Homosexual & Sexual Orientation OCD: Not as Uncommon as You Might Think
OCD is a wildly misunderstood illness, frequently looked at as a minor condition marked by an obsession with symmetry, organization, and hygiene. However, OCD is neither minor or common (2.3% of the adult population suffers from it). What’s more, although OCD can involve obsessions in the aforementioned areas, it’s never limited to order or contamination. In fact, OCD involves obsessions about anything.
One rarely-discussed area where OCD is known to latch on includes sexuality. Homosexual OCD (sometimes called HOCD) is a type of OCD marked by excessive fear of being homosexual (or being perceived as homosexual). Sufferers may exhibit intrusive images of homosexual behavior that lead to compulsive checking.
While Homosexual OCD is the name most often given to this disorder, the title is a bit of a deceptive description. That’s because this type of OCD isn’t limited to the straight population: Members of the LBGT community may experience it too. When they do, their disorder manifests as fears and worries that they are heterosexual.
Because of this, Homosexual OCD is more accurately described as Sexual Orientation OCD. We will use both descriptions in the context of this article.
Check out our video on HOCD!
OCD: The Fine Print
In order to understand HOCD/Sexuality OCD, it’s important to understand OCD as a whole. So, what is it? A reflection of personal reference? Neuroses? A personality quirk? No, no, no. OCD is a mental illness that leaves the sufferer stuck inside a vicious cycle of obsessions and compulsions. Obsessions manifest as intrusive images, thoughts, ideas, and urges that elicit terror and torment. Compulsions are the behaviors the sufferer adopts in an effort to control the anxiety the obsessions cause.
For example, in HOCD/Sexual Orientation OCD, the sufferer may have an intrusive image of engaging in sex with a gender they’re not attracted to (this is the obsession). They may then check to make sure this attraction isn’t real, perhaps by staring at someone from that gender and looking for signs of arousal in their body (this is the compulsion).
The compulsion provides relief but it’s short-lived; OCD is a disorder that is never content and never satisfied. It doesn’t want the sufferer to check once or twice; it wants them to enter a cycle of checking. This is why OCD sufferers feel stuck – they’re stuck inside this cycle, a cycle so vicious it feels as though it takes a life of its own.
Intrusive Thoughts Aren’t Just an OCD Thing
OCD involves intrusive thoughts; if this disorder were a recipe, these thoughts would be the main ingredient. But it’s not only people with OCD who experience unwanted images and ideas.
Intrusive thoughts are normal in everyone, whether or not you have a mental illness. Yet the difference between the normal brain and the OCD brain is that the person without OCD doesn’t pay these intrusive thoughts any mind. And that prevents them from having power.
People with OCD do the opposite: They take these thoughts of nonsense seriously. They don’t believe the thoughts entirely; that’s one of the most interesting things about OCD – the sufferer is aware that they’re being irrational. But the thoughts persist and pester until the sufferer isn’t 100% sure that they’re not real (and OCD requires 100% certainty).
OCD is great at the “What if” game? What if I’m gay? What if I’m straight? What if I’m bi or asexual? And it’s this “what if” that grabs onto the OCD sufferer and refuses to let go. Its grasp is so tight that it causes anxiety, ultimately leading to compulsions and worsening the disorder.
The Specifics of HOCD/Sexual Orientation OCD
HOCD/Sexuality Orientation OCD manifests as obsessions and compulsions centered around sexual orientation. Sufferers with this type of OCD experience intense, vivid, and unwanted thoughts in regard to their long-standing sexual orientation. They fear an unwanted attraction so much that they seek out proof to reassure that they’re fears aren’t real.
When HOCD/Sexuality Orientation OCD is experienced by a straight person, it centers on doubts that they’re not really strait and involves fears that they’re attracted to members of the same sex. When HOCD/Sexuality Orientation OCD is experienced by a gay person, it centers on doubts that they’re not really homosexual and involves fears that they’re attracted to members of the opposite sex.
HOCD/Sexuality Orientation OCD also shows up in members of the bisexual community. When it does, sufferers may question whether they’re truly bi, fearing that they may only be attracted to one gender.
Importantly, this type of OCD is not the same thing as a sexual identity crisis; it’s not the same thing as repressing your innate sexuality, either. We’ll explore this more later in the article.
