions and compulsions. The following are examples of how HOCD symptoms may present themselves…

Obsession examples

  • Relentless intrusive thoughts that sound like:
    • What if I’m gay?
    • What if other people think I’m gay?
    • Did I just check out that man/woman? Does that mean I’m attracted to them?
    • How can I love my partner and have these thoughts about the same sex?
    • What if my partner finds out that I’m having these homosexual thoughts?
  • Unwanted images of sexual encounters with someone of the opposite sex.
  • Experiencing a groinal response in certain scenarios might signpost that you might be gay. For example, watching a homosexual love scene in a television program.
  • Having unwanted urges to kiss or touch someone of the same sex.

Compulsion examples

  • Constantly reassuring yourself that you are straight.
  • Seeking reassurance from others that they believe you’re straight.
  • Avoiding being around people of the same gender so you don’t trigger those unwanted obsessions about being gay.
  • Avoiding contact with people who identify as being gay.
  • Checking to see if you feel aroused when you are near or thinking about someone of the same sex.

HOCD and Arousal: Why does it feel like I want it?

The groinal response within the context of OCD is a type of obsession. A ‘sensation’ experienced in the groinal region at what may be considered an ‘inappropriate’ time triggers those feelings of anxiety and uncertainty.

For example, if someone with HOCD is a straight man and they experience a groinal response after grazing the hand of a man he just passed on the street, this can be taken as a sign.

“Why would I have this feeling of arousal if I’m not attracted to him?”

The paradigm here is as follows…

We believe that sexual arousal or groinal sensations must only be experienced in very specific pre-approved circumstances. A.K.A – they must only appear when I’m in the presence of someone I consider age-appropriate, of the ‘correct’ sex, and who I know that I consider to be attractive.

The reality is quite different as mentioned in OCDLA:

  • Sexual thoughts of any nature can cause sexual arousal.
  • Fixating on one’s groin increases the sensitivity and likelihood of experiencing a groinal response.
  • There are feelings and sensations going on in your groin all the time. Twitches, pulses, vibrations, etc. You only notice them when you pay attention.
  • Groinal responses can occur for no apparent reason and this is normal.

The reason you may have an obsession and feel like you want it, is because you may mistakenly take the groinal response as a sign that there must be attraction there.

But just as intrusive thoughts are not fact, neither is the groinal response.

How does it feel to live with HOCD?

As with all OCD subtypes, living with HOCD can negatively impact quality of life. From distressing obsessions interrupting your ability to focus and function, to bulldozing relationships, to utter exhaustion in all meanings of the word… living with HOCD can limit our experiences of life.

  1. Damaged relationships

It isn’t uncommon for HOCD to put immense strain on otherwise healthy relationships.

A great deal of sadness is experienced by those with HOCD who wish to develop and nurture a strong and loving bond with their partner, whom they love. 

But those relentless obsessions and fears conjure such doubt that they can find themselves retreating from the relationship. Sometimes a person may feel guilt or shame, as though they are misleading their partner because they don’t believe they could possibly love them the way they should if they have these thoughts.

In other situations, the sufferer may lose their sexual drive. When they feel so wrapped up trying to ‘figure out’ who they are and what they want (thanks to those intrusive thoughts), it feels almost impossible to be sexually intimate (or achieve orgasm or sexual arousal) when faced with such anxieties and doubts.

  1. Inability to concentrate

Many who experience OCD struggle with concentration and focus. Those obsessions can feel so intense and frequent that it disrupts our ability to pay attention to the task at hand.

This can negatively impact our work, studies, or relationships.

Please do not punish yourself if this is your experience. With effective OCD support you will find a vast improvement in your concentration and focus.

For those who have not experienced OCD, it can be difficult to comprehend how much time and energy is spent on those obsessions. They can steal our attention and stop us from being present and engaged with our current reality.

  1. Increased isolation

For those with HOCD, it isn’t just their own fear of homosexual thoughts that worries them, it’s fear about the judgment they might receive from others.

For some, they may retreat from social engagements for fear of being ‘found out’. Alternatively, they may feel unable to talk openly with friends or family, in case it leads to rejection or judgment.

This is why OCD as a whole can be an incredibly lonely disorder. There is so much fear and worry about what others might think if they find out what goes on inside our minds, that we believe the solution is to avoid others at all costs.

  1. Hours lost to compulsive behaviors

Those with severe OCD can lose endless hours to compulsive behaviors done in a bid to find some form of relief.

