In the last century, Obsessive-Compulsive Disorder (OCD) was known as "The Doubting Disease." This is an entirely accurate description, as someone who suffers from it can have doubts about some of their most basic human experiences. These doubts can range from being uncertain of whether or not you have just moved a part of your body to wondering whether or not you are the parent of your own child.
All these different and unpleasant doubts are disturbing in a variety of ways. One of the most fundamental is a type in which an obsessive individual begins to have doubts about his or her own sexual identity. This is not the same as the ordinary doubts people sometimes have about themselves and eventually answer in their own minds. With obsessions, questions are constantly repeated in a sufferer's mind, and they refuse to quit. There are never any answers that stick. Those with obsessions recognize that these doubtful thoughts are not their own, and try to resist them. "Could I be gay?" is a common question they ask themselves, or the reverse, as in the title above. The frequency and intensity of these thoughts can worsen under stress or during idle moments, and have a habit of happening at the worst possible times.
As obsessive thoughts go, this type is probably a lot more common than most people realize. Sufferers find them extremely difficult to reveal or discuss, due to the obvious embarrassment they feel. They live in isolation and shame as a result. This is true of most sexual obsessions.
Please Note: Let me say here that I am not referring to those who actually are gay. I am talking about someone having an obsessive thought that happens to be about being gay. I lean toward the theory that sexual identity is imprinted before birth and that a person is really not given any choice in the matter, one way or the other. Homosexuality would seem to be a naturally occurring variation among humans and, as such, it is neither good nor bad. I'm sure there are some who would differ with me on this point. When we talk about treating these thoughts, we are only referring to working with those who truly are heterosexual and who only obsess about being gay.
In order to have such a thought, a sufferer need not ever have had a homosexual experience, or even any sexual experience at all. I have observed this symptom in both children as well as in adults. It may begin in adolescence or crop up later in adulthood. As with other obsessions, the thought has a repetitious and nagging quality.
Part of the distress connected with these thoughts must surely be social in origin. Let's face it: gay people have always been an oppressed minority within our culture, and to suddenly think of being in this position and to be stigmatized in this way can be frightening. People don't generally obsess about positive subjects. I have sometimes wondered if those who experience the most distress from such thoughts as these do so because they were raised with more strongly homophobic or anti-gay attitudes to begin with, or if it is simply because questioning one's own sexuality can be such a basic doubt. I suppose this remains a question for research to answer. Older psychoanalytic therapies often make people with this problem feel much worse by saying that the thoughts represent true inner desires. This has never proven to be so.
Obsessions eventually lead to mental or physical compulsions. This is because compulsions relieve the anxiety caused by obsessions, at least for a little while, though they make things worse in the long run. Because compulsions are rewarding in this way, they tend to be repeated. In the case of homosexual obsessions, the most common compulsions people use to escape their fears are double-checking (especially mental self-checking), compulsive questioning, and avoidance.
Checking can include:
Looking at attractive men or women, to see if you are sexually attracted to them.
Observing yourself while behaving heterosexually to see if you are really "enjoying" it.
Testing your mental and physical reactions with gay or straight porn.
Observing yourself to see if you "look", talk, walk, or gesture like someone who is gay.
Compulsively reviewing and analyzing situations you were in with other men or women to see if you acted like a gay person or acted sexually toward someone of the same sex.
Checking the reactions of others toward you to determine whether or not you were acting appropriately, or if they were looking at you strangely.
Taking so-called tests online that supposedly test a person’s sexual orientation
Obviously, those who keep checking their own reactions to members of the opposite sex will create a paradox for themselves. They become so nervous about what they may see in themselves that they don't feel very excited, and then think that this must mean they are gay. When they are around members of their own sex, they also become anxious, which leads to further stress and, of course, more doubts about themselves.
Compulsive questioning usually involves others who may be close to the sufferer. The questions are never-ending and repetitive. Some typical ones are these:
Do you think I could be gay?
How can I tell if I'm really gay?
When do people know that they're gay?
Can you suddenly turn into a homosexual?
Did I just act sexually toward you? (Asked of a member of the same sex.)
Do I look gay to you?
Am I acting like a gay person?
Did I just touch you?
Obviously, no amount of this type of checking or questioning is ever enough to satisfy a sufferer for more than just a short time. As mentioned before, there may be some short-term relief from the anxiety, so this behavior tends to be repeated, and it becomes habit. Even occasional relief from the doubt is enough to keep it all going. Unfortunately, sufferers do not always realize that they have difficulty in processing and holding onto this information. In reality, a sufferer could gather enough information and answers to fill a library, and it still wouldn't satisfy the doubts for very long.
The effect of the questioning behavior on friends and family can be rather negative, drawing a lot of angry responses or ridicule after the thousandth time. One young man I know questioned his girlfriend so often that she eventually broke up with him, and this added to his worries since he now wondered if she did so because he wasn't a "real man."
