What to Read
OCD, as we know, is largely about experiencing severe and unrelenting doubt. It can cause you to doubt even the most basic things about yourself – even your sexual orientation. In order to have doubts about one’s sexual identity, a sufferer need not ever have had a homo- or heterosexual experience, or any type of sexual experience at all.
Some examples individuals may ask themselves:
- How do I know whether I prefer women or men? Maybe I really don’t know what I am. Maybe I’ll never know what I am.
- How does anyone tell what sex they really are?
- How will I ever be able to tell for certain?
- What will happen if I make the wrong choice and get trapped in a lifestyle that really isn’t for me?
Doubting something so basic about yourself can obviously be quite a torturous business. When I first see people for this problem, they are typically engaged in any number of compulsive activities which may occupy many hours of each day.
These can include:
- Looking at attractive men or women, or pictures of them, or reading sexually oriented literature or pornography (hetero- or homosexual), to see if they are sexually exciting.
- Imagining themselves in sexual situations and then observing their own reaction to them.
- Masturbating or having sex repeatedly just for the purpose of checking their own reaction to it. (This may also include visiting prostitutes in more extreme cases).
- Observing themselves for evidence of “looking,” talking, walking, dressing, or gesturing like someone who is either gay or straight.
- Compulsively reviewing and analyzing past interactions with other men or women to see if they have acted like a gay or straight person.
- Checking the reactions or conversations of others to determine whether or not they might have noticed them acting inappropriately, or if these people were giving the sufferer strange looks.
- Reading articles on the internet about how an individual can tell if they are gay or straight to see which group they might be most similar to.
- Reading stories by people who “came-out” to see if they can find any resemblance to their own experiences.
- Repeatedly questioning others, or seeking reassurance about their sexuality.
Some typical cognitive errors made by OC sufferers include:
- I must always have certainty and control in life (intolerance of uncertainty).
- I must be in control of all my thoughts and emotions at all times. If I lose control of my thoughts, I must do something to regain that control.
- Thinking the thought means it is important, and it is important because I think about it.
- It is abnormal to have intrusive thoughts, and if I do have them it means I’m crazy, weird, etc.
- Having an intrusive thought and doing what it suggests are the same morally.
- Thinking about doing harm, and not preventing it, is just as bad as committing harm (also known as Thought-Action Fusion).
- Having intrusive thoughts means I am likely to act on them. I cannot take the risk that my thoughts will come true.
The compulsive activities sufferers perform in response to their ideas, of course, do nothing to settle the issue. Often the more checking and questioning that is done, the more doubtful the sufferer becomes. Even if they feel better for a few minutes as a result of a compulsion, the doubt quickly returns. I like to tell my patients that it is as if that information-gathering portion of their brain is coated with Teflon©. The answers just don’t stick.
In addition to performing compulsions, one other way in which sufferers cope with the fears caused by the obsessions is through avoidance, and by this I mean directly avoiding everyday situations that get the thoughts going.
This can involve:
- Avoiding standing close to, touching or brushing against members of the same sex (or opposite sex if the sufferer is gay).
- Not reading or looking at videos news reports books or articles having anything to do with gay people or other sexual subjects.
- Never saying the words “gay,” “homosexual,” (or “straight”) or any other related term.
- Trying to not look or act effeminately (if a man), or in a masculine way (if a woman), (or vice versa if the sufferer is gay).
- Not dressing in ways that would make one look effeminate (if a man), or masculine (if a woman), (again vice versa if the sufferer is gay).
- Not talking about sexual identity issues or subjects with others.
- Avoiding associating with anyone who may be gay or who seems to lean in that direction (if the sufferer is heterosexual).
People like to ask if there are any new developments in OCD treatments. Aside from a few new medications since the last article, treatment remains essentially the same. The formula of cognitive/behavioral therapy plus medication (in many cases), is still the way to go. The particular form of behavioral therapy shown to be the most effective is known as Exposure and Response Prevention (ERP).
ERP encourages participants to expose themselves to their obsessions (or to situations that will bring on the obsessions), while they prevent themselves from using compulsions to get rid of the resulting anxiety. The fearful thoughts or situations are approached in gradually increased amounts over a period of from several weeks to several months. This results in an effect upon the individual that we call “habituation.” That is when you remain in the presence of what you fear over long periods of time, you will soon see that no harm of any kind results. As you do so in slowly increasing amounts you develop a tolerance to the presence of the fear, and its effect is greatly lessened. By continually avoiding feared situations, and never really encountering them, you keep yourself sensitized. By facing them, you learn that the avoidance itself is the “real” threat that keeps you trapped. It puts you in the role of a scientist conducting experiments that test your own fearful predictions to see what really happens when you don’t avoid what you fear. The result is that as you slowly build up your tolerance for whatever is fear provoking; it begins to take larger and larger doses of frightening thoughts or situations to bring on the same amount of anxiety. When you have finally managed to tolerate the most difficult parts of your OCD they can no longer cause you to react with fear. Basically, you can tell yourself , “Okay so I can think about this, but I don’t have to do anything about it.” By agreeing to face some short-term anxiety, you can thus achieve long-term relief. It is important to note that the goal of ERP is not the elimination of obsessive thoughts but to learn to tolerate and accept all thoughts with little or no distress. This reduced distress may in turn, as a byproduct, reduce the frequency of the obsessions. Complete elimination of intrusive thoughts may not be a realistic goal given the commonality of intrusive thoughts in humans in general.
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.
Adapted from Fred Penzel, Ph.D..
What to Watch
Please watch the videos below relating Sexual Orientation OCD.
[VIDEO]
What to Do
Create your ERP hierarchy following the example and instructions below.
- [Sexual Orientation Hierarchy example]
- [ERP Instructions]
What to Measure