The word “denial” is at the root of all forms of OCD.  It is popularized culturally to relate to issues of sexual orientation, but every person with any form of obsessive compulsive disorder experiences the fear of “denial” whenever they choose to do exposure instead of rituals.

I don’t know if you’re gay.  I don’t know if what you are experiencing is a fraud perpetrated against yourself, identifying as one sexual orientation while secretly being of another, and having both the insight to know it’s a secret and the pre-meditation and masochism to keep that secret from yourself.  All I know is this – if you are obsessing and engaging in compulsions, it will fail to bring about certainty.

The word “denial” is at the root of all forms of OCD.  It is popularized culturally to relate to issues of sexual orientation, but every person with any form of obsessive compulsive disorder experiences the fear of “denial” whenever they choose to do exposure instead of rituals.  The compulsive hand washer who chooses to allow themselves to touch a dollar bill and then eat a french fry is sitting with the terror that they may be in denial of the cold hard fact that a molecule of someone’s feces may have made its way from the dollar, to the fry, to their mouth.  The Harm OCD sufferer, who lives in a war-torn mind of horrific images of violence against loved ones, holds a baby in their arms and tries to breathe evenly while covertly contemplating whether or not they are simply in denial of their closeted sociopathic “true” nature.  Still, nowhere does this word “denial” get tossed around more than in the context of HOCD, the obsessive compulsive fear of being or becoming a sexual orientation not your own.  So what is denial?

This?  http://www.youtube.com/watch?v=zsVpdBIi1BU

Unlikely.

Denial is actively choosing to behave in a way that directly opposes your values or beliefs without being aware of or acknowledging it.  An excellent example of this is the character Milton in the film Office Space.  He stops getting paid, loses his office, is completely rejected by everyone, yet shows up for work, and continues to clock in and out on time.  He gets his revenge in the end, but the character is mostly portrayed as a deranged idiot.  Somewhere at the core of HOCD is a fear that society at large will view you this way, as a deranged idiot who should have known what was going on.   A person in denial in the context of sexual orientation is a person who repeatedly engages in gay sexual activities and refuses to acknowledge that any part of him/her has a same-sex attraction.  It is not simply the behavior (many people of one orientation enjoy experiences of other-orientation), but the refusal to acknowledge the behavior that makes it denial.

A man who sneaks off from his wife in the middle of the night to have sex with other men is not necessarily in denial.  He may be fully aware of what he is doing and simply making a choice to do so.  We might say a woman who repeatedly blacks out after a night of binge drinking and misses work, but refuses to acknowledge the role alcohol plays in her getting fired, is in denial of her alcoholism.   Still, there remains some problems with attempting to define denial.  First, the term is laden with connotations popularized by psychoanalysts, springing from a theory of psychology that hinges on the idea that people suddenly discover who they are after relieving themselves of repressed thoughts and feelings.  This translates into pop culture commentary such as “he’s in denial” without the term actually meaning anything other than “I think that person’s gay.”  Second, obsessive compulsive disorder involves a deficit in tolerance of uncertainty, so when we try to define “denial” as the state of purposefully disregarding one’s genuine desires, it becomes a frustrating endeavor.  What does genuine mean?  How can we be certain that the thought about an act is different from the desire to engage in the act?

An easier exercise would be to identify what denial is not:

Denial is not:

  • Choosing to disregard thoughts, feelings, and sensations associated with another sexual orientation
  • Pursuing relationships of meaning and value despite thoughts and feelings whose content seems incompatible with this pursuit
  • Committing to relationships you are invested in despite the presence of doubtful thoughts about sexual orientation
  • Accepting the presence (without guilt, disgust or fear) of sexual fantasies outside of your historically preferred orientation
  • Letting go of seeking reassurance about your orientation
  • Accepting uncertainty regarding your sexual orientation and the label that goes with it

