OCD Therapy Going Nowhere?

Although any medical doctor can take your blood pressure, only a few can do heart surgery. Likewise, any therapist can help someone who is feeling a bit blue, but only a few can effectively treat OCD. OCD treatment is a type of therapy that requires a specialized protocol called Exposure and Ritual Prevention (ERP or EX/RP). Learn about the Top Mistakes Made by OCD Therapists.

Top Seven Myths About OCD

One stereotype is that people with OCD are neat and tidy to a fault. Actually, nothing could be further from the truth. Although many people with OCD wash because they are concerned about dirt and germs, being tidy is actually not a typical symptom of the disorder. Almost two-thirds of people with OCD are also hoarders... Learn more about the Top Myths about OCD.

Homosexual Fears in OCD

Sexuality Concerns in Obsessive-Compulsive Disorder (OCD)

There are many people with obsessive-compulsive disorder (OCD) who have sexual obsessions surrounding homosexuality. Homosexuality anxiety is a recognized symptom of OCD, sometimes referred to as "HOCD."

HOCD includes the following:

  • the obsessive fear of being or becoming homosexual
  • the experience of intrusive, unwanted mental images of homosexual behavior, and/or
  • the obsessive fear that others may believe one is homosexual.

A person may have only one of these facets of the disorder or a combination. Learn more about sexual obsessions in OCD.

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Sexual and Homosexual Worries in OCD

by M. Williams, Ph.D.

OCD Overview

Obsessive-compulsive disorder (OCD) is considered a type of anxiety disorder that involves recurring, unwanted obsessions and repetitive compulsions. Obsessions are intrusive thoughts that cause severe distress, despite the fact that the individual realizes that the obsessions represent exaggerated fears that are not likely to occur. These obsessions are worries that reach beyond anxiety about everyday problems. So upsetting are the obsessions that the individual attempts to counteract them with a specific behavior or neutralizing thought called a compulsion. The individual feels as though their compulsions must be performed in response to the obsessions. Compulsions are implemented strictly to reduce anxiety or prevent a feared outcome.

Sexual OCD Subtype

Obsessions and compulsions can take many different forms, depending on the individual. Several studies have attempted to classify the various symptom profiles into discrete subtypes of OCD, also called symptom dimensions. The research literature generally agrees that there are five major OCD subtypes: hoarding, contamination, doubt/harm, symmetry/arranging, and unacceptable/taboo thoughts. This subtype has also been called obsessions without covert compulsions (sometimes called "pure obsessions" or "pure o" for short). Within this category are sexual obsessions, which are unwanted sexual thoughts, often involving children, family members, animals, violence or even religious figures. These sexual obsessions may involve homosexual activities or fears about sexual orientation. While much research has been conducted on certain OCD subtypes, very little research has been conducted examining sexual obsessions.

Sexually Intrusive Thoughts

Sexually intrusive thoughts are extremely common, and among the general population, over ninety percent of individuals report having experienced these type of thoughts during their lifetime. Studies have found that as many as a quarter of OCD patients have had a history of sexual obsessions. These numbers may be an underestimate of the actual number of people suffering from unwanted sexual obsessions because the stigma associated with sexual thoughts may cause individuals to avoid reporting their obsessions. Sexual obsessions and sexually intrusive thoughts are equally divided among males and females. These thoughts typically start in early adolescence and may progressively worsen, or have a waxing and waning course.

Homosexual Obsessions — HOCD

When conceptualizing sexual obsessions, it is important to recognize that people with sexual obsessions find their thoughts immoral and do not wish to act them out. They are different from fantasies, as the obsessions are unpleasant and provoke guilt, rather than being enjoyable. As a result, the thoughts cause distress, which may be connected to unwanted emotions, such as lust, disgust, anger, and frequently guilt. This distress is directly related to the frequency of the sexual obsessions, and may lead to depression, difficulties concentrating, and anxiety. Common themes reported in sexual obsessions include incest, religion, AIDS, pedophilia, unfaithfulness, and homosexuality. Obsessions about homosexuality differ from an individual who is actually gay because they do not feel attraction or arousal to members of the same sex. The individual with homosexual obsessions fears becoming gay or discovering that he or she was unknowingly gay all along. There is an even larger paucity of research examining sexual orientation obsessions in OCD, sometimes called HOCD for "homosexual OCD."

The obsessions in HOCD take the form of worry about becoming or being gay, engaging in same-sex sexual behavior, and being ridiculed by others for being gay. This type of OCD is often characterized by excessive doubt. The individual may first experience sexual orientation fears when noticing that a member of the same sex is attractive. The individual then questions why they had the thought and mentally panics. These fears are more than just fleeting thoughts; they become powerful obsessions that keep coming back. In an effort to make the thoughts stop, the individual performs compulsions, which may present as checking for indications of physical arousal when around attractive members of the same sex. Compulsions also include avoidance, such as not watching television shows in which there is a homosexual character or avoiding spending time with same sex friends. Conversely, the individual may watch pornography with homosexual characters to determine if it arouses them, and then compare their reactions with heterosexual pornography. Another compulsion to combat the obsessions is to increase sexual intercourse with their partner in order to reassure themselves that they are not homosexual. People with sexual orientation obsessions are driven by the fear of losing access to people of the opposite sex and acquiring an attraction to people of the same sex.

It is reported that homosexual obsessions have lifetime rates of about ten percent among treatment-seeking people with OCD. In addition, it appears that more males experience sexual orientation obsessions than females. The lack of a specific diagnostic tool to identify people with this subtype of OCD can cause people to be undiagnosed or misdiagnosed by clinicians that are not experienced in treating people with OCD. Such a therapist may mistakenly believe that the individual is undergoing a sexual identity crisis due to "being in the closet," and this sort of discussion only increases the fear in the individual. Being unable to obtain a proper diagnosis or proper treatment may lead to feelings of hopelessness, despair, and even suicidal ideation. This makes sexual orientation obsessions a particularly worrisome type of OCD. Thus it is vitally important that people with sexual obsessions in OCD be treated by an experienced and effective OCD therapist.

More Information

Help for Sexual OCD

For an evaluation and specific treatment recommendations for sexual obsessions, contact Monnica Williams, Ph.D.

References

Gordon, W.M. Sexual obsessions and OCD. Sexual and Relationship Therapy, 17(4), 343-354, 2002.

Grant, J. E., Pinto, A., Gunnip, M., Mancebo, M. C., Eisen, J. L., & Rasmussen, S. A. Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder. Comprehensive Psychiatry, 47, 325-329, 2006.

Williams, M. Homosexuality Anxiety: A Misunderstood Form of OCD. In Leading-Edge Health Education Issues, L. V. Sebeki, ed., Nova Science Publishers, 2008.

Williams, M. T., Crozier, M., Powers, M. B.: Treatment of Sexual Orientation Obsessions in Obsessive-Compulsive Disorder using Exposure and Ritual Prevention, Clinical Case Studies, 10: 53-66, February 2011.

Williams, M. T., Farris, S.G.: Sexual Orientation Obsessions in Obsessive-Compulsive Disorder: Prevalence and Correlates, Psychiatry Research, 187: 156-159, 2011.

Williams, M. T., Farris, S. G., Turkheimer, E., Pinto, A., Ozanick, K., Franklin, M. E., Simpson, H. B., Liebowitz, M., Foa, E. B.: The Myth of the Pure Obsessional Type in Obsessive-Compulsive Disorder, Depression & Anxiety, 28: 6, 495-500, 2011.

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