In essence, HOCD/Sexuality Orientation OCD isn’t really about sexuality at all; like all types of OCD, it’s driven by doubt. Sexuality, in this case, is simply where the doubt decided to burrow in. It’s not about homophobia either; while straight sufferers may experience feelings of guilt and shame as a result of their intrusive thoughts (especially if they were raised in religious households and taught that being gay is a sin), homosexuality in others doesn’t tend to bother them.
HOCD/Sexuality Orientation OCD is often linked to another type of OCD, Relationship OCD. In the latter, the sufferer experiences worrisome and troubling thoughts about their relationship; they may constantly worry about cheating on their spouse or their spouse cheating on them, they may ask for reassurance that everything in the relationships is okay, and they may behave a specific way because they think it’ll keep their partner from leaving.
When HOCD/Sexuality Orientation OCD and Relationship OCD merge, the sufferer may experience doubts about their relationship that are compounded by doubts about their sexual preference. A man, for example, may worry that he’s not really in love with his wife because he’s secretly attracted to other men. Or a woman in a lesbian relationship may fear that she’s not in love with her wife because she’s really straight.
HOCD/Sexual Orientation Incidence
Depending on the source, HOCD/Sexual Orientation OCD may be described as both rare and more common than people think. It’s difficult to say how habitually it truly presents because of the secrecy involved.
OCD sufferers who experience Contamination OCD or Relationship OCD are usually more open about their OCD because it feels safer and accepted by society. But, when OCD involves sexuality, pedophilia, or harm, it adds another layer of shame.
HOCD/Sexual Orientation OCD sufferers don’t regularly speak about their disorder (at least not with any candidness), making it impossible to know the accurate incidence. Even so, OCD conventions and conferences are filled with people suffering from sexual orientation doubts, which makes it easy to assume that it is – indeed – more present than realized.
Common HOCD/Sexual Orientation Obsessions
People who have OCD are well aware of its unique ability to get highly creative in its intrusion, regardless of how this disorder presents. Sufferers of HOCD/Sexual Orientation OCD are no exception, which means they experience all kinds of obsessions from the plain to the truly imaginative.
Still, there are certain obsessions most common in this type of OCD. Including:
- The sufferer may worry that they’ll get aroused by looking at someone from the same sex (or that they’ll get aroused by someone from the opposite sex if the sufferer identifies as homosexual)
- The sufferer may experience graphic fantasies that bring about terror, fear, and angst
- The sufferer may wonder if they are really straight (or if they are really gay or bi)
- The sufferer may have an intrusive thoughts about dating or being intimate with a gender they’re not really attracted to
- The sufferer may fear sending out signals of attraction to members of the same sex (or members of the opposite sex in homosexual sufferers)
- The sufferer may worry about ruining their current relationship because they fear they’re suppressing their sexuality
- The sufferer may worry that any preexisting issues in their relationship are signs they’re living the wrong sexual identity
- The sufferer may worry that they won’t be able to perform sexually because of their latent sexual orientation
- The sufferer may worry about their sexual identity changing
- The sufferer may fear that they’re in denial about their sexuality and that they don’t actually have OCD
Like other types of OCD, HOCD/Sexual Orientation OCD involves some aspects of “magical thinking.” This is the process of assuming something will happen because of a thought, a word, or an action. For example, a straight woman suffering from HOCD/Sexual Orientation OCD may fear that saying the name of a beautiful, female coworker will turn her gay. A straight man may fear that he’ll become gay unless he organizes the cups in his kitchen cabinet a particular way, lining them up in straight rows that assure he also stays straight too. A gay man may think that liking football will make him straight. A gay woman may think that high-fiving a good-looking male friend will take away her attraction to women. A bi-sexual sufferer may think that reading a masculine book will sway their preference to one gender.
Common HOCD/Sexual Orientation OCD Compulsions
Because obsessions are so unsettling and cause so much anxiety, sufferers look for a way to counteract them; this is where compulsions, rituals designed to decrease anxiety, come in.
Compulsions are highly time-consuming and interfering to life. Though they reduce anxiety, they make OCD worse in the long-run (compulsions are really OCD’s best friend). What’s more, the reduced anxiety is temporary and it reappears after a while. That leads the sufferer to repeat the compulsion again and, eventually, again and again. This is why compulsions are rituals and not one-time things.
