Photography by Ethan Hill.
At the age of 13, Olivia Loving considered coming out as a lesbian. It was not a happy thought. Only the year before, she had developed her first crush, on a boy, and it had filled her with the same nervous excitement of any preteen girl in love. She fantasized about holding his hand, maybe even kissing him. But now Loving was plagued by graphic sexual fantasies about her female classmates. It began in September, volleyball season, with her obsessing over thoughts of grabbing their breasts. She was overwhelmed with crude mental images of performing oral sex on them. And at the same time her brain rattled with other disturbing thoughts about committing violence against people, harming children, and murdering her mother.
She retreated into her Catholicism, believing it was the only way to control her dark thoughts, and prayed each night that she wasn’t gay, and that she wouldn’t kill anyone.
“I think so many people, especially kids, are suffering silently across the country,” says Loving, now 24 and a writer who works at New York’s Strand bookstore. “It’s not that I was afraid to be gay — when I was 10 years old I wrote a paper supporting gay rights — it’s that I was resigned to a life I felt I would get no pleasure out of.”
At 18, Loving finally told someone the detailed nature of her violent and sexual thoughts. She attended a private, conservative high school in North Palm Beach, Fla., and confided in a teacher with whom she was close. Fearing she was a threat to students’ safety, the teacher reported the conversation to the school’s administration. (Loving says the school had also, at the time, banned an LGBT club from forming.) Loving was suspended, but allowed to return to school days later with a note from a therapist.
Three years later, while she was living in England, Loving learned that she was neither homicidal nor a lesbian. She had just been diagnosed with obsessive-compulsive disorder, and during a Google search she came across a strange acronym: HOCD, or homosexual obsessive-compulsive disorder, also called gay OCD, or SO-OCD, as in “sexual orientation OCD.”
In the United States, about one in 40 adults and one in 100 children — roughly 1% of the population — suffers from OCD, a condition characterized by debilitating obsessions and mental and physical compulsions that consume at least one hour a day, and often more. The public’s misconceptions of OCD are staggering, largely due to the way the condition is treated in popular culture — the highly organized neurotic, the obsessive hand-washer. And although there are no hard data, some suggest that HOCD and other sexual obsessions are common types of OCD. According to Dr. Fred Penzel, a psychologist on Long Island, N.Y., and author of the book Obsessive Compulsive Disorders, it might afflict as many as 10% of OCD sufferers.
“OCD, in the 19th century, used to be called the ‘doubting disease,’ and that’s really at the heart of many people’s OCD: extreme doubt and uncertainty,” says Penzel, who has treated OCD for 35 years and is a leading specialist in HOCD. “OCD can also make people doubt their sexual identity. It’s a real phenomenon that affects a lot of people, and no one has any idea how many people are affected by this. I get e-mails from India, China, Saudi Arabia, Africa — all over the place. The overwhelming majority of e-mails I get are on this particular type of OCD.”
For a 26-year-old California man, who asked to be identified only as Michael, it began at age 16 while he was sitting next to another student in class in high school. “The thoughts I think I had were, Why is my leg so close to his leg?” he says. “And it just spiraled from there.” At the time, Michael says, he was homophobic and began to compulsively search the Internet for coming-out stories and anecdotal online quizzes that test “How gay are you?” He evaluated his attraction to women constantly. He soon developed an out-of-control obsession with watching gay pornography to check if it could arouse him. He says it did not, but the uncertainty remained and became so extreme he considered suicide. He adds that, once or twice while watching gay porn, he did have an orgasm.
“That was a terrible, terrible choice on my part,” he says. “I gave OCD a massive weapon to fight against me, and I suffered for it. I went further down the rabbit hole. I knew I always wanted to go back and look at women. Women got me more excited than men did.”
This behavior is known as “checking,” which is essentially no different from the person who flips the light switch repeatedly. Michael never attempted to have sex with another man, but, like watching porn, many experiencing HOCD do engage in sexual activity as a form of checking, behavior that throws their doubt into overdrive. Even if a person is certain they didn’t enjoy the sex, the relief is short-lived, and doubt soon creeps in that, perhaps, the next time will be enjoyable, or the next.
When psychologist Dr. Monnica Williams moved to Kentucky five years ago, she says she was the only mental health practitioner in the state who specialized in OCD. She opened the Louisville OCD Clinic, one of only a handful of outpatient clinics in the country specializing in OCD. Until fairly recently, some online forums for OCD prohibited people from posting about HOCD because of the overwhelming skepticism as to whether it was real.
“There’s a lot of misunderstanding,” Williams says. “Some folks say, ‘It’s not really OCD — these people just need to come out of the closet.’ Others say, ‘[Treating HOCD] is no different than reparative therapy.’ It was really hard to combat some of the criticism because there was nothing in the scientific literature about this form of OCD.”
“That’s not really the case,” Williams says. “Some people are homophobic, because of their religious concerns or how they were brought up. But we see plenty of people who don’t have anything against being gay — they just aren’t gay. Yet they keep having these unwanted thoughts about it. I think a lot of people commit suicide. I’ve had a number of people tell me, ‘I was getting ready to kill myself before I found you.’ ”
In a paper published in 2008, which she says was the first of its kind on HOCD, Williams interviewed an unnamed young man.
“I have been diagnosed with OCD for a while now. The therapist I was seeing told me that I should try to be with a man, and that everybody is bisexual,” he says. “It really freaked me out, and I was suicidal for five months thanks to what she said. The thoughts grew even stronger. Eventually, I couldn’t be with any person of the same sex alone in the same room, watch TV, read the newspaper, or listen to music with male voices. I’m amazed that I’m still in this world after that experience.”
