My Secret Self: HOCD Myth of Denial

Gay OCD, also known as HOCD (Homosexual Obsessive Compulsive Disorder), is a condition where individuals, regardless of their actual sexual orientation, obsessively doubt their sexuality. Many HOCD sufferers, regardless of subtype, become obsessed with the idea that others might perceive them as gay. Consequently, men with HOCD might overly scrutinize their clothing choices, favoring baggy, neutral outfits over fitted, stylish ones they associate with homosexuality. They might also be hyper-aware of their mannerisms, such as how they speak or hold a drink, to avoid any hint of being perceived as gay. Women with HOCD might focus excessively on their hair length or whether their clothes are sufficiently “feminine.” Both men and women may obsess over their body type, worrying if there is something inherently “gay” about it.

This distorted thinking often stems from limited or incorrect information about homosexuality, leading sufferers to compulsively avoid stereotypes that are not actually indicative of being gay. The HOCD sufferer fixates on a misguided notion of what “gay” looks like and strives to avoid that image. This fear isn’t typically about negative evaluation but rather a fear that someone identifying them as gay is seeing into their true self, confirming their worst fear of latent homosexuality.

The concept of gay denial is a fallacy. There is no latent homosexuality or hidden self awaiting discovery. The idea of denying one’s subconscious sexuality is a myth. There’s no secret version of yourself that is being hidden (yes, we anticipate lots of angry emails from psychoanalysts).

People often modify their behavior to fit societal expectations. Some may live a lifestyle different from their true sexual preference to avoid perceived negative consequences, whether professional, cultural, or religious. A small percentage might genuinely be unaware of their preferences until they meet the right person, but this isn’t “coming out” as much as it is “waking up.” True “coming out” begins with yearning, not fear.

One of the more insidious aspects of OCD is the fear that having HOCD is just a way of denying one’s true sexual orientation. Individuals with various forms of OCD often obsess over whether they truly have OCD. For example, those with Scrupulosity OCD may worry that their OCD is merely a way to deny being sinners. Similarly, someone with contamination OCD might question if they are inherently lazy about cleanliness. Likewise, those obsessing over being a pedophile or a murderer may fear that labeling their thoughts as OCD is an attempt to avoid the truth about themselves.

The crucial point is that non-OCD sufferers don’t obsess over having OCD. While nearly everyone experiences some obsessions and compulsions, only about 2-3% of the population has them to a degree that impairs functioning, qualifying as a disorder. Non-OCD individuals might be disturbed by intrusive thoughts or engage in rituals, but these do not significantly impact their quality of life, and they are unlikely to be concerned about having OCD.

HOCD sufferers often seek reassurance from therapists to confirm they have OCD. This reassurance-seeking is part of the compulsion to gain certainty about not being gay. HOCD sufferers must learn to tolerate uncertainty both about their sexual orientation and their diagnosis. If someone were in such denial that they convinced an OCD specialist of a disorder they didn’t have, their compulsive need for reassurance from a professional would still indicate OCD.

People may experience gay sexual fantasies, have OCD, or both, and these are not inherently linked to one’s sexual orientation. Sexual fantasy is generally a healthy activity, though it can become compulsive or destructive. Most sexual fantasies involve taboo elements, which can be stimulating. For example, a heterosexual man might fantasize about cheating on his wife, finding the idea exciting while being repelled by the reality due to moral and practical concerns.

For many heterosexuals, gay fantasies are not unwanted thoughts but rather intriguing because of their taboo nature. However, a gay fantasy should not be confused with an HOCD obsession, which involves intrusive, unwanted thoughts about the fear of being gay. The obsession for those with actual gay fantasies and HOCD is not the existence of these thoughts but the fear that enjoying them means they are true.

This is particularly distressing for heterosexual men who may find certain aspects of masculinity stimulating. These men are attracted to women but might find penises or masculinity conceptually arousing, potentially due to associations with beauty, power, or freedom from gender roles. It’s important to live in the present and value current relationships without overly worrying about potential future changes.

