HOCD or Denial? Understanding Arousal and the Groinal Response

Episode 5 of OCD Insights with host Samantha Bray, LCSW. Samantha's first Q&A episode, answering a real listener's question about HOCD (sexual orientation OCD). Lightly edited for readability; the listener's question is reproduced as submitted, with his permission.

00:00 Introduction to HOCD and the Listener's Question

Samantha Bray: Hello, Samantha Bray here, host of OCD Insights. I'm going to do my first Q&A episode. I saw a post that really struck a chord. I've had several clients who have had this nearly exact situation come up in the past, and I felt like it would be a very helpful thing to address here.

I asked the young man if I had permission to read this question, and he said yes. Here is what it says.

Can HOCD (he's meaning homosexual OCD in this post) make you feel aroused to your thoughts? I try to do exposure by trying to masturbate to thoughts of men. It made me feel uncomfortable, but after a little bit I felt myself getting aroused. And I looked up pictures and I got more aroused.

The thought of coming out doesn't scare me. It feels almost freeing. I've had HOCD in the past. I don't know why this is happening. I don't even get anxiety while I'm typing this. I feel like I want to be gay now. I don't know what's happening. It feels like I just want to be gay now, but it feels okay?

I try doing exposure by using my mom's soap and shampoo and trying to smell like a girl, but it doesn't give me much anxiety. I don't have anxiety about it even while typing this. It just feels like I'm gay now.

For context, I've had HOCD before, years ago, and I kind of know how it works. So I don't know if it's just switching things up and making things feel more real, or maybe I'm just in one big backdoor spike.

Samantha Bray: I think that is a very brave and a very wonderful question to ask. So I'm going to break it down in pieces, because there's a lot going on here.

02:27 Understanding Arousal and HOCD

First, I'm remembering a piece of research I saw somewhere once, and don't ask me where, but I could find it if I had to, I think. It was looking at putting electrodes on people to measure the state of arousal when they saw different types of pictures. They showed pictures of humans, males, females, all kinds of shapes and sizes, and they threw in some experiments using turtles or bears having sex.

What they found is that it doesn't matter if you're looking at two turtles having sex, you can get aroused. And that doesn't mean anything, because this is a problem of assigning meaning to the response and to the thought and to the response. Having an arousal response, or any kind of physiological response, to seeing animals or humans having sex doesn't mean you want to have sex with them, with turtles. Of course not. It is a primal biological response, sometimes called a groinal response. All our mind knows is that we're putting a visual in front of ourselves.

It also has to do with “what you resist, persists.” I'll get into that in a second. But for this first piece, it doesn't matter what you look at, there is potential to become aroused.

So when you say you try to do exposures by masturbating to thoughts of men, what you're actually doing isn't an exposure. It's a test. It's a longing to get certainty that you're not aroused to men by thinking about them, and then seeing if you're aroused, or if you can follow through with masturbating. The hope is, typically what my clients tell me, that you'll feel some sort of disgust or aversion, or nothing at all.

But like I just told you, thoughts about sex, no matter who you're thinking about, can cause these sensations and physical arousal to happen. So thoughts of men made it feel uncomfortable, but after a little bit you felt yourself getting aroused. That makes total sense.

And then when you looked up pictures, you got more aroused. That's just increasing the stimulus. You were just thinking at first, but now you're adding a visual, and that's going to send more signals from the brain to the body: prepare for sex, we're thinking about sex. It's not really concerned with who you're thinking about, or what you're thinking about, when you're thinking about sex.

06:17 The Role of Developmental Stages in HOCD

So the thought of coming out doesn't scare you, it feels almost freeing. I can't tell you how many clients I've had with this HOCD theme who actually say they feel bad for having it, because they have good friends or roommates who are gay, or maybe a sibling who's gay. They really want to tell me it's not about a fear of gay people, and it isn't that they don't like gay people, but they can't put their finger on why this fear brings up that “oh my gosh” panic feeling when they think they might be attracted to the same sex.

Through a lot of talk with clients over the years, the pattern I've seen on repeat often answers another question about why this is happening. It often correlates with a developmental stage or a time in your life. I don't know this young man's age, but for the clients I see with this near-exact question, they're usually young adults, somewhere between teenager and maybe mid-thirties. It tends to fade out as people age. That's not for everybody, but it's a pattern I've seen over ten-plus years with clients I've known across a variety of themes.

What I mean by developmental stage is this: when you're a young person, even if you're not consciously thinking about it, there could be a context, a culture, an environment you've been brought up in that has you subconsciously thinking the next goal in life is to find a partner, a mate, maybe a long-term girlfriend, a committed partner, and then move closer toward marriage and family.

