Can individuals with a heterosexual orientation become homosexual?

by Fred Penzel, PhD

This piece was initially featured during the winter of 2007 edition for the OCD Newsletter.

OCD, as we understand it, largely involves encountering intense and constant uncertainty. It has the potential to make you question even your core characteristics, even your identity sexually. A study conducted in 1998, which was featured within the Journal of Sex Research, brought to light that among a sample size consisting of one hundred seventy one students in college, approximately eighty-four percent documented experiencing intrusive sexual thoughts (Byers, et al. 1998). To have doubts concerning an individual's sexual orientation, a person affected is not required to ever have experienced homosexual or heterosexual encounters, or any sexual encounter whatsoever. I have noticed this indication in both young children, teens, as well as adults. It's intriguing to note that Swedo, and others, in 1989, discovered about four percent of youngsters dealing with OCD go through obsessions that have to do with forbidden violent or deviant sexual thoughts.

Although uncertainties regarding a person's own sexual preferences might seem quite straightforward as a sign, there are essentially a range of variations. The most apparent version is when a person affected experiences thinking that they could possibly be of a differing sexual preference than what they formerly believed. If the affected individual identifies as heterosexual, then the thought might revolve around the chance that they are in reality homosexual. If however, they are homosexual, they might fixate regarding the chance that they could possibly really be straight. Proceeding further, some individuals affected have obsessions which suggest they could have behaved, or will behave, according to their thoughts. One variation regarding uncertainty concerning sexual identity would be when the obsessive thinking has become fixated on the notion that the person will simply never manage to determine their actual sexual preference. Patients at times express the conviction that 'I have the ability to cope with whatever my sexuality becomes, though my thoughts simply won't allow me to decide on anything.' A few people's uncertainties get additionally complex by having such experiences such as overhearing others in conversation or glancing towards their direction and assuming that these individuals are likely evaluating their actions or physical appearance and speaking about them - going over how they must be gay (or straight).

For those grappling with thoughts of being homosexual, a portion of the anxiety definitely stems from social factors. To be honest, homosexual individuals have consistently been an oppressed minority within our society, therefore, to suddenly consider finding oneself in this circumstance, together with facing stigma this way, can be alarming. People usually don&8217;t obsess over aspects they perceive as positive or pleasurable. I have occasionally pondered whether those who go through the most pain from thinking like these experience it because they were brought up holding more deeply anti-homosexual perspectives to start with, or whether it simply occurs because one&8217;s sexual preference is capable of creating such essential doubt. I imagine this remains an avenue for research to provide an answer. Traditional psychoanalytic treatments generally worsen this issue by claiming the thoughts signify genuine inner yearnings. This hasn't been proven as factual.

Questioning such an integral aspect of yourself can obviously be an extremely agonizing undertaking. When I initially meet people battling this issue, they are frequently immersed in numerous compulsive actions which might take up numerous hours on a daily basis.

These might consist of:

Observing attractive men or women, including pictures of them, or immersing in sexually explicit literature or pornography, regardless of orientation (heterosexual or homosexual), to assess whether they trigger sexual arousal.
Envisioning oneself in intimate scenarios, subsequently scrutinizing their personal responses to such scenarios.
Engaging in repeated masturbation or intimate relations solely with the intention of scrutinizing their personal reactions. (This might additionally entail using the services of prostitutes when cases are more extreme).
Observing themselves to find signs of &8220;looking,&8221; conversing, ambulating, dressing, or using gestures akin to an individual who identifies as either gay or straight.
Constantly going over and analyzing prior interactions involving other men or women to ascertain if they behaved in a manner aligned with a gay or straight individual.
Monitoring the responses or dialogues of other individuals to deduce whether they could have spotted them acting inappropriately, or if these individuals were directing unusual glances towards the individual affected.
Going through articles available online addressing how a person might determine their sexual orientation to ascertain which demographic they closely match.
Going through narratives shared by individuals who have openly disclosed their orientation, intending to spot any resemblances within their own experiences.
Repeatedly questioning others, and also seeking reassurance regarding their orientation.

