Homosexual Obsessive Compulsive Disorder (HOCD)

When a disorder causes sexual disorientation.

Posted Apr 16, 2018

iStock by Getty Images
Source: iStock by Getty Images

In my practice I sometimes encounter men who are so obsessively worried they may be gay or bisexual that it takes up such a significant amount of their daily life and thoughts and causes them nearly crippling anxiety. Sometimes they truly are gay or bisexual, and sometimes not at all.

Such a man may constantly think about whether the way he walks is too “girly.” He may worry that he appears to be gay if crosses his legs at the knee like a woman when sitting down rather than having the typical “man spread.” He may even avoid being alone with other men for fear of being attracted to them. Like those with Obsessive-Compulsive Disorder (OCD), he may exhibit the same kind of repetitious behaviors, such as sitting and standing over and over again to see if they may appear gay in the way he does it.

This may sound like it’s a set up for a joke, or an ongoing laugh line in a sitcom, but it is a real disorder that some have labeled as Homosexual Obsessive-Compulsive Disorder (HOCD), though the Diagnostic and Statistical Manual of Mental Disorders, the “bible” of psychiatry, has yet to recognize it. 

HOCD is also known as Sexual Orientation OCD to be inclusive of LGBQ sufferers instead of HOCD. This article is for those who are men and this can occur for anyone of any gender and any sexual orientation. 

Obsessive Compulsive Disorder

While HOCD remains largely unrecognized in the larger therapeutic community, Obsessive-Compulsive Disorder (OCD) has been widely researched and determined to affect roughly one percent of the population. It is characterized by hours of the day being consumed by mental and physical compulsions. One of the few psychologists addressing HOCD is Dr. Fred Penzel, the author of Obsessive Compulsive Disorders.

HOCD can suddenly occur for some men who, for example, find themselves being hit on by other gay or bisexual men, mistaken for being a gay or bisexual man, find themselves attracted to another man or stumble onto gay porn that excites them. They will often blame these things as reasons for how the HOCD started but it isn’t about homosexuality nor bisexuality, it is about OCD.

In my own clinical experience working with these men, those who suffer from this may find themselves obsessively looking at porn, either gay or straight, to see if they become sexually excited by either. They might constantly check out others’ reactions to their gestures or conversation to see if they get any strange looks or other signals that would imply homophobia. They sometimes will go to extreme lengths, such as having sex with men even though they are not gay or bisexual, which typically leaves them feeling unsatisfied and uncomfortable. Even so, because this is an anxiety-driven obsessive-compulsive disorder they may decide that they just chose the wrong man, or that they may even have erectile dysfunction because they couldn’t remain erect, and so they repeat the same behavior only to have the same confusing results. 

Doubt is their constant companion. 

As such thoughts and behaviors become more and more intrusive in their life, they show up in my office, desperate. Even though they have not been able to confirm by their compulsive experimentation that they are, indeed, gay they may even ask me to help them come out as gay or bisexual just to end the suffering (some of these HOCD characteristics are adapted from brainphysics.com).

Four Questions to Distinguish Gay, Bisexual and Straight Men

I am a specialist in sexual orientation and relationships and not trained to deal with OCD, so I first must set out to determine if they are simply closeted gay or bisexual men or if there is something else going on. I approach this with four questions I have used over the years. 

1. Childhood memories.

I ask men if they remember having sexual and/or romantic feelings for boy. Did they have a unique liking toward another male that didn’t seem sexual or romantic but now looking back it clearly was. HOCD men always say no. Straight men with OCD never say yes. 

2. Homophobia. 

Closeted gay men are often virulently anti-gay, whereas HOCD men are not. They may even say to me, “If I’m gay, okay. Just help me get past this confusion.” 

3. Beach Test. 

I ask them that when they are at the beach, who do they find themselves ogling, men or women. Truly gay men just say that they’re annoyed that women keep getting in their line of sight. Straight men only look at women. Bisexual men will say one or the other, or both. The HOCD man is only checking themselves to determine their level of arousal while looking at either men or women. 

4. Who do you want to come home to?

I ask them who they want to come home to. I call this their “home culture.” Gay men invariably say a man. Bisexuals typically will say either or more to one or the other.HOCD men will say a woman. 

Of course, the whole question of sexual identity — and confusion — is exacerbated by societal pressures. Influenced by the heated atmosphere around sexual politics nowadays, and even the amount of media coverage around LGBTQ issues, some gays argue that in the coming-out process they went through much of the same confusion, and therefore believe that the HOCD person is simply experiencing the same thing. 

They are not the same thing. 

Theirs is a particular kind of trouble, one that will not be resolved by “coming out of the closet” because they truly are not gay or bisexual. Unfortunately, some therapists fall into this camp, as well, and because naming something has a significant cultural and psychological impact, may be reluctant to do so. 

There are some clinical therapists, such as Monnica Williams, author of “Homosexual Anxiety: A Misunderstood Form of OCD” in Leading Health Education Issues, who may help bring more a serious conversation of this disorder to the therapeutic world.  

When I’m working with men experiencing HOCD, I refer him to a specialist who has specialized training in OCD interventions and medications that may be helpful in addition to working with me. Very few therapists work with both and hopefully this will change as there becomes an increase in awareness of HOCD.

References

1. Fred Penzel, “How Do I Know I’m Not Really Gay?” International OCD Foundation, ocfoundation.org/EO_HO.aspx, accessed 12/24/2013.

2.  www.brainphysics.com/hocd.phpreviews the characteristics of HOCD. Accessed 12/18/2013.

3. Monnica Williams, “Homosexual Anxiety: A Misunderstood Form of OCD,” in Leading-Edge Health Education Issues, ed. Lennard V. Sebeki (New York: Nova Science Publishers, Inc., 2008), 195-205.  

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