Compulsions, like obsessions, are individualized and vary from person to person. However, the most common ones that presents with HOCD/Sexual Orientation OCD include:
- Avoiding events in social settings
- Avoiding public transportation or places with crowds
- Refusing to date
- Questioning sexuality compulsively
- Adopting behaviors that change the sufferer’s image (for instance, an effeminate straight man may go out of his way to adopt characteristics incongruent to his true personality, such as riding a motorcycle, talking crassly about women, or getting a tattoo)
- Refusing to say specific words (gay, straight, queer)
- Having homosexual or straight sex to test the level of attractiveness (this usually only happens in extreme cases)
- Praying, counting, or organizing household items a certain way so that the sufferer assures they remain straight (or remain gay or bi)
- Repeating actions because of the fear that it gave off the wrong kind of vibe (for instance, a straight woman may re enter a room, feeling as though she walked in too manly before)
- Avoiding specific types of clothes, fashion, music, and style (a gay woman may avoid growing her hair out, believing long hair makes her straight)
- Repeating self-assurances (i.e., “I’m not gay” or “I’m not straight” or “I am not only attracted to women”)
- Thinking of imaginary scenarios to see how they’d react
- Ruminating on past experiences to gauge whether they revealed any signs of homosexuality or heterosexuality
- Fantasizing compulsively about straight sexual encounters (if the sufferer is heterosexual) or gay sexual encounters (if the sufferer is homosexual)
- Compulsively looking at pornography that aligns with their identified orientation (here, the sufferer is checking to make sure they like it)
- Compulsively looking at pornography that counters their identified orientation (here, the sufferer is checking to make sure they don’t like it)
- Asking others for reassurance
- Manipulating others into making comments about their sexuality
Arguably the most common compulsion involves looking at people, thinking about people, or studying photos featuring people of the same sex (or the opposite sex when the sufferer is homosexual) and checking for signs of arousal (typically referred to as “groinal responses”).
Naturally, this creates its own problem. The HOCD/Sexual Orientation OCD sufferer may feel a twinge in their groin when they think of members of the same sex or members of the opposite sex. Then again, they may feel a twinge in their groin when they think of a piece of broccoli. It’s not the subject matter that’s causing the reaction; thinking about the groin in whatever capacity can cause a response, even when no sexual element exists.
Groinal responses are talked about frequently in the OCD community, with discussions of why they happen a hot topic. The reasons theorized include:
- For no known reason
- Fear: Fear changes blood flow to the groin, possibly causing a reaction
- Chemical changes in the body as a result of biology or lifestyle
- Joy: Joy activates the body and makes it more responsive to sensation
- Focusing attention on the groinal area: This increases sensitivity and awareness
What Causes HOCD/Sexual Orientation OCD?
People with OCD, regardless of type, have brains that function abnormally; there are problems with communication in parts of the brain, such as the orbitofrontal cortex, the anterior cingulate cortex, the striatum, and thalamus. Neurotransmitters, the body’s chemical messengers, factor in too; OCD sufferers have low levels of serotonin and dopamine, which is why antidepressants – medications that increase these chemicals – may be effective.
Historically, research has focused on these two neurotransmitters, but recent studies suggest that glutamate may play a significant role in OCD, too. Glutamate is plentiful in the brain; it’s the most excitatory neurotransmitter and influences the how well nerve cells communicate with one another. But, in the OCD brain, it’s more abundant.
Researchers aren’t entirely clear why this is – whether high levels of glutamate are a cause of OCD or a symptom of it. However, studies point to the former, a hypothesis that’s led to the exploration of more medications.
While an abnormal brain or a miscommunicating nervous system can lead to OCD symptoms, it’s hereditary that kicks things off, causing abnormalities in the first place. The serotonin transporter gene (hSERT) is mutated in some OCD sufferers, interfering with the transport of serotonin between neurons.
Perhaps that’s partly why OCD tends to run in families, popping up within immediate family members 25% of the time. It’s even more common in identical twins; if one twin has it, there’s a 90% chance the other will, too. This speaks to a strong genetic link, since identical twins have very similar DNA (recent research has discovered that their DNA is not identical as previously thought as it’s influenced by environmental factors).
This isn’t to say genetics are the sole factors in OCD development, but they matter heavily. There are other determining aspects, such as behavioral conditioning. These are the compulsions adopted by the sufferer in an attempt to keep their anxiety at bay. They effectively keep OCD going, turning the intrusive thought into a full-blown disorder. Without compulsions – whether physical or the mental ones seen in Pure O – OCD won’t persist.