Love and HOCD

One common concern among HOCD sufferers is that if they choose to accept uncertainty and stop doing rituals, they may discover that they are gay and that discovery will result in a revelation to their loved ones that they have been lying about their orientation.  The fear thrives on an image of a tearful husband or wife feeling deceived, tricked, lead on a long and ultimately meaningless journey to middle age alone, the victim of a fraud perpetrated by the a fool who couldn’t come to terms with their homosexuality.  In other words, “I can’t just be with this person I love if there is any doubt as to the meaning of these gay thoughts, so I must get certainty to protect my loved one from a future betrayal.”  To the contrary, cognitive behavioral treatment for HOCD when there is a significant other involved must include exposure to the idea of denial and the way in which it could destroy the other person.  HOCD becomes a form of Harm OCD in this way.  So in addition to imaginal scripting exposures in which the sufferer could write out the feared consequences of persisting in gay denial in a relationship, the sufferer should also do exposures to strengthening their relationship.  By investing more fully and more completely in their love for their significant other (despite sexual dysfunction that may have occurred due to OCD anxiety), they are getting both exposure to the fear of destroying a loved one and, as an interesting side effect, a better, more meaningful relationship.  In short, invest in your relationships in such a way that if they fail, it will be the most devastating.  That is romance.

Loving Your Friends

People often write to me about their confusing feelings for their platonic friends (this is especially common in younger people it seems).  Not to put too fine a point on it, but what often distinguishes our friends from lovers is whether or not we stimulate each other’s genitals.  Much of the hallmarks of romantic relationships are congruent with platonic ones: mutual interests, unconditional respect, reliability, feeling good in the presence of each other, all of these experiences are indicators of healthy friendships.  Because these relationships are essential for healthy functioning on a very basic level (friends help watch your kids while you’re outside the cave hunting mammoths), they become a source of anxiety.  What if I lose my friend?  This makes them an easy target for OCD.  So while I can’t give you certainty about whether or not you are in love with your friend, I can tell you what HOCD sufferers often fear is gay denial and simply isn’t:

  • Anxious butterflies in your stomach when you get a call from or see your friend
  • Desiring physical closeness with a friend
  • Having intrusive sexual thoughts about a friend (note: people with Harm OCD have intrusive thoughts of harming the ones they care about)
  • Feeling love for a friend
  • Feeling no one else can understand you like your friend

Testing, Testing, One Two, One Two

The root of all HOCD evil is testing.  Testing means seeking out emotional or genital stimulation for the purpose of attaining certainty about your sexual orientation.  This often comes disguised as exposure with response prevention (ERP) but is actually a wolf in gay clothing.  What I mean by this is it’s a setup by the OCD to get you to think you are doing therapy when in fact you are just doing compulsions.  Watching gay pornography and masturbating to it for the purpose of checking to see how easy it was, then analyzing how easy it was in an attempt to prove to yourself that you are definitely straight or gay is just a convoluted compulsion and has no chance of benefit.  Exposure without response prevention is not OCD treatment.  It is just responding to unwanted thoughts with self-reassurance and mental review again.  Compulsively masturbating to different material, gay or straight, with the intention of proving something, will always backfire in the end.  People who get stuck on this compulsion create a feedback loop of gradually conditioning themselves to become more and more stimulated by their fears, but, sadly, without getting to really enjoy any of it.

There’s nothing wrong with enjoying sexual fantasies that feel taboo or are different in some way than the real sexual relationships you like to pursue.  But compulsive testing often leads to hours and hours of desperately trying to feel aroused by something and then studying the minutia of your response to it, killing any chance of it being genuine sexual exploration.  Was my orgasm as big as it is to my preferred orientation?  Did my penis swell the exact amount, less, or more?  Did my vagina respond the way it would to my husband?  These are bait laid out by the OCD for you to do more and more compulsions.  Only now they come with their own evidence, a mountain of gay porn and shaming sexual manipulation.  If it came without the shame and without the analysis, it could be a beautiful thing.  Exploring your sexual mind is as much an act of mindfulness as any.  But like all forms of mindfulness, the value exists only in non-judgmental, non-shaming exploration, curiosity about what you find, not desperation. It’s like demanding your doctor keep running tests for a disease you fear and then using all the testing as evidence that the doctor must think you have it!