Culturally, there seems to be more acceptance of lesbian fantasies, likely due to patriarchal influences that sexualize women together. However, women with HOCD do not benefit from this cultural loophole, as their OCD turns potentially pleasurable thoughts into distressing ones. This makes HOCD both easier and harder for women, as societal acceptance of lesbian fantasies can increase the fear that being gay is a real possibility.

In summary, it is normal and healthy for straight people to occasionally have gay thoughts. Enjoying or disliking these thoughts is less important than understanding that our lives are defined by our behaviors in response to them, not the thoughts themselves.

Research consistently shows that the most effective treatment for HOCD and other forms of OCD is Cognitive Behavioral Therapy (CBT), with a specific focus on Exposure and Response Prevention (ERP).

Over the past decade, many OCD specialists have also integrated concepts from Mindfulness-Based Cognitive Behavioral Therapy (MBCBT) into their treatment plans. MBCBT aims to change one’s perspective towards their thoughts and the behaviors these thoughts trigger. Through mindfulness, patients can learn to circumvent and ultimately reverse the OCD process, leading to remission.

Mindfulness is particularly effective in treating obsessional variants of OCD, including HOCD. By combining MBCBT with traditional CBT techniques, the following strategies are used to address the intrusive thoughts and compulsive behaviors characteristic of Sexual Orientation OCD.

CBT and Mindfulness-Based CBT (MBCBT) aim to reverse the learned fear cycle inherent in HOCD. HOCD insists that one must not have gay thoughts, yet these thoughts naturally occur. Denying their existence is futile, as everyone has gay thoughts to some degree; recognizing what the term “gay” means requires experiencing such thoughts. Instead of trying to eliminate these thoughts, one should accept the reality that a variety of sexual thoughts are a normal brain function and then train oneself to assign them significance based on personal choice, not OCD.

Mindfulness involves actively observing the tendency to over-attend, over-value, and over-respond to thoughts. In Sexual Orientation OCD, sufferers over-attend to ego-dystonic thoughts about their sexual identity. For example, a fleeting thought about being gay can provoke an overwhelming need to investigate and neutralize it, leading to compulsive behaviors.

Over-attending to thoughts gives them undue importance. These thoughts, which are meaningless and fleeting for most people, become significant and anxiety-provoking for those with HOCD. Compulsive behaviors aimed at neutralizing these thoughts typically include:

Cognitive Restructuring for Gay OCD / HOCD

Cognitive restructuring involves identifying and challenging distorted thinking with rational, evidence-based thoughts. For those with HOCD, distorted thinking about their sexuality can be pervasive. Cognitive distortions in HOCD often include:

In cognitive restructuring, the goal is to identify these distortions and replace them with rational thoughts. This should not become a mental ritual but a straightforward exercise to counter OCD-driven thoughts.

The most effective treatment for all forms of OCD is a type of Cognitive Behavioral Therapy (CBT) called Exposure with Response Prevention (ERP). A common barrier to ERP for HOCD is the continued practice of compulsive behaviors during exposure. Often, this takes the form of self-reassurance. HOCD sufferers might try to overcome their fears by exposing themselves to gay pornography, gay neighborhoods, or “coming out” stories online. These attempts can backfire because trying to prove you don’t like gay porn, don’t belong in a gay neighborhood, or that a “coming out” story doesn’t apply to you, reinforces the notion that your sexuality is up for debate.

ERP works only if the individual resists these mental rituals and accepts whatever thoughts and feelings the OCD throws at them without protest. In more intensive ERP, you actively agree with the thoughts, diving headfirst into the fear rather than tiptoeing around it. Any effort to analyze the exposure for evidence of your sexual orientation tells the brain that certainty about your sexuality is crucial. However, if you stop these mental compulsions, your brain learns that such certainty is unnecessary.

Exposure and Response Prevention for HOCD

ERP involves changing behavior first and allowing thoughts and feelings to catch up. The goal is to face the fear (exposure) and prevent the compulsive response (response prevention). In HOCD, this does not mean engaging in homosexual behavior but rather exposing oneself to thoughts and fears about sexual orientation without engaging in compulsions.

