H-OCD In Teens & Adults – “What If I’m Gay?”
Obsessive Compulsive Disorder (OCD) is a disorder that causes significant distress and negatively affects and interferes with daily activities. OCD affects children, teens, and adults, it is most common in teens and adults. Obsessions consist of intrusive, unwanted thoughts, impulses, or images that trigger distress and anxiety. Compulsions are behaviors done to reduce anxiety and distress caused by obsessions and compulsions can be mental or physical. Both obsessions and compulsions come in a variety of types and each individual’s symptoms are different.
HOCD – Fears of Being Gay
Obsessive Compulsive Disorder (OCD) has many “themes”. The themes that an individual with OCD experiences often correlate with what is important to the person. Homosexual OCD (HOCD) also called Sexual Identity OCD (SI-OCD) is a very common theme of Obsessive Compulsive Disorder that involves intrusive, unwanted sexual obsessions and continuous doubt about one’s sexual orientation. Yet although this sub-type of OCD is common, most mental health professionals do not know how to correctly diagnose and treat sexual orientation OCD or HOCD. Research published in the Annals of Clinical Psychiatry (Glazier et al, 2013) reported that most therapists diagnose a person with HOCD symptoms with “sexual identity confusion” instead of OCD. The study evaluated psychologists’ capacity to correctly identify common symptoms of OCD; 77% misdiagnosed the individual with sexual identity obsessions as sexual identity confusion. 82% of these clinicians were doctoral-level psychologists and more than half stated that they were Cognitive Behavioral Therapy (CBT) therapists. Because of this high number of misdiagnosis, it is likely that most individuals with HOCD or SO-OCD will be misdiagnosed and receive inappropriate treatment.
In many cases, obsessive-compulsive symptoms begin to show up in the late teens. However, nearly 30% of OCD onset is before the age of 14 (although it may present with different thoughts or obsessions at that time). Being a teenager with OCD can be scary, confusing and distressing and can lead to a great deal of shame. During this time, the teen is also going through hormonal changes and sexual maturation and is becoming interested in romantic and sexual relationships. Because of their emerging sexuality, teenagers are particularly vulnerable to HOCD or SO-OCD. Many teens experience a panic attack during adolescence or early adulthood that is related to the thought that he or she might be gay. And like all individuals with OCD, they begin to be tormented by pathological doubt. Even though a part of them knows that they are straight, they distrust themselves. For instance, a young girl might think to herself, “Oh no. I noticed that girls breasts. What does that mean?” And then, she begins to get lost in her need to be sure and the never-ending quest of figuring out what that thought might mean.
Teens (and adults) with HOCD or SO-OCD often experience:
• A fear of becoming gay
• Anxiety about finding members of the same sex attractive
• Negative beliefs about the consequences of being gay
• Worry they are not sufficiently attracted to the opposite sex
• Fear that others might think they are gay
HOCD is not exclusive to heterosexuals and typically has nothing to do with homophobia. Gay individuals with OCD can also be tormented by thoughts of being straight. Persons with HOCD aren’t afraid of being gay (or straight) – instead they are afraid of never knowing for sure and never knowing 100% if they are in the right kind of relationship.
Because the driving force of compulsions is chronic doubt, teens with HOCD often come up with all kinds of “tests”. They often spend time comparing which sex they find more attractive, they look at pictures of themselves to see if the “looked gay”, review past situations to try and figure out if they “acted gay”, and read stories on the internet to see if they identify more with gay or straight people.
Like other types of OCD, HOCD or sexual orientation OCD is not effectively treated through reassurance, reasoning, or finding evidence. Also, trying to find the presumed root of the problem is entirely unnecessary and unhelpful to treatment. When searching for a potential therapist, be cautious of therapists who claim they can help you or your teen to stop his or her gay thoughts or help your teen to “know for sure” whether he or she is gay or straight.
At GroundWork Counseling in Orlando, therapists who specialize in treating OCD are very familiar with this theme of OCD and use evidence-based treatment utilizing Exposure and Response Prevention (ERP), a specific type of Cognitive Behavioral Therapy, considered the gold standard of OCD treatment. *When selecting an OCD provider, we suggest asking these questions