Compulsive questioning may routinely arise, and typically brings in individuals who could be close to the person affected. These inquiries are ongoing and repeating. Listed below are a couple of common inquiries individuals affected might potentially ask, categorized in accordance with these two groupings:

For those that obsess over not being aware of their identity:

How might I determine whether I am keen on women or men? Perhaps I truly am not aware of my identity. Maybe I'll never determine what I am. How will anyone tell what sex they truly are? How might I potentially determine for certain? What would transpire in the event that I made an incorrect decision and then ended up trapped within a way of life that does not really accommodate me?

For individuals that obsess that they may be of an alternate orientation sexually:

Do you assume that I may be gay (or straight)? How might I determine whether I'm really gay (or straight)? At what time in their lives will individuals know their orientation? Could someone unexpectedly transform into a homosexual (or heterosexual) despite never having felt or behaved that way? Did I just behave sexually towards you? Does my appearance (or actions) appear gay (or straight) to you? Did I happen to touch you? If I receive sexual feelings when observing sexual material originating from an alternate orientation, might it signify that I am gay (or straight)?

In the context of the question presented last mentioned, one of the most difficult scenarios for this demographic of individuals affected is when they go through a sexual reaction to something they perceive as unsuitable. A typical case could be a heterosexual man that goes through an erection while observing gay pornography. It must be mentioned that it's remarkably typical for individuals to turn to various types of fantasy material with regards to unconventional or prohibited sexual actions that they would never actually partake in, but which they do find stimulating. Under the right set of circumstances, a variety of things may set off sexual arousal for a person. The truth is that individuals react sexually to sexual stimuli. I'm not exclusively referring to individuals dealing with OCD in this context, rather individuals in general. I can't count the times that patients have described to me that they've experienced sexual sensations coupled with feelings of stimulation upon coming across aspects they deemed as taboo or forbidden. Of course, this then contributes to their thinking that their thoughts must reveal a genuine inner desire and also are a sign that they truly are of a different sexual orientation. This reaction gains strength due to the wrong notion that homosexual cues never stimulate heterosexual people. One additional element causing complexity with all of this is that a number of obsessive thinkers mistake feelings of anxiety when it comes to feelings of sexual arousal. Both actually bear physiological similarities in some respects.

Aspects develop into even more complex because of various cognitive (thinking) mistakes observed in OCD. Such errors are what cause OC individuals affected to react anxiously when it comes to their thoughts and subsequently to have to take part in compulsions to alleviate that anxiety. Cognitive OCD theorists think that obsessions stem from typical unwanted, intrusive thoughts observed within the general population. What sets apart such everyday intrusions from obsessions observed in OCD are the meanings, and even appraisals, the OC individuals affected connect with the thoughts. As I prefer to explain to my patients, the problem isn't the thoughts themselves, but rather the way they understand those thoughts, in addition to their endeavors to alleviate their anxiety through compulsions in addition to avoidance.

Many typical cognitive errors made by OC individuals affected include:

I should always have certainty and control in life (intolerance of uncertainty). I have to be in control of my thoughts and feelings always. If I were to lose control of my thoughts, I have to take action to recover that control. Conceptualizing a thought indicates its importance, and its importance derives from my consideration of it. It is irregular to go through intrusive thoughts, and on the occasion that I do encounter them, it signifies that I'm crazy, peculiar, and so forth. Encountering an intrusive thought and doing what it implies are morally equivalent. Conceptualizing performing harm, without preventing it, is just as undesirable as committing harm (additionally recognized as Thought-Action Fusion). Encountering intrusive thoughts indicates I'm inclined to act on them. I cannot take the chance that my thoughts will materialize.

The impact of the questioning actions on family and friends is able to become somewhat unfavorable, resulting in numerous irritated responses or ridicule once it has been asked a thousand times. I'm acquainted with one young man that questioned his girlfriend so routinely that she or he eventually broke up with him and this contributed to his concerns considering he now questioned whether she or he did so because he or she wasn&8217;t a &8220;real man.&8221;

The compulsive actions that individuals affected carry out in response to their ideas, without a doubt, fail to fix the situation. Oftentimes, the greater the checking and questioning that takes place, the more hesitant the individual affected ends up being. Even though they may feel somewhat better for a short time as a consequence of a compulsion, the uncertainty swiftly returns. I prefer to explain to my patients that it's similar to the information-gathering segment of their minds being covered with Teflon©. The responses simply don't stick.