Effective ERP for HOCD might include:

The aim is to raise anxiety intentionally and demonstrate to the brain that these thoughts can be tolerated. Compulsions, on the other hand, reinforce the idea that these thoughts are dangerous and intolerable.

As ERP work intensifies, OCD fights for its survival by leading sufferers to fear they are “feeling” gay. A common fear with ERP treatment is the belief that accepting gay thoughts will lead to gay behaviors. This OCD logic creates a double bind, where compulsions seem to protect against becoming gay but actually fuel the obsession about one’s sexual orientation. When someone with HOCD stops the compulsions, they fear it will open the door to unwanted gayness. This is similar to Harm OCD sufferers fearing that accepting harm thoughts will lead to violence, or contamination OCD sufferers fearing that not washing will lead to disease. ERP for OCD always feels wrong because what you thought was right (compulsive behavior) is actually the problem.

A truly gay person does not fixate on gay feelings; these are a normal part of their existence. It’s the OCD that distorts these feelings into something to obsess about. An HOCD sufferer might report feeling gay during exposure work and be terrified by this, but this indicates they don’t understand what it actually feels like to be gay.

A challenge in ERP treatment is when a person starts seeing benefits. They habituate to triggers that previously caused significant anxiety. As this habituation occurs, thoughts and feelings become more congruent with those of non-HOCD sufferers. The individual becomes less upset by unwanted thoughts and feelings related to sexual orientation. At this point, some HOCD sufferers begin to obsess that not being “bothered enough” by the trigger is evidence of their homosexuality. This is known as a “backdoor spike,” where OCD shifts from identifying fear as evidence of being gay to identifying the lack of fear as evidence.

HOCD and similar obsessions often involve compulsions like demonstrations of disgust and terror, which are behavioral strategies to avoid discomfort. Actively causing oneself to be repulsed by gay thoughts avoids the discomfort of thinking the thoughts are acceptable and inferring this makes them gay. Whether OCD uses fear or ambivalence, the treatment goal remains focused on accepting whatever is going on inside. Thoughts, feelings, and sensations happen without certainty about what they mean. Life without OCD is lived in the present, making choices based on current preferences, not predictions, and choosing labels based on patterns in those preferences.

ERP is particularly effective for treating HOCD because it addresses the root of the problem: the compulsive behaviors and mental rituals that reinforce the obsession. By gradually exposing clients to their fears and preventing their usual responses, ERP helps them learn to tolerate the uncertainty and distress associated with their obsessive thoughts. Over time, this process reduces the intensity and frequency of the obsessions and compulsions, leading to significant improvements in daily functioning and quality of life. ERP’s focus on accepting thoughts without engaging in compulsive behaviors retrains the brain to understand that certainty about sexual orientation is unnecessary, which is crucial for overcoming HOCD.

HOCD sufferers fear severe consequences from being gay, such as living a lie, rejection, ridicule, and a lifetime of unhappiness. However, these fears are often unfounded and exaggerated by OCD. CBT and MBCBT aim to reverse the learned fear cycle by exposing the sufferer to the reality that a variety of sexual thoughts occur naturally.

This subtype is common yet underreported because it can be overlooked due to its subtlety. All-Or-Nothing HOCD describes individuals who have always identified with one orientation, have never explored other orientations, and do not have gay fantasies but are suddenly alarmed by a random gay thought. This often begins with questions like, “Did I find that person attractive?” and “What does it mean if I’m not 100% sure I didn’t?”

The primary distorted belief here is that straight people never have gay thoughts, so any gay thought indicates latent homosexuality. In reality, straight people do have gay thoughts but usually don’t act on them sexually. HOCD sufferers view these thoughts as contaminating their otherwise purely straight mind, leading to compulsions aimed at eradicating gay thoughts through various rituals. This might involve compulsive masturbation to straight fantasies or avoiding anything that might trigger a gay thought, including people perceived as potentially gay.

CBT for All-Or-Nothing HOCD involves gradual exposure to triggers while practicing resistance to the urge to deny one’s orientation.