Collecting evidence about your orientation by testing your reactions to sexual material doesn’t work.  Evidence collected during the course of a compulsion is no more evidence than a confession derived by torture is a reliable source of the truth.

Hello, Good Bi

In the end, unless you are willing to do ERP to the idea that you may be in “gay denial” and so long as you remain committed to achieving certainty about (instead of confidence in) your sexual orientation, there will always be material for your OCD to bait you with.  This is not a challenge unique to HOCD, though it often feels that way.  People with contamination OCD eventually need to expose to the uncertainty over whether they are just trying to get away with being irresponsible or disgusting.  People with Harm OCD still have to expose to the idea that they are just trying to blend in and not get caught being psychopaths.  The obsession with sexual orientation and labeling it correctly may go on for years, decades, coming and going throughout your life, being addressed with and without therapy, lurking in the shadows, then pouncing with the threat of gay denial when you least expect it.  Until you do exposure to denial, you are only scratching the surface.

ERP specifically targeted at denial fears may be more nuanced or abstract than ERP to a fear of being gay.  Typical exposures for HOCD fears may involve looking at triggering materials, listening to triggering music, and being around triggering people (all without doing compulsions of course).  But for the specific fear of being denial, life itself is the trigger and exposure means committing to that life.  This may mean following through on your plan to propose to your girlfriend, letting yourself enjoy a gay fantasy while having sex with your boyfriend, letting yourself really be moved by a homosexually-themed film, and so forth.  In other words, be yourself in the moment and really commit to that self even when it seems disingenuous.

Long Term Management – The Bigger Picture

It may feel like this, but this is irrational and that’s what makes it comedy:  http://www.youtube.com/watch?v=YyxqlA4rqaU

OCD is a chronic disorder.  No matter what level of mastery you develop, obsessions are going to show up sometimes and your instinct will be to engage in compulsions on some level.  What this means is remembering all along that the bigger picture is tolerance of uncertainty and acceptance of the presence of unwanted thoughts.  It is not the eradication of unwanted thoughts.  HOCD sufferers often become disheartened when, after effectively crushing the obsession with CBT/ERP, somewhere along the line finding themselves taking the bait again.  This is most often triggered by a fear that the essentially free and fulfilling life you’ve earned back from your OCD with treatment is really just a lie, a perpetuated act of denial.  So it’s important to approach the fear of denial, whether it is currently at the forefront of an active HOCD obsession or the product of a brief lapse after getting better, with the same tools.  Don’t buy in to OCD’s distorted logic that “because it came back, it must be the truth.”  Kill two birds with one stone by immediately going back to the mindfulness and CBT tools that worked last time.  By immediately returning to ERP and mindfulness tools, you not only put the OCD in its place, but you also get exposure to what may feel like an act of denial (Here I go again, pretending this is OCD).  If you’re new to OCD treatment, get help in whatever way you can access CBT.  If you are actively in treatment, use it to confront your fear of denial head on.  If you have had treatment in the past, don’t be afraid to check in with your OCD therapist to get back on track.  Booster sessions are a normal and healthy part of CBT for OCD.

Consider this – we may define denial as running from the truth.  If this is the case, then it is far worse to be in denial of your OCD (and not committing seriously to treating it with CBT) than it is to be in denial of whatever your OCD is talking about.  While the consequences of your fears coming true are quite unknowable, to deny yourself OCD treatment has clear and predictable consequences.

Jon Hershfield, MFT is a psychotherapist in private practice licensed in Maryland and California, specializing in the treatment of OCD.  Follow him on Twitter and Facebook

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