OCD comes in many varieties. HOCD is one of them — and it involves obsessive thoughts about one’s sexual orientation. Read on to hear two stories of HOCD and recovery.
How to obsessive thoughts work?
Obsessive thoughts come in several varieties. Among the most popular themes for these thoughts are blasphemy, violence, and sex. All obsessions consist of a thought (e.g., “I want to pick up that knife and stab myself”) followed by intense anxiety at having had that thought. “Am I Gay?” is a thought that can create intense anxiety for some people. Another thing obsessions have in common is that it is difficult to completely disprove the fear they create.
For example, if someone has an obsessive thought about harming themselves, how can they prove that it’s not true, beyond a doubt? If someone has an obsessive thought like “I hate God,” how can they then convince themselves that they don’t? If someone has an obsessive thought about wanting to sexually molest their dog, how can they prove to themselves that they will never do it? For people with OCD, the uncertainty that accompanies these situations can be very distressing.
This is the paradox of obsessive thinking. We get anxious about the possibility of something that can’t be proven or disproven. Then the search for such proof only leads to more anxiety. Obsessive thoughts about being gay are one example of this process. This is not an uncommon type of obsessive thought. It occurs most frequently in heterosexual people suffering from OCD. (Someone who identifies as gay, on the other hand, might be vulnerable to obsessive thoughts about being straight.) For the person with this type of obsession, finding immediate proof that one is not gay can be difficult. After all, how do people “know” whether they are straight or gay?
Rob’s HOCD story
Take, for example, the case of Rob (not his real name), a straight man in his later 30s. Rob struggled with OCD since his late teens. Over the years he experienced symptoms as diverse as excessive handwashing, having to get up and sit down “just right,” and obsessions about harming others. For Rob, the obsessions about being gay started suddenly. When in an airport terminal with some time to kill, he wandered into a bookstore, and was looking at the various magazines. One of the magazines, Mens’ Vogue, featured a picture of an attractive male actor on the cover. Rob noticed that he had a hard time taking his eyes off the picture, and thought, “I like the way he looks.” This was followed by the thought, “Does this mean I’m gay?” which made Rob immediately very anxious.
He had never even wondered before whether he was gay or straight. He had been in several heterosexual relationships, and had never been involved with another man. In Rob’s very alarmed state of mind, he wracked his brain to reassure himself that he was straight. He looked at the magazines with attractive women on the cover to gauge his reaction. He looked for an attractive woman in the terminal, and finding one, looked at her to see if she “did it” for him. After a while, he was able to reassure himself that he was not, in fact, gay. However, Rob was not able to prevent this thought from coming back. The fear that he might be gay troubled him for years following the incident in the airport.
HOCD coping strategies
As previously described, obsessive thoughts about one’s sexual orientation (sometimes referred to as “gay thoughts”) are not uncommon for sufferers of OCD. How can one cope with these troubling thoughts? There are two strategies often used – one good, one bad. We’ll start our discussion with the bad. (The good one comes after Sharon’s HOCD story.)
Seeking reassurance about one’s sexuality is perhaps the most common strategy for people with OCD who have sexual obsessions. Seeking reassurance can be either mental or behavioral. For a straight male, e.g., mental efforts to reassure oneself could entail trying to remember all the women he previously dated. Similarly, the man might imagine an attractive female and mentally “check” whether the finds the girl/woman attractive.
It may be more common, however, for the OCD sufferer to engage in behavioral reassurance seeking. This is the strategy that Rob, in the companion article to this one, used in the airport. Examples of behavioral reassurance seeking can be seeking out members of the opposite sex, either to interact with or to look at, in the hopes of feeling an attraction. Some people with these types of obsessions will begin or continue romantic relationships partially for the purpose of achieving this kind of reassurance.
Sharon’s HOCD story
Sharon was a heterosexual 22-year-old woman when she began to have obsessive thoughts that she was gay. She had been in three romantic relationships, all with men. Sharon had never even entertained the idea that she might be gay.