Relationships are inherently complex, and this subtype of HOCD attributes failed heterosexual relationships to latent gayness. Women may self-identify as “man-hating dykes,” while men may feel they “just don’t understand women,” interpreting these feelings as denial of their “true” sexual orientation. This often involves compulsively reviewing childhood memories or any past same-sex exploration, seeking answers about their sexuality.

During puberty, confusion about gender and orientation is common, and for teenagers with OCD, this can be particularly troubling. Those whose HOCD develops later may retrospectively analyze their developing sexuality, looking for inconsistencies with their current preferences.

CBT for this subtype includes identifying mental checking as a compulsion and resisting the urge to analyze one’s past for clues about their sexual orientation.

This form of OCD fixates on cultural expectations of masculinity and femininity. A male sufferer might notice an attractive male and criticize himself for noticing, interpreting this as a sign of femininity. Women might do the same regarding noticing other women, believing “real women” only think about men. This can lead to avoidance of behaviors or interests seen as non-masculine or non-feminine.

CBT treatment involves exposure to material considered “non-masculine” or “non-feminine” to challenge these beliefs.

Here, the concern is about experiencing sexual arousal or sensations only in specific approved contexts, usually with an opposite-sex partner. However, sexual thoughts can cause arousal regardless of the context, and focusing on one’s groin can create sensations. Groinal sensations occur regularly without specific triggers.

CBT for this type involves challenging distorted beliefs about groinal responses and exposure to arousing material outside traditional preferences.

Some people believe, like Alfred Kinsey, that sexuality exists on a spectrum. Heterosexuals may have occasional homosexual thoughts and fantasies but do not identify as bisexual. HOCD sufferers on this spectrum fear not knowing their precise sexual orientation.

Treatment focuses on Mindfulness-Based CBT and resisting the compulsion to mentally analyze one’s orientation, with exposure aimed at tolerating uncertainty rather than proving one’s sexuality.

Some HOCD sufferers progress from mental to physical checking, even to experimental checking, in their quest for certainty about their orientation. This can involve seeking treatment from LGBT specialists or engaging in sexual experimentation to determine their true orientation. This usually backfires, leading to either ambivalence or aversion and more uncertainty.

CBT here focuses on tolerating uncertainty rather than seeking proof, acknowledging that complete certainty about one’s orientation is unattainable.

These are the various subtypes and treatment approaches for HOCD. Future discussions will explore additional nuances and common treatment challenges.

Conclusion

Ultimately, the treatment goal is acceptance and mindfulness—understanding that having a thought does not equate to it being significant or true. Recognizing and challenging the OCD-driven fear cycle can help sufferers manage their symptoms and lead a more fulfilling life.

HOCD (Homosexual Obsessive Compulsive Disorder) and SO-OCD (Sexual Orientation OCD) are types of OCD that cause individuals to fixate obsessively on their sexual orientation, leading to significant distress and anxiety. These conditions can profoundly impact one’s mental health and daily functioning.

Research has consistently shown that Cognitive Behavioral Therapy (CBT), particularly when combined with Exposure and Response Prevention (ERP), is highly effective in treating these forms of OCD. Integrating Mindfulness-Based Cognitive Behavioral Therapy (MBCBT) enhances this treatment approach by promoting mindfulness and acceptance, which help individuals change their relationship with their intrusive thoughts and reduce the compulsive behaviors associated with these thoughts.

Mindfulness teaches patients to observe their thoughts without over-attending, over-valuing, or over-responding to them, which is crucial for managing HOCD and SO-OCD. This approach helps to normalize the occurrence of a variety of sexual thoughts, allowing individuals to treat these thoughts with the appropriate level of significance—defined by their own values, not by OCD-driven fears.

For anyone experiencing distress related to their sexual orientation, consulting with a doctor or a therapist in Burbank, CA is essential. There are various effective treatment options available that can help manage symptoms and improve quality of life. Through a combination of CBT, ERP, and mindfulness techniques, individuals can learn to tolerate discomfort, challenge cognitive distortions, and achieve significant relief from the symptoms of HOCD and SO-OCD.