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How to Treat HOCD

Obsessive Compulsive Disorder (OCD) is an extremely debilitating yet widely misunderstood illness. Often, people chalk it up to perfectionism, hygiene, and behavioral quirks.

But OCD is so much more than whimsical behavior. Many OCD sufferers experience immense guilt and shame over their obsessions and compulsions.

One severely misunderstood form of OCD is HOCD, mainly because it deals with “taboo” sexual topics. This type of OCD revolves around a person’s sexual orientation. But as we’ll soon see, there’s a lot more complexity to this OCD subtype. 

Accordingly, the treatment for HOCD is just as complex. But that’s not to say it isn’t achievable. 

What is HOCD? Definition and Symptoms

Homosexual OCD (HOCD)  is a form of OCD. All forms of OCD involve recurrent, distressing, intrusive thoughts (obsessions) and uncontrollable, borderline ritualistic behavior to temporarily soothe those obsessions. Hence, HOCD manifests as obsessions and compulsions centered around their sexual orientation. 

For example, a person with HOCD might have a sexual image about a gender to which they know they’re not sexually attracted. However, this one thought will make them question their sexual orientation to a point of obsession. 

As a result, this person may perform self-checking behavior, such as staring at a person from that gender and checking their body for signs of arousal. Or, they might socially isolate themselves because they are uncertain about how they may act or feel. Some might alter their behavior or appearance in an attempt to “reaffirm” their sexual orientation. 

There are countless other examples of HOCD obsessions and compulsions. The specific content of obsessions and types of compulsion vary person to person. But it all boils down to persistent and intense self-doubt. 

HOCD Vs. Sexual Identity Crisis and Homophobia

Anyone can experience HOCD, as it is not limited to only one gender or sexual identity. HOCD can affect: 

  • A straight person, making them question if they might be attracted to the same gender. 
  • A homosexual person, making them question if they might be attracted to the opposite gender. 
  • A bisexual person, making them question if they might be attracted to just one gender. 

Hence, the more accepptable name for HOCD is Sexuality Orientation OCD. This name invalidates the common and damaging misconception that HOCD stems from homophobia. On the contrary, people with HOCD don’t look down on others with a different sexual orientation than their own. 

No; their doubts, fears, guilt, and shame are directed toward themselves only. 

Keep in mind, though, that HOCD is entirely different from exploring your sexuality or having a sexual identity crisis. When it comes down to it, HOCD isn’t about sexuality at all. 

Just as other types of OCD, HOCD is driven by overwhelming self-doubt. People with HOCD fail to recognize that intrusive thoughts are perfectly normal and they don’t define your identity, intentions, or actions. Moreover, they can’t reconcile the fact that not all attraction is sexual attraction. 

At the end of the day, people with HOCD aren’t actually sexually attracted to a gender other than their sexual orientation. But all it takes is one intrusive thought to make them question everything they know about themselves. 

To put it in more simple terms, HOCD gaslights the sufferer into doubting about their sexual identity.

Treatment for HOCD

As of now, OCD remains an incurable mental health disorder. However, it is treatable. 

What this means is that a person may not ever fully rid themselves of the unwanted thoughts or images. However, HOCD treatment trains the sufferer to ignore the unwelcome voices or control how much they affect the person’s life. 

To achieve this, though, professional help is required. Self-treatment for OCD is not only ineffective but can also worsen the symptoms. 

ERP therapy

Exposure response prevention (ERP) therapy is the gold standard for OCD treatment. It is a type of Cognitive Behavioral Therapy (CBT), a psychotherapeutic treatment that helps you recognize and control intrusive thoughts, and change the way you respond to them. Hence, ERP 

ERP typically involves hour-long sessions with a trained ERP therapist once a week for up to 12 weeks. However, the duration and other technicalities vary from patient to patient and therapist to therapist. 

The purpose of ERP isn’t to affirm the sufferer’s sexuality, since their sexuality isn’t the core issue. Instead, ERP helps the sufferer handle intrusive thoughts, in general, more appropriately and productively. It just so happens that, in this case, the intrusive thoughts concern the patient’s sexual identity.   

For example, a straight person suffering from HOCD may be asked to look at a picture of someone from the same gender. Then, the therapist will instruct the patient to refrain from any checking, neutralizing, or reassurance-seeking behavior, such as checking their body for signs of arousal. 


There isn’t any cure-all medication specific to HOCD. In fact, it is impossible to treat any form of OCD with medication alone. Instead, medication merely supplements ERP therapy, and makes the treatment easier and bearable. 

ERP therapy is an extremely difficult and exhausting process, requiring the sufferer to confront their fears and refrain from any reassurance-seeking behavior. Therefore, certain medications can help make the process a little easier. In fact, 70% of OCD patients see significant improvements in their symptoms with medication-supplemented ERP therapy treatment. 


More severe cases of HOCD may require hospitalization, whether partial or residential. 

Partial hospitalization involves more frequent treatment sessions held in a mental health facility. However, the patient is not required to stay at the hospital. 

On the other hand, residential treatment programs allow the patient to voluntarily live in the hospital’s treatment units. In rare cases, a patient may be admitted involuntarily, especially if they become a danger to themselves. 

In either case, though, hospitalization is a final resort. 


The symptoms of HOCD can be extremely overwhelming. However, the appropriate treatment can help lessen the severity of these symptoms. 

The most widely-used and accepted treatment for HOCD is exposure response prevention therapy, often supplemented with medication. 

But keep in mind that no form of OCD is curable. The chance an intrusive thought might pop up again is always there. Moreover, someone who has gotten treated once may relapse at some later point in their lives. 

However, the treatment for HOCD is highly effective, and can certainly help you reclaim your life.

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