Whether this presents itself in the form of relentless rumination and mental review of one’s actions, or the physical acts of checking and testing themselves to ‘make sure’ they are not homosexual… those with OCD lose precious moments of joy and normality to this disorder.

It is truly exhausting. 

OCD can affect your sleep as those obsessions may feel louder and those urges may feel stronger at nighttime when the world is silent. Ultimately, you can be left both mentally and physically exhausted.

Many feel that there is no way to escape this cycle but there absolutely is!

Highly effective OCD treatment is available and can help you manage your HOCD symptoms. Recovery is possible for you with the right support from a highly qualified professional.

Please do not hesitate to reach out to your local OCD specialist as you could see a drastic increase in quality of life much quicker than you might think!

What do HOCD thoughts mean about you?

In short, absolutely nothing!

We all experience intrusive thoughts. The difference is that those with OCD apply greater meaning to these thoughts.

They take them to mean something about them.

Coupled with the physiological response of anxiety surging through our bodies, OCD becomes incredibly convincing. Everything in your mind and body suggests that these thoughts must be true and they must be ‘questioned’.

The honest truth is, these thoughts don’t mean anything about you.

You fear these thoughts because they go against your values, challenging your identity. This is why OCD is known as egodystonic in nature… it goes against who you are and thrives off your fears.

It is when you can diffuse yourself from these thoughts and give them less weight and validity that you can allow them to pop up without needing to address them, fight them, or wrestle with them.

You can accept them because you know that you are not your thoughts.

How can you get rid of HOCD thoughts?

We do not get rid of HOCD thoughts. The irony here is that every time you attempt to suppress, fix, or fight these thoughts, they become more sticky.

By giving them this attention, you signify to your brain ‘These thoughts are important and must be monitored!’. In doing so, your brain is now on the ‘lookout’ for these thoughts and sounds the metaphoric alarm each time they arise.

This is the opposite of what we want to do.

We want to be able to have those thoughts and not feel compelled to respond. To allow them without feeling the need to react to them.

Why?

Because you cannot get rid of HOCD thoughts. We cannot stop any thoughts, for that matter. 

But over time, with effective tools and practices, your tolerance of them will naturally decrease your anxiety levels and they will feel less frequent and less intense.

Best HOCD Treatment

The best treatment for HOCD is Cognitive Behavioral Therapy (CBT) and Exposure and response prevention (ERP). In many cases, utilizing these modalities alongside medication (although medication is not always needed for a successful recovery) is the way to go.

These are science-backed methodologies that have proven to yield incredible results in OCD recovery.

Within CBT, patients are encouraged to establish a new relationship with their thoughts. Psychoeducation is the first step in effective treatment and during this time, the sufferer learns how OCD functions and why these thoughts cause them such distress.

Once they have this knowledge they can begin to accept and allow those thoughts and practice giving them less meaning and validity.

In tandem with this, ERP then encourages participants to practice resisting the urge to engage in compulsive behaviors and return back to a value-based life.

This often results in what is known as habituation.

What this means is that when you appear in the presence of something you fear over prolonged periods of time, you will learn that you can tolerate the thoughts and not get overwhelmed with needing to solve the uncertainty of your sexuality.

For example, someone with HOCD may be asked to engage in certain activities such as:

  • Watching a TV show that involves a relationship between to people of the same sex.
  • Visiting friends of the same sex of whom they have been avoiding.
  • Maintaining longer eye contact with people of the same sex.
  • Writing a story about your obsession.
  • Visiting certain locations that stimulate obsessive thoughts.

The idea here is to work alongside your therapist who will support you as you willingly place yourself in positions that intentionally evoke anxiety so that you can resist the urge to engage in compulsive behaviors.

Over time, you will learn that you do not need those safety behaviors in able to tolerate the anxiety.

1:1 Private Therapy for HOCD

If you are based in the state of Caifornia, our compassionate team of highly qualified mental health professionals can support you in a private setting.

Our team are trained to the highest level and practice under the supervision of top OCD specialist, Kimberley Quinlan.

You will work together to define a treatment plan that best supports your needs and outcomes and at every stage you will feel supported by one of our elite clinicians.

If you resonate with the content in this article and would like to see if we could be a good fit for one another, please submit an initial intake form here.

We welcome you without judgement and are committed to your HOCD recovery so you can feel comfortable in your own skin and experience joy and happiness in your relationships again.