Factors that May Lead to OCD’s Onset
OCD is more common in adults than it is in children; even adults who have severe cases can have childhoods relatively free of the disorder. Generally, there are two times in life when it pops up most frequently. The first time is between the ages of eight and 12 when puberty takes hold; the second time is at around age 19 or 20 (late childhood and early adulthood). It’s rare for OCD to present for the first time after the age of 50, though it may happen. Technically, OCD can appear anytime and anywhere.
Genetics, as discussed above, partially dictate whether someone gets OCD, but there are things that act as triggers as well. Times of transition are among the most common; interestingly, transition can trigger OCD whether it’s a sad or happy change (such as starting an exciting new job). Emotional and physical trauma can trigger it too (especially the death of a loved one or a head injury).
In kids, a condition called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) causes OCD symptoms to appear literally overnight and completely out of the blue in predisposed populations. Unlike true OCD, it’s treatable with antibiotics (as well as the other typical OCD treatments). It may take a while, but most children recover fully as long as they get the proper treatment. Of note, it can reappear whenever the child has strep.
Children with OCD can also get PANDAS whenever they’re dealing with strep. When this happens, their symptoms worsen, becoming dramatically more severe.
Same Disease, Different Flavors
It’s been said that people with OCD are all driving on the same highway, they’re just riding in different cars. One car may focus on contamination, where another is concerned with sexuality. One car may be filled with relationship worries, where another is consumed by fear of harm.
It’s not clear why some people with OCD suffer from one type (or “flavor”), while others suffer from another type. But – in regard to HOCD/Sexuality OCD – there may be a few things that play a role, including:
- Religion – Those who grow up being told that homosexuality was a sin may be more likely to suffer from fear of it in themselves
- Low self-worth
- Traumatic dating experiences
- Abusive relationships
The Power of Dysfunctional beliefs
Sufferers of HOCD/Sexual Orientation OCD possess dysfunctional beliefs (as do sufferers of all flavors of OCD). These beliefs carry tremendous weight and help give OCD its power.
The Obsessive-Compulsive Cognitions Working Group lists six types of dysfunctional beliefs common in the OCD mind. These include:
- Responsibility: OCD sufferers believe it’s their responsibility to prevent bad things from happening. Someone suffering from HOCD/Sexual Orientation OCD may believe that their feared sexuality will destroy their family, ruining their children’s lives. Thus, they make it their responsibility to assure that doesn’t happen.
- Thought-Action Fusion: Thought-action fusion (part of the magical thinking previously discussed) involves the belief that thinking about something will cause it to happen. In HOCD/Sexual Orientation OCD, the sufferer may believe that thinking about a same-sex celebrity will cause their sexuality to change.
- Control: If OCD sufferers could control their intrusive thoughts, they wouldn’t have OCD! Since this is an impossibility, any attempt to seize control only strengthens the intrusive thought and locks it inside the mind. A lesbian suffering from HOCD/Sexual Orientation OCD who tries to control thoughts about men will experience the same type of thought more often. It’s simple, really: The more you try not to think about something, the more you will.
- Overestimation: OCD suffers buy into their intrusive thoughts, paying attention to them instead of dismissing them as meaningless. But they overestimate these thoughts too. In HOCD/Sexual Orientation OCD, a straight woman may think her attraction to her female boss means she’s gay. Yet, in reality, same-sex attraction happens all the time, even in platonic situations. Attraction is by no means purely sexual.
- Perfectionism: You can be a perfectionist and not have OCD, but perfectionism is common among sufferers. In HOCD/Sexual Orientation OCD, a gay man may feel as though he needs to organize his clothes just right, believing that he’ll become straight if he doesn’t.
- An inability to tolerate uncertainty: Uncertainty is the most prominent theme of OCD (side bar: What rock band is the favorite among OCD sufferers? No Doubt). People with OCD feel as though they “have to know” and they’re unable to tolerate ambiguity. In HOCD/Sexual Orientation OCD, sufferers are consumed with proving that they know their sexuality, beyond all question.
An Ego-Dystonic Disease
OCD is an ego-dystonic disease: It is separate from self and goes against the values, morals, and desires of the sufferer. That’s extremely important to recognize, specifically when dealing with Harm OCD and Pedophilia OCD, but it plays a role in HOCD/Sexuality OCD as well.
To the untrained eye, HOCD/Sexuality OCD can look a lot like a sexual identity crisis or someone struggling with the idea of coming out. Yet there are several difference between the two.
