HOCD (Sexual Orientation OCD): Part Two

So now what?

Obsessive compulsive disorder is treated with a form of psychotherapy called cognitive behavioral therapy.  It is a present-focused therapy that addresses how you are responding to your thoughts and feelings and how these responses can be modified to improve your mental health.  Treatment for HOCD is no different from treatment for other forms of OCD.  You identify the obsession, identify the compulsions, stop the compulsions, and starve the obsession.  To achieve this, you attack the OCD from three angles, exposure, critical thinking, and mindfulness.

Exposure for HOCD – it’s not all about gay porn

OK, it’s a little about gay porn, but keep reading anyway.  Exposure with Response Prevention (ERP) is a way of overcoming fears by gradually confronting things that cause the fear state while (and this is key) resisting the compulsive response.  It’s not enough to look at weights at the gym.  You have to pick them up and resist gravity’s objection.

Working with an OCD specialist, you will want to identify what it is about your HOCD that really compels you to ritualize.  For some, it’s a straightforward discomfort with gay imagery and for that, you might do exposure to gay-themed pictures and videos of gradually increasing intensity while resisting the urge to convince yourself that you are straight.  For others, the fear is more abstract, having to do with a loss of identity or a fear of emotionally scarring your loved ones by “coming out” to everyone’s dismay.  For this, exposure to sexual material is less relevant because you may not be fighting a fear or disgust with gay sexual imagery, but instead are grappling with a fear of being an imposter.  Exposures for this type of HOCD may focus more on being in environments where the thoughts are likely to be active and resisting checking or reassurance-seeking behaviors.  You may also use imaginal exposure, such as writing narratives about your fears possibly coming true and the consequences therein.  Many HOCD sufferers benefit from a combination of exposures.

In both cases, it will also mean identifying what you are avoiding and gradually reintroducing yourself to those things.  This doesn’t mean having gay sex.  You weren’t avoiding that before HOCD started.  You just weren’t doing it.  But you may have started to avoid reading a magazine if there happens to be an article about a gay celebrity in it, or listening to a piece of music performed by a gay person, or having cordial conversations with your local barista who you think may be gay.  So a lot of ERP is really about gradually returning to a life of behaviors totally unrelated to sexual orientation that got thrown off course by the HOCD.

Dealing with the HOCD thoughts

Critical thinking means recognizing when a pattern of thought is distorted and may be playing into the hands of the OCD.  This may be addressed in therapy with something called cognitive restructuring, a way of challenging intrusive thoughts without doing compulsions.  A good example of distorted thinking is the tendency in all forms of OCD to look at things in black-and-white terms.  For example, equating the presence of one gay-themed thought with the self-identification of “being gay.”

There is also a powerful tendency toward disqualifying a life history of being one orientation in the face of fear over being another.  In other words, though you may have always pursued members of the opposite sex, your obsessive thoughts about being gay seem to make that seem irrelevant – or worse, like a desperate attempt to deny the truth!  Another common distortion in HOCD is equating the presence of any gay thoughts or feelings with being less of a man or woman.

Though it is important to identify and challenge distorted thinking in all forms of OCD, you want to be very careful not to use logic as your main weapon against the disorder.  You can’t fight OCD illogic for very long with logic.  You have to fight it with better illogic in the form of exposure.

Mindfulness skills and HOCD

Accepting thoughts, feelings, and physical sensations as they are.  This is all mindfulness really means.  It is noticing and accepting without judgment.  Hey, look at that, another HOCD thought.  All right then.  But in HOCD, accepting thoughts, feelings, and sensations seems like accepting a death sentence.  A very gay death sentence.  If I accept a thought like, “I would love kissing that guy” then what’s to stop me from making out with my best buddy?   Well, nothing really, except that you are basically only going to do it if and when you want to.  You cannot control the thoughts and feelings and random physical sensations that happen to occur in you.  No one can.  You just choose what to do with them.  I kill several people a day and probably sexually assault about the same number in my head.  And look, they let me be a therapist.

Mindfulness for HOCD often means allowing yourself to incorporate unwanted sexual thoughts, feelings, and sensations into the larger picture of whatever you are experiencing in that moment.  So, rather than attend to wishing that you could have a conversation with a same-sex friend without “gay thoughts”, actively embrace the experience of having both the conversation and the thoughts simultaneously.  The experience you are having involves both of those things.  When you focus your attention only on the unwanted thoughts, their origins, and when you imagine they will leave, then you are depriving yourself of the other experience, a nice conversation with a friend.  If, on the other hand, you can allow yourself to stop “minding” that the thoughts are there and commit to having whatever experience you are having, you not only get to enjoy more of your life, but you send a powerful message to your OCD mind that these thoughts are not particularly important and not worthy of intruding so aggressively.