ERP SCHOOL: Online program to help you overcome your OCD

If private therapy is currently unavailable to you then our online OCD course, ERP SCHOOL is an affordable and accessible alternative.

Created by Kimberley Quinlan, this self-study program will teach you the exact tools and techniques Kimberley uses to support her private clients through the recovery process.

You will learn how to apply these tools to your specific HOCD obsessions and compulsions so that you can stop letting intrusive thoughts ruin your life and relationships, and resist the urge to do compulsive behaviors that keep the OCD cycle in motion.

With the right education and treatment, you will no longer need to lose hours of quality time to fear and rumination surrounding your sexual orientation.

You can feel confident in yourself and others again, and build strong loving relationships with yourself and others.

Join ERP SCHOOL here.

FAQ’s about HOCD

When will HOCD go away?

The honest truth is that your HOCD thoughts may never go away, and that’s okay!

You can get to a point where they don’t haunt you and you can find freedom from those compulsive behaviors that keep you trapped in a cycle of despair.

Remember, fixating on ‘when it will end’ will only hinder your recovery.

Take one day at a time and celebrate with every ounce of progress you make – every victory counts, no matter how small.

Can you recover from HOCD?

Yes.

OCD is a condition you can fully recover from. When you’re in the throes of this disorder, you may feel like there is no way out and that this will be your life from now on.

But this is not true!

Many clients of ours see rapid results for themselves, reporting to feeling better within themselves within a matter of months. This does not mean that it won’t take persistence, dedication, and patience (as everyone’s timeline will be different).

And, you do not need to be subject to a lifetime of treatment.

But you can recover and we feel confident that you won’t regret starting treatment.

Is there a cure for HOCD?

ERP and CBT therapy often combined with medication remain the most medically reviewed and proven methods for effective OCD recovery.

Can HOCD change your sexuality?

HOCD cannot change your sexuality. This particular subtype makes you doubt your attraction to someone of the same sex. Within HOCD, sufferers then take that doubt to mean something about their sexual orientation.

This ‘false attraction’ does not mean that your sexuality has changed and the experience of HOCD versus actual homosexual tendencies is very different.

This comparison explains it well…

What is the difference between HOCD and denial?

Those with HOCD have a genuine fear and overwhelming uncertainty about their sexuality. They are often confused when they feel aroused or attracted by the same sex, which is why those obsessions feel so jarring and uncomfortable.

People with HOCD engage in exhausting checking compulsions, avoidance, reassurance seeking, and spend hours ruminating, trying to solve their sexual orientation. In some cases, people with HOCD say, “I don’t care what sexual orientation I am. I just want this anxiety and uncertainty to go away”.

In contrast, denial involves purposely trying to hide or suppress the truth. In regards to sexual orientation, denial involves not wanting to know and delaying trying to figure things out.

As you have already read, this is the opposite of the HOCD. OCD is a serious mental illness that has people doing anything they can to seek and gain certainty.

What is Retroactive Jealousy OCD? An In-depth Guide

Those with retroactive jealousy OCD suffer from an immense fixation on their partner’s previous relationships that cause a painful level of jealousy, anxiety, and insecurity.

Retroactive jealousy within a relationship is actually fairly common.

We have all had momentary emotional blips where we find ourselves strangely curious about our partner’s past relationship. However, it’s when this curiosity grows into a relentless sense of jealousy, anxiety, and fixation that it can become destructive and negatively impact our relationships.

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False Memory OCD: How do I know what’s real?

False Memory OCD (Obsessive-Compulsive Disorder) is a subtype of OCD that involves recurrent, persistent, and intrusive thoughts or doubts about past events or experiences. 

These thoughts or doubts are often accompanied by strong feelings of guilt, shame, and anxiety about the experience, even when the person with OCD cannot be sure that the thoughts are rational or true.

In False Memory OCD, a person may obsess over a memory or a thought that they believe is a true event from their past, but in reality, the memory is false or distorted. 

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What is Sexual Orientation OCD (SO-OCD)? Everything You Need To Know

Sexual orientation OCD (SO-OCD) is an OCD subtype that is characterized by immense fears about an individual’s sexual orientation.

This subtype was originally referred to as HOCD (homosexual OCD), but SO-OCD affects people of all sexual orientations. HOCD is now only used to describe those who very specifically struggle with homosexual obsessions.

Those with SO-OCD are plagued with highly distressing intrusive thoughts and urges that make them doubt their true sexual orientation.