Her best friend at the time was a gay woman. One evening, Sharon though that her friend was acting flirtatiously with her. She thought nothing of it, and was not particularly bothered by it. However, days later, the thought occurred to her:if she didn’t mind her friend’s flirting, she must actually be gay too. Why else would she have reacted the way she did? The thought sent Sharon into a panic. She felt that a rug had been pulled out from under her, as she had never questioned her sexuality before.
Sharon thought back to her experience in high school and college. She wondered whether she had missed any hints of attraction to gay women she had known in the past. She mentally reviewed some romantic and sexual experiences she’d had with men to “decide” whether she had really enjoyed them, or whether she just suffered through them. The more she tried to reassure herself that she was straight, the more unsettled and panicky she became. Eventually, she decided that she needed to become involved with a new boyfriend to feel sure about her sexual identity. However, Sharon was unable to free herself of these troubling “gay thoughts” despite her new relationship and all her best efforts.
What can help?
This brings us to a more helpful strategy. Anxiety tolerance can lead to long term reductions in anxiety and obsessive thoughts. When Sharon first came in for treatment, she couldn’t fully grasp the notion that it might help to go through the intense anxiety HOCD thoughts bring up. She had become so accustomed to seeking reassurance about her sexual orientation that it was difficult to imagine doing anything else.
Sharon began Exposure and Ritual Prevention (ERP) therapy. She tried hard to learn to bear the anxiety that came with thoughts about being gay. With the help of her therapist, she trained herself to respond to that anxiety by talking back to it. She would say, “maybe enjoying flirty interactions with my friend means I am gay, or maybe not. It’s hard to tell,” and would then try her best to resist the temptation to “figure out” whether she was gay or not. This was difficult for her. But after working hard at her exposure exercises, she was able to gradually change her response to these thoughts. Sharon noticed a decrease in the anxiety that such thoughts caused her. Eventually, the thoughts became less frequent, as well as less distressing.
Her therapist explained that through her hard work, she had taught herself to tolerate the anxiety associated with her obsessions instead of giving into her compulsive urge to reassure herself. Sharon left cognitive-behavioral therapy feeling much better prepared to deal with obsessive thoughts about her sexual identity. Her symptoms had all but disappeared.
The poorly understood phenomenon of obsessive “gay thoughts”
Sharon was lucky to have found a therapist that correctly understood her symptoms as a type of obsessive-compulsive pattern. Many people who have come to the Manhattan Center for CBT describe talking to many friends, therapists, and other well-meaning people who have told them that “it’s okay to be gay,” “we still accept you for who you are, gay or not,” or even, “I went through a similar tough time when I realized that I was gay.” As well-intentioned as these sentiments may be, they are unhelpful to the person with sexual obsessions. The sufferer often comes away from these conversations feeling more misunderstood than before.
Therapy in particular can be dangerous for people with sexual obsessions if the therapist does not have expertise with OCD and sexual obsessions. Unfortunately, these patients are sometimes told that their confusion is due to denial or to repression of their true identity, and that the sooner they face up to that, the better.
Mike’s HOCD story
Mike (not his real name), a heterosexual man, was 21 when he came to see me about his OCD. He had seen two prior therapists who apparently misunderstood his sexual obsessions as a part of the coming out process. Mike suspected he had OCD, and read about research suggesting that cognitive-behavioral therapy can be helpful.
In college, Mike’s friends joked with him that he was “fighting a losing battle” against realizing that he was gay. After struggling with HOCD thoughts through high school and college, he decided to have a sexual encounter with another man. Mike hoped to gain some certainty about his sexuality. He came away from the experience feeling assured that he was straight, but he described lingering regret that “(he) was so confused” at the time.
Using the techniques of ERP, Mike eventually learned to manage these thoughts by coming to accept the possibility that he might be gay, while at the same time accepting the possibility that he might be straight. Becoming more comfortable with the uncertainty in the combination of those two ideas is a key skill. Although Mike never saw the obsessive thoughts disappear completely, he learned to manage his response to them such that they were no longer distressing.
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