Someone in the middle of a sexual identity crisis will experience thoughts and images that align to their true sexual orientation; these thoughts are ego-syntonic and parallel to one’s desires. Conversely, those suffering from HOCD/Sexuality OCD get no pleasure or enjoyment from their thoughts – they are opposite of their true desires.
Furthermore, someone repressing their sexuality may have a past marked by sexual experiences that speak to their true orientation. They prefer to date and have romantic encounters that align to this orientation. And they typically report feeling different than their peers in childhood.
In therapy, doctors might ask questions to try to determine the differences between the two. These might include:
- Have you ever had romantic feelings for members of the same sex (or the opposite sex in the case of someone who identifies as homosexual)?
- What kinds of people do you look at when out in public or visiting swimming pools?
- Who do you see yourself marrying?
- What are your feelings about homosexuality?
The last question speaks volumes: Typically, those who are closeted vocally speak out against homosexuality whereas those suffering from HOCD/Sexuality OCD aren’t against homosexuality in others, even if they fear it in themselves.
What Doesn’t Cause Homosexual/Sexuality OCD?
Science isn’t entirely sure what causes OCD to latch onto one person and leave the other alone. But it has learned, through all of the research, what doesn’t cause it.
In the past, it was believed that the way moms and dads potty-trained their child affected OCD (an idea first theorized by Sigmund Freud). If the parent was controlling or domineering, their child was more likely to be diagnosed. Nowadays, that theory has been flushed down the drain and potty-training isn’t believed to play any role in incidence. Parents, aside from the genes they pass on, aren’t believed to cause OCD at all.
Other things that don’t cause it include:
- Stress: Stress can exacerbate OCD but it won’t cause it to manifest in people who don’t have it.
- Families: Families don’t cause OCD either, though they can also exacerbate its symptoms. This most often happens in two ways: By helping the sufferer perform compulsions (which strengthens the OCD cycle) and by criticizing or shaming the sufferer (which causes stress, worsening symptoms along the way)
- Diet: Gluten, caffeine, and sugar won’t cause OCD, but they may increase symptoms in some people. Individuals may benefit from tracking their diet and noticing if their symptoms worsen when they consume these types of food.
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Misconceptions About HOCD/Sexual Orientation OCD
The most common misconception about HOCD/Sexual Orientation OCD is that it’s caused by homophobia in straight people or a fear of heterosexuals in gay people. However, this isn’t the case.
It’s also a misconception that the sufferer of HOCD must come from a strict religious background or belong to a community known for ostracizing homosexual members. While these factors can contribute to HOCD, many sufferers have no religious affiliation and many believe they’d enjoy wide acceptance among family and friends if they were gay in real life. The same can be said for homosexual sufferers experiencing heterosexual thoughts.
Another misconception, addressed previously in this article, is that the HOCD/Sexual Orientation sufferer is simply in denial about their true sexuality. Even medical professionals perpetuate this untruth. It’s not all that uncommon for a sufferer to seek help for their feelings and then hear, from underqualified or entirely unqualified clinicians, that they just need to come to terms with who they really are. This is why it’s so crucial for sufferers to make sure the therapist they choose specializes in OCD (more on that below).
The concept of attraction is misunderstood as well in regard to HOCD/Sexual Orientation OCD. Sufferers erroneously assume that straight people are never attracted to members of the same sex and gay people are never attracted to members of the opposite sex. They may also assume that all attraction is sexual attraction, an all-or-nothing notion that lacks credibility.
For example, many women are attracted to other women without any element of sexuality – they seek each other out for conversation, advice, and friendship. Science is paying more and more attention to this, with some people theorizing that platonic relationships among women are more important than marital ones between woman and man.
Other common OCD misconceptions aren’t limited to the HOCD/Sexual Orientation type but apply to OCD as a whole. These include:
- OCD is a minor illness
- OCD is a quirky personality trait
- People with OCD are neurotic
- People with OCD can turn off their intrusive thoughts
- People with OCD are anal-retentive or picky
- OCD is always about order, organization, and handwashing
- People who claim they’re “so OCD” because of personal preference actually have OCD
- Everyone is a little bit OCD
- OCD is annoying (conversely, OCD torments its sufferers rather than merely pestering them)
Treatment for HOCD/Sexual Orientation OCD
Though OCD is considered a treatable condition, there is no magic potion that cures it. There are medications that certainly help, but they don’t eliminate the disease entirely the way antibiotics eliminate strep or staph.
