HOCD, or sexual-orientation OCD, is a name some clinicians use for a particular type of OCD: Obsessive and intrusive doubts about one’s sexual orientation and the checking, testing, analyzing and reassuring one’s self in a compulsive and repetitive cycle. I use the term to describe the obsessive cycle I went through. The question is usually some version of "Am I gay?". The obsessive mind scans every past detail or thought or fantasy to try to answer that question. However, the evidence is never enough. There are always new elements to analyze or consider. The thoughts morph into behavior to “check” one’s orientation. Did I find that man attractive? What would happen if I look at gay porn? What happens if I kiss a girl? Am I aroused? What happens if I don't get an erection? Is that because of my sexual orientation or was I just nervous? It quickly escalates into a never-ending anxiety driven cycle which never really settles the question.
This obsessive compulsive cycle however might be accompanied by other elements of sexual confusion or same sex attraction as was my case. This particular predicament can add fuel to the OCD. It's now not only a mental process. There is a real sexual element to contend with! This overlap in my experience is a big barrier to healing for people experiencing both HOCD and confusing sexual fantasies or attractions. This mixture of obsessive questioning of their sexual orientation accompanied by confusing or unwanted sexual fantasies, dreams or behaviors can be extremely debilitating. My goal throughout this series of articles is to show how OCD and Sexual Confusion are intertwined and ultimately propose a road to healing that integrates both concepts.
Back to OCD. Exposure and response prevention is the usual first-line behavioral treatment for OCD. When my OCD first arose I sought help and was quickly diagnosed with HOCD. I was travelling abroad and had a sexual experience with a woman in which I couldn't get an erection. That quickly led to me obsessing about why that happened and a review of all of my past sexual thoughts, fantasies and dreams. Sure enough I had had some same sex sexual dreams and I had at certain moments in my life masturbated to some same sex fantasies. My anxiety was through the roof. I could not sleep, study or think. I was depressed and somehow I still made the effort to conceal all of this from my friends whom I was traveling with. As I look back now I see how difficult that time was for me. I was alone in many ways. Full of doubts and shame. Pretending to be OK yet quietly suffering much. I was even suicidal at times.
The pain was too much and I reached out to a friend who connected me with a psychiatrist. I was 22 and it was my first encounter with a therapist. As I shared my story he quickly diagnosed me with HOCD. I felt relieved to learn about HOCD! Apparently I was not the only person in the world doubting and obsessing about my sexual orientation! It even had a specific terminology! Perhaps I wasn't “gay” as the therapist insisted but I was “only” suffering from an obsessive episode which had centered on my sexual orientation.
The plan was standard ERP therapy. That means you expose yourself to confronting thoughts or situations while avoiding responding to the associated anxiety through a compulsive act. You build your exposure list and start moving upwards. The basic idea behind ERP is to show yourself and your nervous system that you can tolerate the anxiety generated by the exposure or obsessive thoughts without going into a compulsive cycle to alleviate it. A compulsive cycle action can be anything from checking the door is locked for certain types of OCD to obsessively going over your masturbation history to make sure you are not gay. To potentially watch gay or straight porn and see how you react to “settle the question once and for all”. I also read some books the therapist suggested and which gave me a basic framework to understand OCD and HOCD. Those books and that understanding gave me hope at a time when I desperately needed it. Those resources are important and valid for anyone dealing with OCD and I have referenced them in the resources section.
The problem I had with standard OCD therapy was that it did not address the real and complex issues around my same sex sexual fantasies and sexual confusion. When I brought the subject up in therapy I was usually dismissed with some version of “Don't pay too much attention to them”. ERP is all about “accepting” uncertainty and avoiding compulsions and from that perspective any intent to dig deeper into my sexual story and arousal template was always seen suspiciously as an OCD loop to be avoided.