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Suicidal OCD: A Complete Guide

Suicidal obsessive-compulsive disorder is categorized by the terrifying and unwanted fears about killing oneself.

Closely linked to Harm OCD, this subtype is sometimes called harm OCD with suicidal obsessions.  Although the fears of potentially harming oneself feel very real, suicidal OCD is actually driven by the desire to protect oneself from harm.

Those with this subtype are no more likely to die by suicide than any other OCD subtype.

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What is Harm OCD? A Definitive Guide 

Harm OCD is a subtype of OCD that focuses on obsessions surrounding harm to self and/or harm to others.

For people with OCD, harm thoughts evoke excessive feelings of shame due to the violent nature of the intrusive thoughts and the misunderstanding of OCD.  It is important that you understand that there is nothing to be ashamed of. 

Harm obsessions can be all-consuming fears about our own safety or the safety of the people that the sufferer loves most.

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Fear of Choking: Pseudodysphagia, Explained

Fear of choking is known as pseudodysphagia, often confused with phagophobia which is the intense fear of swallowing.

The two commonly overlap but you can experience one without the other.

The difference is small but distinct. Those with phagophobia fear the process of swallowing, while those with pseudodysphagia are afraid of choking after swallowing.

Choking phobia is a rare condition where sufferers hyperfocus on the sensations they experience when eating and swallowing food in a desperate bid to avoid choking at all costs.

Avoidance becomes a dominant behavior in this cycle. People with choking disorder may restrict their diet and avoid certain food types, blend their food to reduce the risk of choking, and may also avoid taking tablets.

Fear of choking within OCD involves the intense fixation on the bodily sensations when swallowing, with a particular focus on the back of the throat. The vicious cycle sufferers find themselves trapped in remains the same; caught in a loop of obsessions, uncertainty, and compulsions.

Fear of choking within OCD

Diagnostically, the fear of choking (pseudodysphoria) is categorized as a Specific Phobia and lands in the category of specific phobia disorder of anxiety disorders in DSM IV, and has been retained in DSM 5 (The Diagnostic and Statistical Manual of Mental Illnesses).

Phobias often fall under a category called OCD spectrum disorders along with other conditions such as panic disorders and health anxiety, for example. All OCD spectrum disorders feature obsessions and compulsions.

Using the conceptualization of OCD, the fear of choking is the core obsession for someone with pseudodysphoria.

Those intrusive thoughts do not pass quickly, they are relentless and demand time and energy. Mentally, it’s exhausting. You can be left feeling trapped in loop of rumination about what might happen at the next mealtime, or how you’re going to manage at the next family birthday dinner.

The most common compulsion is avoidance behaviors and mental rumination. Most often, this looks like avoidance of certain foods (and drinks) because ultimately, those obsessions play on a fear that goes beyond choking; a fear of dying.

Because of this, it can result in malnourishment and have a negative impact on our physical health. People who suffer from this rare condition not only have to battle with the noise inside their minds but the medical implications as well.

Fortunately, like all phobias and anxiety disorders, it can be treated and you can feel free to enjoy the foods you love again and relieve yourself from the daily terror.

How does fear of choking present itself?

Obsessions:

  • Hyperfixation on the sensory feelings in the throat
  • Excessive fear of what might happen if they eat something without chewing enough
  • Hyperfixation on the texture of foods
  • Hyperawareness of sensations in the mouth and throat
  • Excessive fears about swallowing liquids, foods, or saliva

Compulsions:

  • Avoiding certain foods that ‘might’ cause you to choke, even if you love them
  • Avoiding going to the dentist for fear of the utensils they may use in your mouth
  • Ruminating about how you felt when you ate your last meal
  • Ruminating on how you’re going to cope at the next social gathering where food is a core component of the experience
  • Avoiding eating in front of anyone for fear of choking in front of them, or fear of judgment over what they might think of your eating/drinking habits

What does it feel like to live with a fear of choking?

Living with the fear of choking feels like constantly living on the edge of ‘danger’.

Every day we need to eat. Every day we need to ingest something at some point. We need to do this to stay alive, and so it’s tremendously debilitating to fear something that we have to face every single day.

People with a fear of choking can face challenges at every mealtime.

Battling with intrusive thoughts and ruminating on potential consequences, food becomes a source of angst and pain where it was once a source of joy.

The clients who come to work with us explain how they would love to love food again, instead of it being a trigger for their fears. Their fear of choking has them fixated on those bodily sensations in the back of the throat and food/drink (or anything that could cause us to choke) becomes the source of perceived danger.