The intention of treatment isn’t to cure OCD (as it’s not frequently curable), but to control its symptoms. In order to do this, sufferers must seek out professional help. While it’s possible for someone to treat OCD on their own, it’s not generally effective and thus not recommended.
There are several common treatments and medications used for OCD, including:
CBT with ERP: Cognitive behavioral therapy (CBT) is considered the gold standard of OCD treatment. Exposure and response prevention (ERP) is typically used when working with sufferers. During ERP, patients expose themselves to their anxiety-provoking thoughts and then they refrain from doing any compulsions (mental or physical).
For example, the HOCD/Sexual Orientation sufferer concerned with being gay may be asked to stare at a picture of someone from the same sex. Then, they’re instructed to avoid any sort of checking, neutralizing, or reassurance-seeking behavior. They should not study their body for signs of arousal, for instance.
On paper, ERP comes across as simple and easy but it’s extraordinarily hard for the sufferer. Refraining from performing the compulsion causes intense and overwhelming anxiety and worry and too much too soon risks the sufferer giving up. ERP exercises work best when they’re done gradually, dipping a toe in the pool instead of diving headfirst into the deep end. Ideally, the sufferer is placed in scenarios that are more tolerable before moving onto challenging ones.
At its root, ERP is about accepting uncertainty (something that’s extremely hard for the sufferer). The intention of the exercise is not to prove that the sufferer is straight or to prove that they are homosexual or bi; rather, it’s to get the sufferer to accept the idea of not being 100% sure either way.
Medication: Not everyone with OCD benefits from medication, but most do: About 70% of people respond. Even when medication is helpful, it doesn’t eliminate the intrusive thoughts entirely and that’s okay! Medication is used to take the sting away from the thoughts, dulling them so they aren’t as potent in the person’s mind.
On its own, medication is only somewhat helpful, which is why it’s almost always coupled with ERP. Medication reduces the severity of the thoughts enough that the ERP exercises are easier to manage. And that’s when true healing takes place.
Not all medication is appropriate for all sufferers. Those with preexisting conditions or who are already taking other medication must practice extra caution with any pharmaceuticals.
Even people taking over the counter herbs may put themselves at risk if they combine those herbs with prescription meds. St. John’s Wart, something found on the shelves of any drugstore and used to boost mood, increases serotonin in the bloodstream. Because antidepressants do this as well, combining the two increases the risk of Serotonin Syndrome. This condition is the result of too much serotonin in the body; it ranges in severity from mild to fatal.
Age is a factor too, as children, teens, and young adults are at risk of suicide when taking certain antidepressants. The risk is most evident when the medication is new or the dosage increases.
Keeping the above in mind, there are common drugs that acts as the first-line of treatment. Typically, these medications are Serotonin Specific Reuptake Inhibitors (SSRIs), a type of antidepressants that increase serotonin (which OCD sufferers are lacking). These drugs include:
Anafranil (or Clomipramine) is used too. It’s not an SSRI but a tricyclic antidepressant. The benefit of Anafranil is that it appears to be especially effective in treating OCD. The downside is that it comes with side effects, including the risk of an irregular, rapid heart rate. So, it might not be appropriate for someone with a heart condition or other medical issues.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs related to SSRIs) are used too, as they work to increase both serotonin and norepinephrine in the brain. These drugs include Venlafaxine (Effexor) and Duloxetine (Cymbalta).
Some sufferers find relief through treatments that are not specifically approved for OCD (at least not by the FDA though medical doctors prescribe them often).
Several of the off-label medications used (as standalone or supplemental treatment) include:
Medication that works for one person might not work for another. The efficiency of any given pill is usually dictated by genetics and some people, namely those who are ultra-rapid metabolizers, may find the SSRIs prescribed inadequate.
Ultra-rapid metabolizers aren’t common (only about 5-8% of the population fits this category) but it’s important for the OCD sufferer to know their status.
They (and anyone else interested) can learn what kind of metabolizer they are through a genetic study that uses saliva to generate a profile. This is covered by many insurance companies and, when done, allows the sufferer to save time and avoid frustration by side-stepping any medications that don’t work with their body chemistry.
Hanging Out with Homosexuals/Heterosexuals: One type of treatment that’s specific to HOCD/Sexual Orientation OCD is the concept of befriending homosexuals (if the sufferer is straight) or heterosexuals (if the sufferer is gay).