One other way in which sufferers cope with the fears caused by the obsessions is through directly avoiding everyday situations that get the thoughts going. This can involve:
Avoiding standing close to members of the same sex.
Not reading or looking at videos, news reports, books, or articles having anything to do with gay people or subjects.
Not saying the words "gay," "homosexual," or any other related term.
Trying to not look or act effeminately (if a man) or in a masculine way (if a woman).
Not dressing in ways that would make one look effeminate (if a man) or masculine (if a woman).
Not talking about gay issues or subjects with others.
As with other types of OCD, there is no magical or instant "cure" for these thoughts. OCD, as we know, is chronic ebbing and flowing, but never totally disappearing. The news is not all bad, however. You can find recovery as others have via medication and behavior therapy. If the thoughts tend to be mild to moderate, it may even be possible to treat them behaviorally with the proven OCD treatment (Exposure and Response Prevention) alone while avoiding the standard OCD medications. More serious cases usually require medication, however. It can be of great help, and is an important tool in helping people to do therapy.
Exposure and Response Prevention (E&RP) is carried out in stages, and is based on a listing you and your therapist make in which you rank fearful situations in terms of how much they would bother you. They are usually rated from 0 to 100. Using this technique, you work with a therapist to expose yourself to gradually increasing levels of anxiety-provoking situations and thoughts. You learn to tolerate the fearful situations without resorting to questioning, checking, or avoiding. By allowing the anxiety to subside on its own, you slowly build up your tolerance to it, and it begins to take more and more to make you anxious. Eventually, as you work your way up the list to facing your worst fears, there will be little about the subject that can set you off. You may still get the thoughts here and there, but you will no longer feel that you must react to them, and you will be able to let them pass.
Some typical Exposure therapy homework assignments I have assigned to people are highlighted below (please note that these are in no special order):
Reading books by or about gay persons.
Watching videos, movies, or TV shows with gay themes or about gay characters.
Visiting gay websites and podcasts of gay interest.
Visiting gay meetings, browsing in gay bookstores, or visiting areas of town that are more predominantly gay.
Wearing a T-shirt (at home or just alone in your room) that says "I am gay" on it.
Wearing clothes in fit, color, or style that could possibly look effeminate for a man, or masculine for a woman.
Looking at pictures of good-looking people of your own sex and rating them on attractiveness.
Reading mainstream gay magazines such as Out or Curve.
Reading magazines such as Playboy if you are a woman or Playgirl if you are a man.
Standing close to members of your own sex.
Making casual physical contact with members of your own sex (touching someone's arm, hand, or shoulder).
Hugging a same sex friend.
Doing a series of writing assignments of a couple of pages each that suggest more and more that you actually are gay or wish to be.
Making a series of two-minute audio recordings that, based on the writings, gradually suggest more and more that you are gay, and listening to them several times a day (changing them when they no longer bother you).
Listening to gay rock or music by gay singers or groups.
Writing graduated sentences 25x per day that are challenging and raise anxiety.
Reading a gay romance novel.
Some typical Response Prevention exercises might include:
Not checking your reactions to attractive members of your own sex.
Not imagining yourself in sexual situations with same-sex members to check on how you might feel about it.
Not behaving sexually with members of the opposite sex just to check your own reactions.
Resisting reviewing previous situations where you were with members of the same or opposite sex or where things were ambiguous to see if you did anything questionable.
Avoiding observing yourself to see if you behaved in a way you imagine a homosexual or member of the opposite sex would.
Resisting reassuring yourself that you are not gay, and also do not seek reassurance from others.
Not questioning, arguing with, or analyzing your thoughts. Simply agree with them.
Not avoiding being around members of your own sex.
Not avoiding taking part in conversations that are about gay people or gay subjects.
Although all of the above techniques are helpful, the audio recordings, in particular, are one of the most powerful. They help you to directly confront and build a tolerance for the thoughts. Overcoming obsessive thoughts takes persistence, but it can be done. Old reports that they are harder to treat than compulsions simply aren't true.
If you decide to go for help, be certain your therapist is qualified and experienced. Be sure to ask if he or she has treated such problems before and if he or she has specialized behavioral training. If the therapist starts talking about your symptoms as if they perhaps represent some kind of true inner desire that you are suppressing, you are not getting the right approach. Be a wise consumer.
Fred Penzel, Ph.D., is a licensed psychologist who has specialized in the treatment of OCD and related disorders since 1982. He is the executive director of Western Suffolk Psychological Services in Huntington, Long Island, New York, a private treatment group specializing in OCD and related disorders. He has written numerous articles that have been featured in many issues of the International OCD Foundation Newsletter.
If you would like to read more about what Dr. Penzel has to say about OCD, take a look at his self-help book, "Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well (2nd edition)," (Oxford University Press, 2016).