When a goal or a value is very important to a person, it can become a lightning rod for OCD. OCD strikes it. It asks: what could take this away from you? What could throw a monkey wrench in this? And then your imagination gets sparked, and it lays out all the ways this next step in your life might be ruined. One of the first fears to come up can be that you're not even interested in the opposite sex. That's the only time the track needs to be laid down. After the first thought, the white flash, the turning of attention to it, saying “that's not true, that's not me, look at all the ways I've proved that in the past,” all of that mental behavior, arguing, debating, analyzing with it, is what strengthens that pathway.

So if you don't recall ever having thoughts about this before, that's fine, it isn't always conscious. When it started years ago, were you just coming into dating, or finishing a goal like graduating high school or college, where the next assumed step would be finding a life partner? Just questions, I'm curious. But sometimes that's how it develops.

It doesn't mean you don't like men, or that you have an aversion to gay people. It only has to do with your hopes, dreams, and goals for yourself, or what you've assumed the next steps in your life should be.

11:53 Navigating OCD Thoughts and Compulsions

So the thought of coming out doesn't scare you anymore, it feels almost freeing. I think in a way you're wearing this obsession out. One way to deal with “what if I'm gay” thoughts is: if I am, I am, but until I know for certain, I'm going to put one step in front of the other. If you see a girl you like, and she's potentially able to go on a date or get to know you better, just keep living your life. Don't keep turning your attention to OCD when it says “maybe you're gay, go test it out.” Think of that as a waste of time. Turning your attention to it and trying to figure out for certain feeds the obsession every time.

Put the whole theme in a bubble and put it on the shelf. That's OCD. You're not going to get certainty around that, especially when your anxiety is high and you've flipped your lid, because there's no new learning that comes on board at that point. Put it on the shelf, then get back to your life, doing things you value. This doesn't have to do with dating at all. Put your attention back on the present moment, the email you were writing, the beautiful dinner you were eating, your five senses, ground yourself in the here and now, and redirect your attention gently, without judgment, when those OCD thoughts pop up.

In a nutshell: as soon as that thought comes up, you note it as OCD, and you gently redirect your focus back to the present moment. If you can, don't talk to it at all. But if you have to, something like “I hear you, I don't know,” and then put your attention back on the present moment.

The more you do that, the more you let your mind rewire and break a feedback loop you've created over the years, one that says “when I get triggered by that theme, I need to do a compulsion, look it up, research it, test it, to feel better.” That loop briefly makes you feel better, but it strengthens the cycle every time you do one of these tests or research experiments.

Instead, when you get triggered, identify it, name it to tame it: “that's my theme, that's OCD.” Then will yourself to put your mind back on the present moment and let time pass. Every time your mind wanders back to the OCD thought, gently put it back on what you're doing, no judgment, no frustration. This is just the mind doing what the mind does, and when we reinforce a thought by thinking it over and over, it gets stronger. We're retraining the brain, no judgment here.

Keep doing that over and over, and you retrain your brain to quickly discern “that's OCD,” put your mind back on the present moment, and in time you feel better. You retrain your brain not to turn its attention to the OCD thoughts. Let time pass, be present, and the OCD loses all its nourishment. Every time you put your focus back on something you actually value, something fruitful, you're not doing OCD, you're growing your life, and in time you can start to squeeze OCD out.

17:35 Desensitization and Misconceptions About Exposure

So the thought of coming out doesn't scare you anymore, it feels almost freeing. You're onto something. It would be freeing if you could just say, “I can't figure this out, if I am, I am,” and live your life. But I don't think that's exactly what's happening here. It sounds more like what happens when you test yourself over and over to see if you have an aversion or disgust to something.

In the beginning you're sensitized to these thoughts. That's what makes a thought feel like it's touching your nervous system like a live wire, it strikes a chord. But the more you go toward it over and over with the types of exposures you listed, what you're actually doing is desensitizing yourself to those exposures. And that misses the mark. You weren't going into therapy or ERP saying “I want to have less aversion when I see two men having sex, it really disgusts me, I have a fear I might be homosexual, it's not something I ever wanted, I don't mind if people are gay, but that's just not me, so I'm going to try to desensitize myself to feel less disgusted.” That doesn't make sense.

I know from clients that this has been the guidance given by less informed, less qualified therapists treating OCD. It misses the mark. When you say you're exposing yourself using your mom's soap and shampoo, that's closer to the mark, sort of, but only if you had an aversion to using her shampoo and soap in the first place. I don't think that's actually the mark here either, because there's nothing wrong with using something like that, of course it doesn't mean you're gay because you like the smell of a soap or a product marketed toward women. Smelling like a girl doesn't give you much anxiety because it doesn't mean anything, you haven't assigned any meaning to it.

