Opposite me sits a desperate young man, aged 23, referred, at his own request by his GP to the outpatient clinic specialized in OCD. For a few months, he has been tormented by constant doubt about his sexual orientation. He knows exactly where and when it started.
He had been to the movies with a friend followed by a drink. The two girls next to them were flirting, and when they didn’t respond one of the two girls had said: “Or are you gay?”
He had not paid any further attention to it, but as he walked home, he suddenly thought, “Could I be a gay?” Since then, the thought had not let him go.
There was nothing that pointed in that direction. He had had several girlfriends and had been living together for one and a half years. He was not sexually attracted to men, not now and not in the past. But no matter how hard he tried to tell himself that there was no reason to believe that he might be gay, thought kept popping up, again and again. “I am gay?”
After long hesitation he talked to his girlfriend about it. She did not know how to deal with it. “You just have to try to find out,” she had said. That it did little good to their sexual relationship was logical, but that made him doubt all the more. “Isn’t this because I’m gay?”
In the end he had gone to the doctor who had advised him to do some experiments. Subsequently he went to a gay bar, but felt no inclination to entertain the proposals that were made to him. At first he felt relieved – see, I’m not a gay after all – but later he began to doubt again. “Maybe I held off because I found it attractive after all.”
He watched gay erotic porn a couple of times and kept a close eye on whether he was sexually aroused. Well a little, which concerned him a lot. A friend in whom he had confided, reassured him: “That says nothing, I have the same”. They laughed about it, maybe they were both gay! But the next day he was in even more doubt. Was he in love with that friend?
It was his girlfriend who found something on the web about compulsive doubting of your sexual orientation. It was called h-OCD: homosexual OCD (Obsessive-Compulsive Disorder).
“Could it be that I have that?” He asked hesitantly.
“Yes,” I replied, “It is a classic story of h-OCD.”
“You sure?” He asked hopefully.
“Sure enough,” was my response.
The story is indeed a textbook case of h-OCD. This is often mistaken for the uncertainty and doubt that homosexual feelings (especially in the beginning) may cause. For someone who is familiar with the phenomenon of obsessions, is it easy enough to distinguish between the two.
With obsessions it is the doubt itself which is the problem and not that which you are doubting. Known examples are endless doubts, whether the door is closed properly, or the gas is off, or you are not infected, even when there is no is reason to doubt. It may even go so far as to still doubt whilst feeling that the door is locked.
It is characteristic of obsessions that (compulsive) searching for reassurance by checking, washing etc., helps for a little while but in the long run strengthens the obsessive insecurity.
In h-OCD there is constant doubt, but no actual homosexual feelings justifying such doubt. The problem is not the subject of the mulling over (sexual orientation), but in the (obsessive) degree of doubt about it. It is therefore not to be solved by acceptance of the orientation, because there is no homosexual orientation. There’s only doubt about the orientation.
This is typical of OCD, an anxiety that is disproportionate to the occasion.
It is important to note that h-OCD has nothing to do with homophobia or discrimination. It also happens to homosexuals who are tormented by obsessive turmoil about whether, or not they are heterosexual. I once had a patient who, to relieve her agonizing uncertainty, “decided” that she was a lesbian. A week later she was back with me. Then with uncertainty about whether or not she was bisexual.
OCD is best known in its most common form, hosophobia (fears of contamination) or compulsion, but it can also present in many other ways. Forms where there are no visible compulsions are often not recognized as OCD. The h-OCD is one of these.
With regard to that man, we have started cognitive behavioral therapy (CBT). At a later stage we can judge whether that is enough or whether medication is indicated.
Giving the news that the problem is a form of h-OCD is often a very useful reassurance but rarely sufficient to alleviate the problem. With compulsions, there is always the question of persistent unrest, very often gnawing away and going against all logic.
It’s true that you have to get yourself through it, but it is not true that though it’s “only” a thought it is easy. To cope with these kinds of obsessive intrusions professional help is often necessary.