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People with HOCD, also known as homosexual obsessive-compulsive disorder, fear that they might be homosexual even though they identify with another sexual orientation. 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 they fear they’re a bad person for not knowing what sexual orientation they are or fear they are not living authentically. But this couldn’t be further from the truth. 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 anxiety or solve their uncertainty as soon as possible. The fear that accompanies these 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 or reduce or eliminate the doubt and uncertainty. But in doing so, the sufferer inadvertently reinforces the intrusive thoughts and 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 change how we respond to these intrusive thoughts and obsessions and 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 (HOCD) 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 NOT SO FUN FACT: 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.  It has now become more politically correct to use the term SO-OCD when discussing HOCD, as it is more inclusive and helps people feel more understood. In addition, people of all sexual orientations can experience unwanted sexual 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 specificity, this article focuses solely on homosexual OCD. But you can read more about SO-OCD here if you wish to have a wider view or if your intrusive thoughts target other sexual orientations. The need for certainty in HOCD It’s important to understand that someone with HOCD views their thoughts as intrusive and anxiety-inducing. The presence of sexual intrusive thoughts does not mean you wish to act on them. Their thoughts and obsessions are incredibly disturbing to them. The obsessions are significantly 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 of people of the same sex 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 Compulsion examples 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 who identifies as a straight man experiences 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?” “Why did I feel something?” 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: 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 facts, 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. 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. 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. For those with HOCD, it isn’t just their own fear of homosexual thoughts that worries them, it’s also a 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 fear of 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. 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 intrusive 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 SO-OCD and 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 taught 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 and understanding, they can start practicing accepting and allowing those thoughts and give them less meaning and validity. In tandem with this, the introduction of ERP encourages participants to practice resisting the urge to engage in compulsive behaviors and return back to a value-based life. ERP also involves facing fears that one has been avoiding due to the distress of the sexual obsessions. For example, someone with HOCD may be asked to engage in certain activities such as: The idea here is to work alongside a 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. In many cases, you will also start to notice a rapic reduction in anxiety and uncertainty and start feeling like yourself again. 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. You will also learn how to be more mindful about your thoughts an feelings and learn important skills to manage strong emotions such as guilt, shame, and guilt. A solid ERP plan for HOCD includes the practice of mindfulness, self-compassion, and Acceptance & Commitment Therapy (ACT). 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.