Beyond this, pseudodysphoria can be incredibly isolating.

Many avoid social occasions where they know food or drink may be involved because they don’t want to have to wrestle with those fears in front of people. 

What if they don’t understand? 

What if I’m peer pressured into eating something I don’t want to eat? 

What if they think my eating habits are strange?

It can become an incredibly lonely disorder, very quickly.

This mental health condition may be rare but it feels incredibly limiting and makes challenges out of behaviors we naturally do every single day.

If you resonate with this then the good news is that there are proven treatments that can help you get back to normality and stop this fear of choking from dictating how you choose to live your life.

Can OCD cause swallowing problems?

A common question clients have is whether or not OCD can cause swallowing problems.

OCD does not cause swallowing problems. 

However, there is a subtype of OCD called Somatic OCD (or sensorimotor OCD) where sufferers fixate on swallowing and the frequency of swallowing.

Those with somatic OCD suffer from an intense fixation with their bodily functions. They may fixate on their breathing, blinking, or swallowing. For example, someone may wonder whether or not they are breathing too loudly or blinking too quickly.

In the case of pseudodysphoria, the focus is on the feelings and sensations within the mouth and back of the throat when swallowing. 

But the fear is, ‘What if I choke on this and I can’t breathe?’

Whereas, for someone with Somatic OCD the fixation is “What if I never stop fixating on my swallowing?”

Someone who suffers with a fear of choking may find themselves caught in a catch-22…

When we are anxious about the uncertainty of whether or not we may choke on our next meal, tension arises in our throats. And because we’re hyperfocused on that area of our body – looking for any sign that something isn’t right and eating this food might be risky – we find it.

When you notice tightness in your throat, it does feel like something could get caught in there.

But because sufferers are now so aware of their bodily functions, any ‘sign’ becomes intensified.

When clients come to work with us, we work together to change the way we think and respond to those bodily functions in order to be free of this cycle and help regain a sense of control so that the client decides where they place their attention rather than the fear directing their attention.

What causes fear of choking?

It has been proposed that this mental health condition is most commonly triggered by traumatic experiences surrounding food and choking.

However, many clients come to us with a phobia of choking who have not had a traumatic experience like this.

The sufferer themselves may have choked on food at some point in their life, or may have witnessed someone else choking, or even seen it on a movie, for example.

Food (or ingestion of any kind) then becomes a trigger for anxiety.

The brain learns that anything that goes into our mouth is perceived as a potential source of danger. While our threat response is doing exactly what it should do – trying to protect us – disturbing thoughts about choking followed by paralyzing anxiety then incentivizes compulsive behaviors.

Although providing temporary relief, this then perpetuates the cycle of fear.

Treatment for Fear of Choking (Pseudodysphoria)

The leading treatment modality for fear of choking (and other somatic OCD subtypes) is exposure and response prevention.

ERP therapy

ERP therapy is a type of Cognitive Behavioral Therapy (CBT). It requires that you do these two things:

  1. Return back to eating a wide variety of foods in multiple settings.
  2. Choose a response other than avoidance or compulsive behavior.

This is an oversimplified overview of how the ERP process works, but ultimately, you will work together with your therapist to create a treatment plan involving exposures that are challenging but also achievable.

Together, you may look at the foods you avoid, for example, and begin to slowly reintroduce them into your diet.

The ERP process is gradual, so you will not be thrust into a situation that feels too big to handle. It’s not about throwing you into the deep end, it’s about taking small steps toward allowing yourself to be guided by your values rather than your fears.

We want to get you to a place where you can say, “What would I choose to do if I didn’t have this fear?” And do it!

It can feel scary to begin this process and many face resistance (which is entirely understandable – that’s fear talking!). However, when our clients begin working with us they rarely regret starting the recovery process.

There will be times of discomfort, but you face that discomfort with a cheerleader in your corner, knowing that it’s leaning into that discomfort that will allow you to live a life without limits once again.

Finding a qualified therapist

If this resonates with you, and you suspect you may be exhibiting symptoms of pseudodysphoria, then please reach out to our friendly team of highly qualified mental health professionals.

Based in the state of California, we are an elite team of trained clinicians who advocate for a compassionate and non-judgemental approach to mental illness recovery.

We’re here to meet you where you’re at, and guide you through an effective and tailored treatment plan that has incredible success rates.

If you’d like to see if we’re a good fit to support you, please submit an initial intake form here.