Dr. Richard Montoro, a psychiatrist at the McGill University Sexual Identity Centre in Montreal who specializes in helping LGBT people come to terms with their sexual orientations and gender identity, saw his first case of HOCD two decades ago; a man came to him convinced he was gay because of the shape of his eyebrows. By the end of the session it was clear to Montoro the man was suffering from OCD.
Since then, he’s seen only a handful of similar cases at his clinic. “We might encourage them to spend a night in the Gay Village here in Montreal, or have dinner with same-sex-identified people — that intervention would be to reduce the anxiety around the possibility of being gay,” Montoro says, a technique that would coincide with other therapies. “You need to undo the avoidance. The checking behavior usually isn’t about other gay people, it’s about the individual.”
Therapy proved successful for Michael, the 26-year-old Californian who learned to control his HOCD. He considers himself an ally of the LGBT community, namely because of this experience. “I think it’s important to know that anxiety or emotion is like gravity,” he says. “What goes up must come down.”
But from time to time he relapses into other types of sexual OCD, including, and among the most anguishing forms, pedophile OCD, or POCD, characterized by a debilitating fear of harming or molesting children. “There’s been almost nothing written about pedophile OCD,” Williams says. “People who have it are very frightened. I had a patient who was suicidal, and when his spouse brought him to the emergency room and he opened up to a clinician about what he was experiencing, the doctor called social services and he wasn’t allowed to be around his child.”
It is unknown why people with OCD develop the obsessions they do, but most are characterized by intrusive negative thoughts. Gay people, however, are also proportionately affected by what might be called straight OCD, consumed by thoughts they might be heterosexual — Penzel has treated several such patients, including one lesbian who had a wife and children and came close to ending her marriage.
In all cases, symptoms tend to develop rapidly, triggered by a precise moment, such as seeing an attractive actor in a movie, having bad sex with your spouse, reading a news item about gay rights, or learning of a friend or family member coming out of the closet.
Paradoxically, psychologists believe increasing acceptance and an explosion of LGBT people in media and pop culture are making HOCD harder to treat. Many well-intentioned but uninformed therapists, believing their patients are merely in the closet, will encourage them to get out there and try it.
“I’ve seen people sent through all sorts of inappropriate therapies to help them explore and discover their true sexual identity when, in fact, it was never the case,” Penzel says. “It makes the person even more doubtful and does a lot of damage. Some people have this thought that they’ll never know their true sexual identity, and it can affect their ability to have relationships. They become reclusive.”
OCD occurs on a spectrum of severity. For most, a mixture of cognitive and behavioral therapy is the most effective treatment because it forces patients to mentally engage with their fears until reaching the point where those fears begin to feel benign. Antidepressants and SSRIs are often effective in treatment. In the most severe cases, brain surgery may be required.
So-called gay-reparative-therapy camps, which have been outlawed in some states, may be getting a spike in business from youth and adults suffering from HOCD, many of whom come from conservative, religious backgrounds.
Mark-Ameen Johnson, 51, an openly gay man and an English-language professor at New York University, has experienced many types of OCD, beginning in childhood, that included natural-disaster OCD, extremist-religion OCD, and health OCD.
“The wackiest one is when I assumed something was wrong with my brain because, without any training, I should be able to read Latin,” he says. “This makes no sense. People with OCD are aware it makes no sense, but it feels real.”
We’re sitting on a bench in New York’s Lesbian, Gay, Bisexual and Transgender Community Center, and Johnson tells me that on his way over, his OCD crept in. What if he doesn’t show up? he thought. What if this is all a joke? Before sitting, he checks the bench for bedbugs. “But that one is not really unreasonable,” he says.
In 2004, while searching online for a support group for gay people with OCD, he stumbled upon a message board where users relentlessly questioned their sexual orientations. He found the posts odd, and then it struck him: This looks like OCD, and this is what they are obsessing about.
He wrote a response along the lines of “I’m a gay man, and I have OCD, and it doesn’t sound like you’re gay to me.” He received a dozen replies, and people continue to contact him today. He estimates he’s written to at least a thousand people, the vast majority with undiagnosed HOCD, and only three or four who were actually gay and wanted to come out. He’s clear he’s not a psychologist and only gives people information about the disorder and links to resources.
“It’s as if there’s one man and one woman writing to me because they all say the exact same thing,” Johnson says. “I say, ‘Here’s how I can tell this is HOCD. You told me when this began — six months ago, you saw a movie, and a character came out, and suddenly you were afraid, What if I’m gay. A real gay person doesn’t suddenly turn gay in a second. The person has always been gay.’ ”
One Muslim woman in the Middle East was nursing false fears of being a lesbian. “She was a student in gynecology, so now she’s looking at women’s private parts all day — not the best thing for her to be doing,” Johnson says. Another man’s gay paranoia began while he was using a public restroom in which he overheard two men talking. Looking down, he noticed a small amount of pre-cum and jumped to the conclusion that it was induced by the men’s voices.
“A lot of people have dreams about their OCD content,” Johnson says. “I definitely do. So what do you think they dream about when they have HOCD? Oy vey!”
The case that affected him the most was a high school football star from the Deep South who moved Johnson to tears over the course of their long correspondence. “He would say, ‘How can I be gay when I’m a football player?’ I didn’t want to tell him there was a gay football league, because that would have been the worst thing for his HOCD.”
At one point, the young man’s mother contacted Johnson to say her son was crying every night, locked in his room. At Johnson’s encouragement, the man sought therapy and overcame his HOCD. The two remain friends.
“Finally, he’s over his HOCD, and how does he celebrate?” Johnson asks. “He has a threesome with two women.”
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