“HOCD”, short for “Homosexual OCD”, is the term used for a theme of Obsessive Compulsive Disorder in which the sufferer has obsessions—unwanted intrusive thoughts—surrounding their sexual orientation.
I will be using the term “HOCD” throughout this article to discuss obsessions of those who identify as heterosexual and have relentless doubts about whether or not they are gay. That being said, the term “Homosexual OCD” is very misleading and stigmatizing. A more representative way to describe these obsessions is “Sexual Orientation OCD” because OCD can latch onto anyone’s sexuality, whether that be someone who identifies as gay or queer or asexual. Furthermore, as sexual obsessions of OCD can be about perverse content (fear that one is a pedophile or unwanted thoughts about incest), the term “Homosexual OCD” implies that homosexuality is perverse. It often, and rightfully so, offends those who identify as LGBTQIA+. Homosexuality is not perversion.
With the HOCD theme, the sufferer has irrational intrusive thoughts that lead them to doubt their heterosexuality. The way many clients describe it is that they had a good sense of their heterosexual orientation and then randomly had an intrusive thought such as “what if you’re gay?” pop in and derail them. It often appears out of the blue and is the opposite of what they have known of themselves, and their attraction to those of the opposite sex, forever. The intrusive thoughts are disorienting to the OCD sufferer because of how irrational they are and often feel like a loss of identity.
As the OCD sufferer often has great difficulty tolerating uncertainty, they perform compulsions—physical or mental behaviors—aimed at seeking absolute certainty about their sexual orientation. This may include staring at people of the same sex while checking their groinal area to see if they feel anything, scouring Google for answers, taking multiple sexual orientation quizzes online, swiping through dating apps to try and prove their sexual orientation, and more.
HOCD is not to be misconstrued with denial or sexual repression, as those who are repressing their true sexuality know that they are attracted to the same sex but push it away, often due to shame that comes from living in a heteronormative and homophobic world. Those with HOCD have intrusive thoughts that are inconsistent with their desires. They do not align with the thoughts but are living with a doubting disorder that makes it difficult to tolerate the uncertainty we all live with. Nobody is 100% certain of their sexual orientation but the OCD sufferer attempts to be.
Without an understanding of OCD, HOCD often sounds like homophobia. It is a touchy subject among OCD sufferers and therapists alike who proclaim that HOCD is not homophobia. While HOCD is not sexual repression, it is not accurate to say that every person with HOCD is not homophobic. With HOCD, the real fear is that the sufferer is not certain of their “true” sexual orientation. By the same token, some people with HOCD fear being gay itself.
I have heard some who identify as having HOCD say:
- “I have HOCD and I’m not homophobic but I would tell my kid that they should not act on their desires if they were gay.”
- “I have HOCD and just because I am not comfortable with or don’t agree with one’s sexual preference doesn’t make me homophobic.”
- “I think I have HOCD and I really fear that I am gay. I don’t want to be gay.”
All of the people above may have HOCD but that does not erase the blatant homophobia. The two can exist concurrently. A sufferer can relentlessly doubt their sexuality while also denouncing homosexuality. It is important to weed out what is what because in addition to hurting the LGBTQIA+ community, internalized homophobia may be keeping those with HOCD further stuck. Phobia towards a community of people makes it difficult to accept the presence of thoughts whether the thoughts are representative of your sexual desires or not.
An OCD specialist can address underlying, or sometimes overt, homophobia by asking the sufferer why their intrusive thoughts bother them so much. Many with OCD will say, “I don’t care if I’m gay. I just want certainty so I can stop turning this over in my head.” This sounds like OCD minus the homophobia. Others will say, “I have never had these thoughts before and they don’t seem like me. They scare me because I don’t support a gay lifestyle.” This could be OCD with homophobia.
It is important to note that not everyone with HOCD is homophobic and that the intrusive thoughts are not a choice. It is equally important to acknowledge homophobia that is present among some OCD sufferers because denying the existence of homophobia perpetuates its existence. When we do not look inward to acknowledge and unlearn harmful narratives that we have been taught, these narratives do not change.
The reality is that we live in a very heteronormative world, which is reflected through mainstream media showcasing heterosexual relationships, lack of diversity in politics, religious groups that denounce homosexuality and claim—with zero evidence—that gay folks will go to hell, and laws that enable discrimination against the LGBTQIA+ community. Look at every Disney movie made in which a prince and princess live happily ever after. Gay love stories within Disney films are non-existent. Look at every male President of the United States thus far who has taken office with their wife, the First Lady. Look at laws in the U.S. that banned same-sex marriage up until only five years ago and currently allow for 60% of states to practice conversion therapy.
Acknowledging the pervasiveness of heteronormativity is not an excuse for the prejudice people carry but is, in part, an explanation. While it may not be the individual’s fault for internalizing homophobia, it is up to them to undo what has been taught—OCD sufferer or not. What is taught can be learned and must be unlearned.
OCD specialists spend a lot of time advocating for and protecting the OCD community, which is why so many are quick to note that HOCD is not homophobia. We must not forget is that the OCD community includes diverse populations, many of whom identify as LGBTQIA+. These humans need protecting, too.
If you’re a therapist wondering how you can help, utilize inclusive language when educating about HOCD. Instead of saying it is the “fear of being gay when one is straight”, describe it for what it really is: the fear of not knowing one’s true sexual orientation. Changing the language we use and ensuring that homophobia is not reflected in our practices will protect the OCD community as a whole. Those with HOCD will be better understood and those who identify as LGBTQIA+ will feel safer to exist as they are. If you’re afraid to speak up because you have internalized the notion that therapists should not discuss politics, remember that human rights are not political. This is not red vs. blue. This is about the LGBTQIA+ community having basic rights to exist as cisgender, heterosexual people do.