23:13 Effective Exposure Techniques and Mindset Shifts

What would be a more appropriate exposure if you want to keep going down the ERP route? First I would ask: what is your heart's desire, what do you really want to be doing, what did you used to do, what did you plan to do, that this theme in particular has you sitting on the sidelines for? Is there anything you're avoiding because you don't want it to come up and derail you, or because you're afraid people will notice and it'll embarrass you? Is there an environment you'd like to be in that you're avoiding for the sake of this trigger? Are there books you've wanted to read, movies you've wanted to watch, activities you've wanted to do or learn?

Think about what this is having you sit out from. Put your attention on adding those things back into your life. That's the exposure, that's the thing that shakes the beehive nest. You do the thing in hopes the bees start buzzing, the intrusive thoughts come, and that gives you the opportunity to practice redirecting your attention back to what you value: “that's OCD, yep, I expected it,” and putting your mind back on the present moment, letting time pass, and letting all the bees settle down. That's exposure and response prevention.

You do something that will stir up the thoughts, allow the thoughts to come, notice them, accept that they're there. When you do an exposure, you're asking for them to come, that's your medicine. It's a mindset shift: have the opportunity to notice intrusive thoughts coming in, but stay the course. In the present moment, gently bring your mind back over and over.

There are other ways to work on this too. We can do inference-based CBT, where we look at your triggers and list them all down. Next: what's the doubt that comes up when you have one of those triggers, the “what if, oh my goodness”? Then, for each of those “what ifs,” what's the consequence your mind imagines will happen if that what-if comes true? Basically, that's your OCD story, for lack of a better word. That's what starts to increase anxiety and discomfort, because when we imagine a story, our mind doesn't really know the difference between imagining it and it happening for real.

So our anxiety levels, and the desire to do a compulsion to fix it, to ruminate, to seek reassurance, to test, to expose ourselves to the thing and see if we're disgusted or not, that's the last link in the chain, the compulsion. With I-CBT, we look at what brings it up for you, what doubts are swirling, and what story we're imagining will happen. It's full of consequences, and most of the time, if you take it down to the last bit, “what's the worst that could happen,” it typically comes down to some element of being alone, not being loved, or being left out.

There are other things you can learn in I-CBT around understanding where this thread of logic that makes it seem believable is coming from, in order to have more grit and courage to do the redirection I'm suggesting. There are a handful of other skills there too, but for the sake of keeping this brief, I'll stop there with I-CBT.

A lot of this is acceptance and commitment therapy: be grounded in your values and your goals. Whenever this theme pops up, it's a speed bump. It can come up, but it's getting in your backpack. It can stay there as long as it wants to hang out, but you're not going to turn your attention to it, you're looking forward.

I don't believe you just want to be gay now. I think you've desensitized yourself and now you're very confused. One way to think about it: it's like leaning on alcohol as a social lubricant. The first time you go into a party or social setting, you can have just one drink and feel a little more talkative, and that works well. But if you have to start doing this on a regular basis, eventually you need more, and then more. That's like doing the compulsions, you need more and more, it's always asking for one more thing, until at some point it doesn't provide relief anymore. You can't do any more, you'd black out, or get so sick, or so drunk that it doesn't help, it hurts you.

Then it can flip on you, where it doesn't help at all. You build up a tolerance, you have to drink too much to maintain the course, and you become a slave to it, a habit you just have to have to survive. I believe that's the stage you've reached with these types of exposures. So you have to abstain from doing the compulsions. If you want to focus your energy on one thing, it's not doing those compulsions. And I want to be very clear: the testing you're doing is missing the mark for an exposure, and is a compulsion.

26:25 Conclusion and Encouragement for Listeners

Samantha Bray: Submit questions for me in the comments, or send them to ocdinsights.com/asksam. I'd love to answer more of these for folks. I'm starting a Substack, so we can have more comments and conversation on these harder, taboo topics, in a safe and contained community.

All right, I'll close it here. We're right at the thirty minute mark. Thank you for listening, and I hope this helped.

If this resonated with you, or you'd like to hear more Q&A episodes, or episodes where I interview folks about their OCD journey and expert guests who can teach wonderful tools to supplement the therapy or work you're already doing, please like and subscribe so you don't miss a beat.

If you'd like to carry on the conversation in a closed, safe container, go over to Substack and find me at OCD Insights. And if you'd like to submit a question, or share your journey here on OCD Insights, head over to ocdinsights.com/asksam and we will get your question answered. Thanks so much.

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