(ROCD) Relationship OCD: A Complete Guide

Relationship OCD (ROCD) is an OCD subtype in which the sufferer is plagued by distressing and persistent doubts about their most valued relationships. These unwanted obsessions thrive in the uncertainty surrounding the quality of the relationship and their love for their partner or child.

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Postpartum/Perinatal OCD (PPOCD): Causes, Symptoms, and Treatment

Postpartum/Perinatal OCD is the subtype used to describe those who struggle with OCD following childbirth or during their pregnancy.

The sufferer may or may not have experienced OCD prior to their pregnancy however, what characterizes postpartum and perinatal OCD is the obsessional fears surrounding their newborn child.

Those obsessions can affect anyone, regardless of gender or whether or not they actually birthed the child.

While it is predominantly mothers who experience this particular strain of OCD, it can affect fathers and cares providers in the same way.

The level of shame that accompanies this particular subtype is incredibly painful as intrusive thoughts can take the form of harmful intrusive thoughts and sexual intrusive thoughts.

Because of this, many avoid seeking help for fear of judgment and fear of being reported for their thoughts. While they know they feel disgusted and tormented by these thoughts, they worry that someone may misconstrue them for liking those obsessions.

When you work with a trained OCD specialist, you are welcomed and supported without judgment.

Our clients come to us with these same fears but we quickly show them that they are in a safe, non-judgmental space. Please get in touch with our highly trained team of mental health professionals if this resonates with you, and we will conduct a thorough diagnosis and ensure you receive the highest standard of treatment.

Postpartum OCD is also now commonly referred to as Perinatal OCD, as obsessions can begin during pregnancy. For the purpose of this article, any mention of postpartum OCD also refers to perinatal OCD and may be abbreviated to PPOCD.

What is Postpartum OCD?

Postpartum OCD typically develops rapidly as the sufferer realizes they are suddenly responsible for a new life, or about to be. 

As with any OCD, sufferers are tormented by unwanted obsessions which they attempt to alleviate by engaging in compulsive behaviors.

For those with postpartum OCD, their fears are directly related to that of their newborn child. Having an immense new sense of responsibility for a person can feel like a lot of pressure.

Added to this, your newborn is a source of love and joy. The unconditional love we have for our children is unparalleled by anything else. It is because of this love that OCD can thrive in new mothers or fathers.

Being egodystonic in nature, OCD goes against the sufferer’s values which is why those intrusive thoughts feel so alarming and disturbing. Obsessions play on our fears about the thing we love most or hold in high value, in this instance, our new child.

In OCD, we are always tormented by uncertainty.

It is the uncertainty surrounding those obsessions that cause us to fixate and try to solve them, which keeps the cycle in motion.

But when you have strong urges or fears of harming your child in some way or experience a groinal response while breastfeeding or changing your child’s diaper, it’s not surprising that you would want to find some sort of definitive guarantee that you can keep your child safe.

However, those physical or mental compulsions done to gain that sense of certainty keep the OCD cycle in motion. 

It is in learning how to change your relationship to those obsessions and resisting the urge to do compulsions that you can finally find joy in raising your child.

Causes of Postpartum OCD

The causes of OCD are still unknown.

Studies have shown that biological factors (such as genetics) and environmental factors (such as upbringing and stressful life events) often combine to trigger the onset of OCD.

The important thing to understand here is that we do not need to deep dive into the reason why you have this condition. When clients come to us, our team of compassionate OCD specialists uses the top methodologies that are proven to yield incredible results in OCD recovery.

Postpartum OCD Symptoms

Postpartum Obsessions

  • Postpartum OCD thoughts involve urgent, intrusive thoughts surrounding the possibility of something bad happening to your baby, either at the hands of yourself or someone/something else. These intrusive thoughts feel devastating and take up much of your time and focus.
  • Feeling triggered by stories of mothers who have harmed their babies, wondering, “what if that’s me?”
  • Those with postpartum OCD experience Harm OCD urges, which involve sensations within the body that make you feel as if you may want to or will harm your baby.   For people with OCD, urges may convince them that they are “capable” of harming someone, despite being terrified at the idea of doing so.
  • Some mothers experience a groinal response when breastfeeding and fear that it means that they are sexually attracted to their child in some way even though they find the thought abhorrent.
  • OCD thoughts, feelings, sensations, images, and urges may also involve dissociation, derealization, or depersonalization. 
  • High levels of shame and guilt, loss of identity, and low self-esteem due to the constant questioning of your character.
  • Fears of dropping the baby, harming the baby, leaving the baby in a strange place, the baby getting sick, the baby dying in their sleep, etc.

