Gay or Obsessive-Compulsive Disorder?

OCD Feature Article

"I worry all the time that I might be homosexual. What is the difference between homosexuality anxiety as a symptom of Obsessive-Compulsive Disorder (OCD) and actually being homosexual? How can I tell if I am suffering from Obsessive Compulsive Disorder or if I am really gay?"

Many people suffering from Obsessive-Compulsive Disorder, with intrusive thoughts about being homosexual, ask these very questions. Having intrusive thoughts about being gay and doubting one's own sexuality are symptoms that characterize a subtype of Obsessive-Compulsive Disorder, sometimes called Homosexual OCD or "H"-OCD. Here are a few guidelines you may want to consider to help you understand the difference between suffering from HOCD and actually being homosexual.

Characteristics of HOCD:

Unwanted or intrusive thoughts about being homosexual
Doubts of one's own sexuality
Inability to get rid of unwanted worries or intrusive thoughts about being a homosexual
Seeing a member of the same sex causes anxiety and triggers unwanted thoughts about being a homosexual
Avoidance of members of the same sex for fear of unwanted thoughts or anxiety
Thoughts or worries about giving off signals that one may be a homosexual
Repeating mundane actions for fear that these actions may have been performed in a "homosexual" way or a way that may signal homosexuality in the person (for example, a male may feel the need to get up from a chair and sit back down in it if he feels that the way he sat in the chair was "feminine," or a male may worry that the way he walks is too "feminine" or signals homosexuality)
Repeating an action may relieve anxiety, but then the person feels the need to repeat the action (or ritual) again and again to relieve anxiety
Anxiety over being a homosexual is in opposition to one's own values and desires
One feels that the thoughts are unacceptable and inappropriate
Homosexual thoughts are repulsive rather than arousing

Characteristics of Being Homosexual (not suffering from HOCD):

Having feelings of attraction for members of the same sex (even if kept secret)
Having sexual encounters with members of the same sex
Preferring members of one's own sex for sexual/dating partners or feeling comfortable with both male and female sexual/dating partners
Homosexual thoughts are pleasant, though a person may be shameful of their sexual orientation or keep it a secret

So, how can I tell the difference?

Homosexual individuals may experience anxiety associated with their sexual preferences as well. However, these anxieties probably stem more from the social stigma that is attached to homosexuality and the additional difficulties that homosexuals may encounter in finding dating partners. Homosexuals may experience enough anxiety about making their sexual preferences known that they may keep their sexuality a secret or avoid dating altogether. However, this anxiety is different from the anxiety that a person with HOCD may experience. Individuals suffering from HOCD have an unrelenting worry that they might be homosexual and constantly remind and reassure themselves that they are a heterosexual. HOCD sufferers may have thoughts that are so unrelenting that they avoid situations where these thoughts are likely to occur, such as situations with high contact with members of the same sex (locker rooms, etc.). Individuals with HOCD often fear that they are homosexual even though they may have dated several people of the opposite sex and feel no attraction towards members of the same sex.

What can I do about it?

HOCD responds to the same treatments as any other type of OCD: medication and cognitive-behavioral therapy. The most important part of good treatment is first finding a clinician who will properly diagnose the problem. There is little in the research literature specifically about HOCD, although sexual obsessions are a well-documented symptom of OCD. Therefore, therapists without much experience treating OCD may not recognize HOCD as a true anxiety disorder. Some may suggest psychodynamic treatment, i.e. "talk" or "insight" therapy, to help the patient "come to grips" with his sexuality. This will not help a person with OCD. The HOCD sufferer needs behavior therapy, which teaches the person how to deal with and successfully diminish obsessions, and SSRI medications (such as Prozac, Luvox, and Zoloft). More about treatments for OCD...

Learn more: WM Gordon. (2002). Sexual obsessions and OCD, Sexual and Relationship Therapy, Vol. 17, No. 4. JE Granta, A Pintob, M Gunnipb, MC Mancebob, JL Eisenb, SA Rasmussen. (2006). Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder. Comprehensive Psychiatry, 47: 325-329. M Williams (2008). Homosexuality Anxiety: A Misunderstood Form of OCD, In L. V. Sebeki (ed), Leading-Edge Health Education Issues, Nova Publishers, 2008.