Besides carrying out compulsions, another method through which individuals affected cope with the fears induced through the obsessions happens through avoidance, and in this regard I mean directly steering clear of everyday scenarios that set the thoughts in motion.

This may involve:

Steering clear of standing near, touching or brushing up against people of the same sex (or opposite sex when the individual affected is gay). Refraining from reading or observing videos, news bulletins, books or articles that contain any relation to homosexual individuals and even other sexual subjects. Never uttering the words &8220;gay,&8221; &8220;homosexual,&8221; (or 'straight') or any other associated word. Seeking to refrain from looking or behaving effeminately (when a man), and also in a masculine manner (when a woman), (and vice versa in the event the individual affected is gay). Refraining from dressing in ways that may trigger them to look effeminate (when a man), or masculine (when a woman), (once more, vice versa in the event the individual affected is gay). Not discussing sexual identity questions or subjects with others. Staying away from associating with anyone that might be gay or who comes across as leaning in this direction (when the individual affected identifies as heterosexual).

Needless to say, it is essential for every person dealing with OCD to understand that steering clear of what they dread is impossible. Addressing what you fear is an avenue to move closer to the reality. The function of compulsions of course, consists of undoing, canceling out, or neutralizing the anxiety caused by obsessions. They could possibly function to some extent in the short term, however, their advantages are merely fleeting. OC individuals affected are unable to process the data they supply and it simply doesn't stick. It is somewhat similar to just having half of the Velcro. Additionally, you should understand that compulsions are paradoxical - meaning they bring about the opposite of what they're designed to achieve. That is, helping the individual affected to break free from anxiety together with obsessive thinking.

I prefer to explain to my patients that: 'Compulsions begin as an answer to the issue of experiencing obsessions, though they rapidly transform into the issue itself.'

The thing compulsions do accomplish is causing the individual affected to become behaviorally dependent on performing them. Even the tiny amount of relief they acquire is enough to establish this reliance. Compulsions only trigger additional compulsions, and avoidance just brings about additional avoidance. This is really only natural for individuals to carry out. It's instinctive to attempt to escape or stay away from that which causes anxiety. Sadly, this presents no assistance in OCD.

A different problem that arises due to carrying out compulsions is that individuals that consistently check their own reactions when it comes to people of the opposite or same sex will undoubtedly trigger a paradox on their own. They grow to be so anxious regarding what they may observe within themselves that they don&8217;t feel extremely excited, and subsequently assume that this must signify they possess the wrong preference. When they are near people of their own sex in addition they get anxious, which brings about even more stress and needless to say, additional uncertainties regarding themselves. The flip side of this is when they observe aspects with regards to sex of an alternate orientation and consequently experience arousal in some manner, which they then conclude means they appreciated it, which means they may be gay (or straight). This is actually the mistake I described earlier when I stated that individuals react sexually to sexual things.

Individuals prefer to inquire whether there exist any new advances in OCD treatments. Besides a couple of new medications since the previous article, treatment is essentially unchanged. The formula involving cognitive/behavioral therapy in addition to medication (in several cases), still continues to be the route to take. The precise style of behavioral therapy demonstrated to be the most effective is recognized as Exposure and Response Prevention (ERP).

ERP motivates participants to introduce themselves to their obsessions (or perhaps to scenarios that will induce the obsessions), whilst they avoid using compulsions to eliminate the ensuing anxiety. The scary thinking or scenarios are approached in progressively increased amounts over a period ranging from several weeks to several months. This brings about an impact upon the individual that we term &8220;habituation.&8221; That's when you remain in the presence of what you dread over extended timeframes, you are going to soon observe that no harm of any kind results. As you do this in gradually rising amounts you create a tolerance to the presence of the fear, and its impact is significantly lessened. By constantly staying away from feared scenarios, and never actually encountering them, you maintain yourself sensitized. By addressing them, you discover that the avoidance itself is the &8220;real&8221; threat that keeps you trapped. It puts you in the position of a scientist conducting experiments that test your individual fearful predictions to see what really transpires when you don&8217;t stay away from what you fear. The result is that while you gradually develop your tolerance for whatever is fear provoking; it begins to take bigger and bigger doses of scary thinking or scenarios to bring about the same amount of anxiety. When you have finally were able to tolerate the most challenging aspects of your OCD they could no longer cause you to react with fear. Primarily, you can explain to yourself, 'Okay, so I can think regarding this, though I don't have to take any action regarding it.' By agreeing to address some short-term anxiety, you may therefore accomplish long-term relief. It's vital that you remember that the goal of ERP isn't the elimination of obsessive thoughts but to learn to tolerate and accept every thought with little to no stress. This reduced stress may in turn, being a byproduct, reduce the frequency from the obsessions. Complete elimination involving intrusive thinking may not be a realistic goal considering the commonality involving intrusive thinking within humans in general.

