Understanding the OCD in HOCD

Reader’s Question

I’m fifteen years old, female, and think I’m suffering from HOCD (homosexual obsessive-compulsive disorder). I’ve been dealing with this for about six months, and it started when I was watching a movie about a gay boy and his struggles with his family not accepting him because of his sexual orientation. In a split second during the movie I had the thought, “I would show this to my parents if I were gay.” Then I thought, “Does that thought mean I’m gay?” Since then I’ve found myself looking at every girl and asking myself whether I like her, would I kiss her, etc. I’ve done the same with any boy I saw.

My anxiety was terrible for the first three months or so, and for almost two weeks I stayed in my room just researching how to know if you are gay or if you are in denial. I cried every day, and missed school. The thoughts in my head were going so fast I felt almost dizzy at times. Then I found out about HOCD and felt some relief because it described me perfectly. Then another thought came: “But, I don’t have OCD. I never obsessively wash my hands or anything like that.”

My mother has generalized anxiety disorder and so do my two sisters. My mother knows I’ve been having some bad anxiety for a while, but I haven’t told her what it was about. She offered to take me to a psychologist in the beginning, but I said no. I worried that they would confirm my fears and tell me I should just accept myself and come out. At this point I feel almost numb. The thoughts come and I don’t even realize it anymore. How can I cope with this, and should I look for a therapist or something?

Psychologist’s Reply

I’m impressed with the research you’ve done and the insight you have into your condition. For those who aren’t familiar with HOCD, it’s a relatively new term referring to obsessive-compulsive disorder focused on obsessions related to questions about one’s sexual orientation. So, OCD doesn’t always include obsessions about germs or cleanliness — obsessions can be focused on anything. Also, there is always a first episode of becoming overwhelmed with obsessive thoughts, and that may occur during childhood. Given your family history of anxiety disorders, and your recent experiences, the diagnosis of OCD sounds reasonable.

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Effective treatment of OCD usually includes medication which, fortunately, is both safe and effective. For that reason, it’s important that you see a psychiatrist — a specialist who can prescribe the right medication for you. From a behavioral perspective, the treatment of OCD revolves around response prevention, that is, how stop yourself from giving in to the compulsion, which is the behavior that feels like it would help reduce the anxiety. So, for someone with obsessions over germs, the compulsion is to clean. It seems rational that getting rid of the germs would take care of the anxiety. Unfortunately, it doesn’t work, because the cause of the obsessions is faulty brain chemistry, not germs. Still, washing might provide a bit of temporary relief, which means that the washing behavior is reinforced. When the obsessions continue, the person is even more likely to turn to the washing behavior again, creating a vicious cycle that comprises the obsessive-compulsive experience.

With HOCD, the obsessions involve concerns and doubts about one’s sexual orientation, but what are the compulsive behaviors? As you described, the compulsion is to check one’s sexual orientation, or seek reassurance or clarification. So, the compulsions that have to be resisted include looking at other people to determine whether there is an attraction, imagining kissing another person to check out the reaction to that image, or seeking reassurance by reading articles or trying to learn more about HOCD or how to determine one’s sexual orientation. You already know, based on your experience, that engaging in these compulsive behaviors does not solve the anxiety, but simply keeps the obsessive-compulsive cycle going.

In addition to medication, it’s up to you to begin resisting the urge to engage in checking-behaviors — behaviors aimed at reassurance or clarification regarding your sexual orientation. When you have those anxious thoughts (obsessions), tell yourself that it is your OCD that is the problem, not your sexual orientation, and that the worst thing you can do is give in to those compulsions. Then, focus your attention on other aspects of your life and what is going on around you. The anxious thoughts will pop up again sooner or later, but keep practicing the same response. With time and practice (and medication), the obsessions will lessen. The goal is to get to the point where you rarely, if ever, have these concerns. At some future point, especially during times of stress, you may find yourself having obsessions of one sort or another. The good news is that the treatment is the same regardless of the form the obsessions take, and self-management gets easier with practice.