The idea is to recognize that being gay or straight is really no big deal; the sufferer recognizes that homosexuals and heterosexuals are all human, regardless of sexual preference and this recognition reduces the power of the intrusive thoughts.
This treatment is somewhat unique to this specific type of OCD. In other types, it’s not possible. For example, if the OCD sufferer suffers from Harm OCD and fears being a serial killer, no one’s going to recommend that they hang out with serial killers to see how normal they are. In other words, this treatment works in HODC/Sexual Orientation OCD because there’s nothing wrong with sexual orientation, regardless of what it is. The same can not be said for murdering.
Likewise, sufferers may be encouraged to learn about homosexual culture (or heterosexual culture), attend pride parades, or read LBGT magazines. This acts as an exposure as well as further showing the sufferer that there is really nothing to be afraid of.
ACT Therapy: ERP remains the first-line of treatment for many, but Acceptance and Commitment Therapy (ACT) is becoming more common in the fight against OCD. ACT focuses on accepting intrusive thoughts and feelings instead of reacting to them. The ACT patient learns to see their thoughts as what they are: Thoughts and nothing more. They learn to accept these thoughts through clever imagery (such as imagining the thoughts on a movie screen) as well as by separating them from the sufferer.
The person with OCD may be asked to write their thoughts down on a piece of paper, giving themselves the chance to view them as thoughts and not actions or anything meaningful.
ACT uses psychological flexibility, mindfulness, compassion for self, and overt acceptance. Suffers are encouraged to look at their thoughts as dispassionately as possible, believing their thoughts are boring, yawn-inducing irrelevancies.
For example, in HOCD/Sexual Orientation OCD, the sufferer may believe that reading the word “gayeties” will turn them homosexual. Instead of challenging or talking back to the thought, the sufferer is asked to say, “I’m simply having a thought that reading the word ‘gayeties’ will make me homosexual.” By labeling it as a “thought” (which, of course, it is), the sufferer can detach, removing the thought’s power.
This detachment is really a key to controlling OCD symptoms. OCD wants the sufferer to react, to pay it attention, to worry and fret at anything it tells them. If the sufferer successfully stops reacting to OCD, then OCD will stop trying to get a reaction. The old adage “ignore it and it’ll go away” applies to OCD in spades.
Lifestyle: It’s hard to control OCD without professional help but maintaining a healthy lifestyle limits OCD by limiting overall stress and maximizing wellness.
It’s recommended that OCD sufferers:
- Eat a diet rich in fruits, veggies, and whole grains
- Minimize red meat and fatty foods
- Exercise regularly (ideally, daily)
- Engage in mindfulness, meditation, or yoga (again, daily is the ideal)
- Limit coffee and other sources of caffeine
- Work with a therapist weekly (a consistent routine is much better than seeing a therapist sporadically)
- Take part in support groups
- Maintain social relationships and talk to friends and family openly about their OCD
- Limit consumption of alcohol, tobacco, and other unhealthy substances.
TMS: A new form of OCD treatment is Transcranial Magnetic Stimulation (TMS). This is commonly used to help people with major depressive disorder, but providers are using it to treat OCD too. It may prove beneficial for people who can’t find relief through conventional means.
TMS is non-invasive; it’s not brain surgery but rather a procedure that uses magnets. With these, TMS can regulate the deeper parts of the brain associated with OCD.
TMS is a commitment, albeit a short-term one. It requires an hour of treatment, five days a week, for several weeks (between four and six weeks total). Because the effects tend to wear off, a maintenance program is encouraged. This isn’t as intensive but requires similar consistency.
Finding an OCD Therapist
OCD is a hard disorder for the sufferer to manage on their own. Professional help is almost always needed to give sufferers guidance and a foundation upon which they build.
Unfortunately, OCD is wildly misunderstood and not only by the layperson: Medical professionals misunderstand it too. Many treat it anyway, a choice that leaves the sufferer with worsened symptoms and, in some cases, real trauma.
With so many clinicians doing the above, the sufferer must engage in their own due diligence to make sure they pick a therapist who will help and not harm.
The most important thing to look for is a therapist who specializes in OCD (be wary of those who claim to treat it but don’t treat it as their specialty). Treating practitioners should also have completed intensive OCD-programs, training, and classes. A general understanding of OCD is never enough.
To look for a clinician with this criteria, visit the International OCD Foundation’s directory. Sufferers can search for providers by location to find someone nearby.