Postpartum Compulsions

  • Seeking reassurance that you will not commit harm. Examples:
    • Googling “what if I think about harming my baby?” etc.
    • Asking your loved ones if you’re a bad mother or a violent person
    • Reassuring yourself by saying things like, “I would never harm my baby”
  • Self-punishment: Criticising yourself for your thoughts and how you feel as a new parent.
  • Excessive and repetitive reassurance-seeking from friends and family that you are not a bad parent and are doing a good job.
  • Checking on your baby constantly throughout the night to make sure they’re okay
  • Refusing to let anyone else care for the baby
  • Mentally ruminating on whether you are capable of harming your baby
  • Struggling to sleep and battling with restless nights due to relentless intrusive thoughts
  • Being hyper-aware of every move you make, and mentally checking for the intentions behind your behaviors. 
  • Avoiding objects, places, or activities that could encourage you to commit harm, such as:
    • Crowded places
    • Knives 
    • Giving your baby a bath
  • Avoiding your baby as much as possible for fear of what might happen if you lose control

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What does Postpartum OCD feel like?

Those with PPOCD commonly experience feelings of overwhelm, shame, guilt, exhaustion, and isolation.

The clients who come to us with this subtype are good mothers (and fathers). More to the point, they want to be great parents. For many, especially for their first child, it is a life milestone they’ve been craving only for it to arrive and OCD feels like it has stolen happy memories from them.

All these clients want for themselves is to be with their new child without drowning in fears. Fears that stop them from living in the present moment and creating happy memories with the one they love most, their newborn.

Many face this battle alone which feels incredibly isolating.

Especially for those with harm obsessions or sexual obsessions, the feeling of shame that arises is gut-wrenching.

As with other subtypes that experience such obsessions, like pedophilia OCD or sexual orientation OCD, the sufferer often feels scared to share their struggles for fear of being misunderstood.

It’s important to know that OCD attacks your values and goes against your nature.

This is why those intrusive postpartum obsessions are so terrifying, it’s because you don’t want them to become a reality.

Tips to remember:

You are not your thoughts

Thoughts are not facts. Just because you think them does not make them true.

Anxiety and uncertainty are not a sign that you are in danger

You are more than your obsessions and compulsions

You are stronger than your OCD

You can break the cycle of OCD by creating a clear plan of attack and standing up to OCD

What’s the difference between normal mother fear and Postpartum OCD?

Every new mother (or parent) experiences worries about the safety of their newborn, this is perfectly natural.

It’s an innate response in us as humans to want to protect those we love and when it comes to a new child, there’s no one who needs greater protection.

However, for those with postpartum OCD, the fear and uncertainty of what might happen can leave them hopeless and helpless. They do not feel confident in leaving those doubts unexplored because the fear of potential consequences if they were to become a reality, is too strong.

Postpartum OCD can haunt every moment with a newborn.

It feels relentless and overwhelming, constantly tormenting the sufferer, and this stops them from enjoying the experience of parenthood. 

What some might consider typical mother fear may come in ebbs and flows and those fears can be brushed aside as they engage in connection and bonding. Those fears can feel never-ending and all-consuming.

How is postpartum OCD diagnosed?

There is no test for postpartum OCD, but there are tests for OCD. 

This is because all OCD, PPOCD related or otherwise, are treated the same. 

No matter the content of your OCD, we’re looking to identify obsessions and compulsions as well as their severity using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). We can then identify the area in which your obsessions are focused on.

During the assessment phase, our trained clinicians (or other OCD specialists) will perform a formal assessment of OCD and other coexisting disorders and make sure you are given a correct diagnosis so that you can receive the best possible treatment. 

How is Postpartum OCD treated?

When a patient or client comes to therapy, the first question they often ask is, “Will Postpartum OCD go away?” or “Please, tell me how to stop prenatal OCD thoughts?” or “Tell me how to make these urges to go away?”  

While these requests are entirely understandable given how scary those obsessions are, our clinicians begin by providing psychoeducation and self-compassion training to our clients so they can learn that this is not the goal in OCD recovery. 

Given the high levels of guilt and shame related to PPOCD we highly emphasize the importance of self-compassion training to help manage the strong emotions our client’s experience.

