HOCD (Signs, Symptoms, & Treatment)

Disclaimer: This article is for educational purposes only and does not replace expert medical or mental health advice. Homosexual obsessive-compulsive disorder (HOCD) or sexual orientation obsessive-compulsive disorder (SO-OCD) requires a comprehensive psychiatric evaluation by a qualified clinician. So, always refer to a licensed mental health specialist for diagnosis and treatment.

Homosexual obsessive-compulsive disorder, or HOCD, is a subtype of OCD that is characterized by unwanted, pervasive, and distressing thoughts that one might be homosexual, despite their true sexual orientation. It is now known as sexual orientation obsessive-compulsive disorder or SO-OCD, as the term “HOCD” became increasingly contested in peer communities.

Despite the fact that OCD impacts nearly 1.2% in the U.S., SO-OCD is still misunderstood and can be a particularly challenging condition to navigate.

In this article, we will explore what is HOCD, how it is different from a homosexual or bisexual orientation, and what your treatment options can be.

HOCD stands for homosexual obsessive-compulsive disorder (OCD), which is marked by intrusive, unwanted mental imagery of different sexual orientation-related behavior. These images can be distressing and contribute to compulsive behaviors, like constant checking, which can take away from the experience of time and life.

SO-OCD is a common subtype of OCD. One review reported that nearly 11.9% of those who seek treatment for OCD can experience SO-OCD-related symptoms.

Despite the fact that the world is becoming increasingly understanding of the LGBTQ+ community, SO-OCD can still come with misunderstanding and stigma, while the experience of the disorder itself can impact daily life and functioning. This is why early diagnosis and intervention are crucial for a successful healing journey.

There is more than one risk factor that plays a role in the development of HOCD or SO-OCD, such as:

• Family studies have indicated that having a close relative with OCD can make it twice as likely to develop SO-OCD.

• Genetic studies have pointed toward chemical imbalances in the brain in dopamine, serotonin, and glutamate levels, which can play a role in SO-OCD. The gene SLC1A1 is being investigated as a crucial factor; however, it is not yet definitive.

• Systematic reviews of etiology and symptom severity have revealed that trauma can contribute to HOCD. 70% said that they developed OCD symptoms after a traumatic incident, while 30% said that their OCD symptoms became worse after the incident.

• Gender differences reveal that women are more likely to experience OCD symptoms than men.

The signs and symptoms of HOCD or SO-OCD are divided into obsessions and compulsions. Medical News Today notes some commonly recognizable SO-OCD obsessions as:

• Fear that they have a different sexual orientation.

• Distress that they are in denial of their sexual orientation.

• Fear of losing their identity.

• Belief that their relationship problems can be traced back to a different sexual orientation.

• Intrusive thoughts and imagery that interfere with their sexual life.

Commonly recognizable SO-OCD compulsions are:

• Unable to stop thinking about their different sexual orientation.

• Observing and noting down interactions with the same sex to understand whether they may be of a different sexual orientation.

• Overanalyzing experiences and behaviors to understand whether they can be perceived as a person of another sexual orientation.

• Ruminating over past sexual experiences to assure themselves that they may not be their feared sexual orientation.

• Avoiding experiences or activities that may be considered different from their sexual orientation.

• Using pornography to gauge whether or not it is sexually arousing.

• Constantly seeking reassurance and validation from others regarding their sexual orientation.

The main difference between HOCD/SO-OCD and being homosexual or bisexual is that a person with SO-OCD typically experiences intrusive doubt rather than genuine, consistent attraction. It is mainly characterized by a fear that they may unknowingly be of a different sexual orientation.

On the other hand, homosexual or bisexual orientations are defined by romantic attraction and sexual arousal toward a person of the same sex or both sexes, respectively.

Once it is diagnosed through structured interviews and insights into intrusive thoughts and behaviors regarding HOCD or SO-OCD-related obsessions and compulsions, this condition can be effectively treated with psychotherapy and medication.

Some of the widely used psychotherapeutic modalities for OCD are cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) therapy. CBT targets the underlying thinking patterns of SO-OCD, while ERP safely exposes the person to their anxieties and fears to develop healthier responses and coping mechanisms that can become the safe alternative to compulsive behaviors.

Medications can be prescribed to relieve the symptoms of SO-OCD. The International OCD Foundation says that selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment for OCD; however, clinical trials have shown that a tricyclic antidepressant known as clomipramine can also be effective.

Peer-reviewed studies have shown that alternative treatments such as transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) can also be effective, especially for treatment-resistant OCD.

It is pertinent to note that close to 75% of those with OCD show meaningful improvement over a period of time with consistent therapy and medication. This is why early diagnosis and intervention become the foundation for a healthier, fulfilling life.

If you think you or a loved one may be experiencing SO-OCD, you do not have to do this on your own. Reach out to the NuView Treatment Center today. Our licensed and experienced clinical team offers a full continuum of personalized outpatient care, involving partial hospitalization programs, intensive outpatient programs, and telehealth services that provide structure and flexibility for an active, intentional healing journey.

Please contact us at (323) 307-7997 to connect with our experts today.

Can HOCD or SO-OCD symptoms shift or change themes over time?

SO-OCD may evolve into other obsession types if the core obsessions and compulsions are not treated early.

Is reassurance from romantic partners or loved ones helpful for HOCD?

While seeking reassurance from others in life may provide relief, it is only temporary as this can reinforce compulsive behaviors in the long run.

Can social media or online content impact HOCD symptoms?

Constant exposure to triggering or content related to identities can intensify intrusive thoughts and self-doubt.

How can someone support a loved one with HOCD without reinforcing compulsions?

By encouraging reaching out to licensed therapists or counselors and avoiding repeated reassurance, one can

support their loved one with SO-OCD without reinforcing their compulsions.

When should someone seek professional help for HOCD symptoms?

If intrusive thoughts and compulsions begin interfering with daily functioning, relationships, or emotional well-being, it can be an indication to reach out to licensed and experienced mental health specialists.