As previously described, obsessive thoughts about one’s sexual orientation are not uncommon for sufferers of OCD. How can one cope with these troubling thoughts? There are two strategies often used – one good, one bad. We’ll start our discussion with the bad.
Seeking reassurance about one’s sexuality is perhaps the most commonly used strategy for people with OCD who have sexual obsessions. Seeking reassurance can be either mental, or it can be behavioral. For a straight male, mental efforts to reassure oneself could be remembering all the women or girls that he had previously been attracted to or been involved with. Similarly, the man might imagine an attractive female and mentally “check” whether the finds the girl/woman attractive. It may be more common, however, for the OCD sufferer to engage in behavioral reassurance seeking. This is the strategy that Rob, in the companion article to this one, used in the airport. Examples of behavioral reassurance seeking can be seeking out members of the opposite sex, either to interact with or to look at, in the hopes of feeling an attraction. Some people with these types of obsessions will begin or continue romantic relationships partially for the purpose of achieving this kind of reassurance. Sharon (not her real name) was a heterosexual 22-year-old woman when she began to have obsessive thoughts that she was gay. She had been in three romantic relationships, all with men, and had never entertained the idea that she might be gay. Her best friend at the time was a gay woman. One evening, Sharon though that her friend was acting flirtatiously with her. She thought nothing of it, and was not particularly bothered by it. However, days later, the thought occurred to her that if she didn’t mind her friend’s flirting, she must actually be gay too. Why else would she have reacted the way she did? The thought sent Sharon into a panic. She felt that a rug had been pulled out from under her, as she had never had reason to question her sexuality before. She thought back to her experience in high school and college, thinking about whether she had missed any hints of attraction to gay women she had known in the past. She mentally reviewed some romantic and sexual experiences she’d had with men to “decide” whether she had really enjoyed them, or whether part of her just suffered through them. The more she tried to reassure herself that she was straight, the more unsettled and panicky she became. Eventually, she decided that she needed to become involved with a new boyfriend to feel sure about her sexual identity. However, Sharon was unable to free herself of these troubling thoughts despite her new relationship and all her best efforts.
This brings us to a more helpful strategy – anxiety tolerance can lead to long term reductions in anxiety and obsessive thoughts. When Sharon first came in for cognitive-behavioral therapy, she was unable to seriously entertain the notion that it can be helpful to experience the intense anxiety she experiences when obsessive thoughts about being gay came up. She had become so accustomed to seeking reassurance that she was straight that it was difficult to imagine doing anything else. When she began Exposure and Ritual Prevention therapy, she tried hard to learn to bear the anxiety that followed thoughts about being gay. With the help of her therapist, she trained herself to respond to that anxiety by talking back to it. She would say, “maybe enjoying flirty interactions with my friend means I am gay, or maybe not. It’s hard to tell,” and would then try her best to resist the temptation to “figure out” whether she was gay or not. This was difficult for her, but after working hard at her exposure exercises, she was able to change her response to these thoughts. Sharon noticed a decrease in the anxiety that such thoughts caused her. Eventually, the thoughts became less frequent, as well as less distressing. Her therapist explained that through her hard work, she had taught herself to tolerate the anxiety associated with her obsessions instead of giving into her compulsive urge to reassure herself. Sharon left cognitive-behavioral therapy feeling much better prepared to deal with obsessive thoughts about her sexual identity. Her symptoms had all but disappeared.
Sharon was lucky to have found a therapist that correctly understood her symptoms as a type of obsessive-compulsive pattern. Many people who have come to see me describe talking to many friends, therapists, and other well-meaning people who have told them that “it’s okay to be gay,” “we still accept you for who you are, gay or not,” or even, “I went through a similar tough time when I realized that I was gay.” As well intentioned as these sentiments may be, they are unhelpful to the person with sexual obsessions, who often comes away from these conversations feeling more misunderstood than before. Therapy in particular can be dangerous for people with sexual obsessions if the therapist does not have expertise with OCD and sexual obsessions. Unfortunately, these patients are sometimes told that their confusion is due to denial or to repression of their true identity, and that the sooner they face up to that, the better. Mike (not his real name), a heterosexual man, was 21 when he came to see me about his OCD. He had seen two prior therapists who apparently misunderstood his sexual obsessions as a part of the coming out process. Mike suspected he had OCD, and was aware of research suggesting that cognitive-behavioral therapy can be helpful. In college, Mike was told by some friends that he was likely “fighting a losing battle” against realizing that he was gay. After having struggled with obsessive thoughts about being gay all through high school and college, he decided to have a sexual encounter with another man, in order to perhaps gain some certainty about his sexuality. While he came away from the experience feeling assured that he was straight, he described lingering regret that “(he) was so confused” at the time. Using the techniques of Exposure and Ritual Prevention therapy, Mike eventually learned to manage these thoughts by coming to accept the possibility that he might be gay, while at the same time accepting the possibility that he might be straight. Becoming more comfortable with the uncertainty in the combination of those two ideas is a key skill. While Mike never saw the obsessive thoughts disappear completely, he learned to manage his response to them such that they were no longer distressing.