Instead, using the below treatment tools, people with OCD learn how to change their relationships and response to their obsessions (which is within our control), instead of trying to stop them completely (something that is not in our control).

The ultimate goal of postpartum OCD and perinatal OCD recovery is to help you feel comfortable and confident in being with your new son or daughter so you can capture those joyous moments throughout their early years.

We place focus on building a value-based life and not living according to what our OCD fears tell us to do.

This means being able to breastfeed without fearing the groinal response.

This means meeting up with friends at a cafe and doing the things you would choose to do if OCD were not present.

This means picking them up and holding them close and creating beautiful memories.

It means enjoying the time you get to spend bonding with your child without fear and panic stealing your attention and precious moments.

Best treatment for Postpartum OCD

Overcoming OCD can feel impossible, but rest assured, it’s far from it. The gold-standard approach to OCD treatment and OCD recovery is Exposure and Response Prevention therapy (ERP) which is a type of Cognitive Behavioral Therapy (CBT). 

The cognitive portion of CBT refers to the identification of distorted thoughts and learning to restructure them into more reasonable, rational thoughts.  The behavioral portion is where ERP comes in. OCD treatment requires that we focus mostly on the behavioral component, as this has the best clinical outcomes. 

The practice of ERP involves the creation of a hierarchy. 

This hierarchy is developed together by the therapist and client.  Once the client has been educated on how to manage their thoughts, feelings, sensations, and urges, they will then begin re-engaging with a daily routine that aligns with how they wish to spend time with their child. 

The purpose is to practice tolerating thoughts and resisting the urge to engage in compulsions. 

Common examples of ERP for postpartum OCD might look like:

  • Talking and singing to your child while changing their diaper without ruminating on whether you will cause your baby harm
  • Going to the park and resisting the urge to ruminate on thoughts like ‘what if I accidentally leave them here’ or ‘what if they get sick from germs in the sand pit’
  • Focusing on getting better sleep and decreasing the number of times you check on your baby throughout the night

During treatment, our clinicians will teach you to use skills such as mindfulness, Acceptance and Commitment Therapy (ACT), and Self-Compassion.  

Recent studies have shown that incorporating mindfulness into CBT and ERP improves recovery outcomes. 

Mindfulness involves experiencing your thoughts, emotions, and physical sensations, from a non-judgmental, “right now” perspective. Mindfulness is a tool that can be used anywhere, in any situation. 

It might feel scary to begin this treatment however, it only takes a moment of courage to get the ball rolling.

With every compulsion you engage it, you strengthen OCD’s hold. For Postpartum OCD, time can be against you. You want to enjoy being with your new child and you want to crystallize beautiful memories that you can look back on in fondness.

So while you may not feel ready, the time to take action is now.

You can see incredibly fast results with the correct treatment, which means you can alleviate those feelings of shame, feel like the good parent we know you are, and experience parenthood the way you want to sooner than you think.

If you want support with this, here is how we can help you…

1:1 Therapy for Postpartum OCD

Our team of highly skilled OCD clinicians are here to support you in your postpartum OCD recovery, without judgment.

We can work with any sufferers in the areas of California to create a specialized treatment plan that utilizes the best methodologies for proven results.

Please reach out to our team by submitting an initial intake form here.

Under the supervision of top OCD specialist Kimberley Quinlan, we can help you feel confident and comfortable to experience those precious moments with your newborn without fear.

Online self-study course for OCD recovery

If private therapy is currently unavailable to you, Kimberley Quinlan has created ERP SCHOOL.

An affordable and accessible self-study program that will give you the exact tools Kimberley uses with her private clients to help them overcome OCD.

It combines the best methodologies that are proven to yield incredible results in OCD recovery. You will understand how to apply these tools and techniques to your postpartum OCD and begin to resist the urge to do compulsions.

We do not want you to feel like you need to avoid your child, feel immense shame around your intrusive thoughts, or limit your experiences with your newborn…

You can stop letting intrusive thoughts ruin your experiences of parenthood and resist the urge to do compulsions so you can have a happy life with the ones you love most.

Join ERP SCHOOL here.

Existential OCD: A Complete Guide to the Fixation with ‘WHY’

Existential OCD is characterized by excessive fear, worry, and uncertainty surrounding life and death. People with this OCD subtype find themselves trapped in thoughts about the meaning of life, the purpose of one’s existence, what’s real and what isn’t, and what happens when they die.

Philosophy, as a study, intentionally poses and ponders these questions. This is why existential OCD is sometimes known as philosophical OCD.

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