Gay in the moment, with or without HOCD

So they’re making another movie about Wolverine from X-Men.  This is a bit odd, I think.  There’s the X-Men movies, then there’s X-Men Origins: Wolverine, now there’s The Wolverine.  Soon we’ll see Wolverine on Ice I imagine as men and women alike simply cannot get enough of this masculine tough guy crybaby superhero who cannot be destroyed.  When I see the latest billboards of Hugh Jackman, the actor who portrays Wolverine in the films, posed menacingly, perfectly chiseled features, a force to be reckoned with, I can’t help but linger.  Do I want to look like him, be him, or just stare at him?  I don’t know, so, for the briefest of moments, I guess I am gay.  I’m not personally interested in gay sex or gay relationships.  I don’t yearn for it.  It just doesn’t feel like home to me.  I’m happily married to a woman and feel quite lucky to be invited to stick around.  But for a brief moment, every time I see the new Wolverine billboard, I am in love with a picture of Hugh Jackman and I am totally gay.

The thing is, throughout the day, I will be a lot of things.  Gay is the friendliest.  I will get irritated by a selfish driver not letting me merge, and I may mentally run them off the road, and in that moment I will be a sociopath.  I’ll destroy that driver and his whole family.  I’m not proud of it, or maybe I am, but it’s just going to happen in my mind and there’s no use stopping it.  So far, thinking this way, and letting it just happen, has not resulted in anyone getting hurt.  So it simply must be the case that what goes on in my mind is about as relevant to my identity as television is to reality.  I can watch it, and I can weigh in on how interesting I think it is, but I can’t control it and I don’t win anything by trying anyway.

There have been a lot of gay moments in my life like the 2 seconds of getting stuck staring at Hugh Jackman, but allowing these moments to occur has not threatened my existence the way it does for someone suffering from HOCD because I always allow it.  For women with HOCD, perhaps even more so than for men, a lot of anxiety surrounds the awareness of beauty in other women.  It’s a terrible double-bind.  Society asks that women study female beauty and try to achieve whatever their culture pre-determines this to mean (society is cruel).  But then HOCD demands that women never admire the sexual attractiveness of other women (OCD is cruelest).

I’m even gayer than that

Anyone who knows me well, knows I have a peculiar fascination with Clive Barker, a well-respected homosexual author, filmmaker and artist.  I recently came across a funny little video blog called Clive Barker Needs More Gay in which a hilarious and articulate gay man describes the work of Clive Barker from a homosexual perspective.  In it, he points out how Barker’s characters are often unorthodox in the horror genre.  Monsters are good guys, the mainstream man is the enemy, and whether you find the acts of individual supporting players to be grotesque or disgusting, you are expected to also have some sympathy for them.  They are just doing what they know how to do.  The narrator of this blog equates this to the gay experience, but this is often the experience of the OCD sufferer too.  The OCD sufferer feels different, feels like an outsider, feels like what normally happens in their head separates them from what they imagine normally happens in the minds of the common man.

Identifying with the outsider is often used as fuel for the HOCD fire.  You may think, I “feel” gay because I “feel” like something about me is off, different.  But simply feeling like you’re on the outside looking in is not an issue of sexual orientation.  Still, the OCD persists.  How do I know if I’m gay?  What if I am?  I have to know!  You have to guess.  You have to settle for confidence instead of certainty.  You have to live your life as if you are the thing you want to be and risk being wrong.  The compulsive handwasher has to live like they’re clean enough without one more wash, and they have to be willing to risk that they are being irresponsible.  The alternative is to remain a slave to the OCD, a fate far worse than whatever the OCD suggests.

In the end, because certainty does not exist, we only ever have two choices in life.  One choice is to take the risk and stand up to your OCD.  Get treatment from an OCD specialist, do the exposure with response prevention, practice mindfulness, and possibly spend the rest of your life happily engaged in whatever you pursue.  It may end up well, it may not.  You may live the life of a straight person and right at the very end decide it was all a sham.  That would be really disappointing I imagine.

But compare it to the alternative.  The alternative is you don’t treat the OCD and you spend the rest of your life devoted to the futile pursuit of certainty, thinking “gay stuff” all day every day, avoiding anything that might make you happy, because happy things trigger the gay thoughts.  You isolate yourself from the people who care about you.  You avoid sex and all sexual expression in an attempt to cleanse yourself of any possibility of a same-sex thought or feeling.  And then at the end of your life, you decide this was all a sham.  You’re straight and you just have OCD.  But you threw your life away for no reason other than the avoidance of fear.  And now it’s too late to start over.  Which scenario is ultimately more disappointing?

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

Click here for HOCD: Part 4

Click here for HOCD: Part 3

Click here for HOCD: Part 1