Utilizing this technique, you cooperate with a therapist to present yourself to gradually escalating degrees of anxiety-provoking scenarios together with thoughts. You learn to tolerate the fearful scenarios without resorting to questioning, checking or avoiding. By allowing the anxiety to decrease independently, you gradually develop your tolerance to it, also it starts to take increasingly more to make you anxious. Eventually while you function the right path up the list to addressing your greatest fears there will be little regarding the subject that may trigger you. You might still get the thoughts every now and then, however, you'll no longer feel as if you should react to them and you'll be capable of let them pass.

There are many strategies for confronting sexual obsessions and various other obsessions that we've created over the years.

Several of such strategies include:

Listening to audio recordings or tape loops regarding the feared subject that last 2-3 minutes. Writing 2-page essays concerning a specific obsession (and then documenting them using your own voice). Repetitively writing feared sentences. Hanging signs in your room and also house with feared statements. Wearing T-shirts with feared slogans. Checking out places that will stimulate thoughts. Being in the presence of people that will stimulate thoughts. Agreeing with every single feared thought and telling yourself they're accurate and reveal your true yearnings. Studying books on the subject of your thinking. Checking out websites that relate to your thinking.

Below are a few typical exposure therapy homework projects I've assigned to people through the years:

Reading books by or regarding homosexual persons. Observing videos on homosexual themes or regarding homosexual characters. Visiting gay meetings, shops, searching in gay bookstores, or checking out regions of town which are more predominantly gay. Wearing a T-shirt in the house using the word ‘gay' on it. Wearing clothes in fit, color, or style that may potentially appear effeminate for a man or masculine for a woman. Observing pictures of good-looking people of your own sex together with rating them on attractiveness. Studying magazines, for example Playboy, in the event you are a woman, or Playgirl, in the event you are a man. Standing near people of your own sex. Doing a series of writing projects of a couple of pages each that suggest increasingly more that you're actually gay or desire to be. Making a series of three-minute tapes that based on the writings gradually suggest increasingly more you are gay, and paying attention to them a couple of times per day changing them once they no longer trouble you).

A few typical response prevention exercises may include:

Not checking your reactions to attractive people of your own sex. Not envisioning yourself in sexual scenarios with same-sex individuals to check up on your own reactions. Not acting sexually with people of the opposite sex just to check up on your own reactions. Resist reviewing previous scenarios where you had been with people of the same or opposite sex, or where aspects were ambiguous to determine if you did anything questionable. Refrain from observing yourself to see if you behaved in a manner you imagine a homosexual or person of the opposite sex would.

A few typical exposure homework for those that have uncertainties regarding their own sexual identity may include:

Studying people who are sexually confused. Studying people that are transgendered. Observing pictures of people that are transgendered or are transvestites. Telling yourself in addition to hearing tapes suggesting you will never really know what you are.

A few corresponding response prevention exercises to choose along with the above may be:

Not checking your reactions when observing people of either sex. Not acting sexually to simply test your reactions. Steering clear of reviewing thinking or scenarios you have uncertainty regarding.

A great number of the above therapy tasks may seem alarming and intimidating. Clearly you don't do these items all at once. Behavioral change is gradual change. Recovering from OCD is certainly not a simple task. We rarely make use of the word ‘easy' at our clinic. It will take persistence together with determination but it could be done. Individuals do it at all times especially, using the proper help and advice. My own advice to those of you reading this could be to find yourself out of the compulsion trap and find yourself into treatment using qualified people.

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Fred Penzel, PhD, is a licensed psychologist that has specialised in the treatment regarding OCD together with related disorders since 1982. He's the executive director involving Western Suffolk Psychological Services in Huntington, Long Island, New York, a personal treatment group specialising in OCD together with OC-related issues.

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