Difference Between HOCD and Denial

Patients and parents have asked me about the difference between HOCD and denial, in terms of sexuality. These terms are both used frequently in social media and online circles but are not necessarily terms used clinically when it comes to sexual orientation, psychiatry, or developmental pediatrics.

What is HOCD?

HOCD, or Homosexual Obsessive-Compulsive Disorder, is considered by some to be a subtype of obsessive-compulsive disorder (OCD). HOCD is characterized by intrusive and/or distressing thoughts about one’s sexual orientation (thoughts about being LGBTQ). People with HOCD might experience persistent doubts and/or fears about their sexuality, possibly even fixating on the idea of being gay or lesbian despite lacking any genuine desire or attraction towards the same sex, for example.

These intrusive and recurrent thoughts can lead to anxiety and can even prompt compulsive behaviors such as excessive reassurance-seeking, mental rituals to “prove” their sexual orientation, or avoidance of situations that trigger these feelings. HOCD can deeply impact an person’s mental health, self-esteem, and relationships, making it essential to recognize possible symptoms and seek appropriate support and treatment from a licensed mental health professional, psychiatrist or psychologist. Note that HOCD, as a distinct diagnosis, is not included in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). Instead, it falls under the broader category of obsessive-compulsive disorder (OCD).

What is Denial, In Contrast to HOCD?

Denial, when used in the context of contrasting it to HOCD simply refers to the possibility that a person is in denial about their sexual orientation. This term is often not used in a compassionate way, as most people have reasons for feeling uncertain or not wanting to come out that can be extremely complex and difficult for them. Denial is often a way to protect themselves from a truth that might be scary, painful, or challenging.

The key difference between denial and HOCD is that OCD is a recognized mental health disorder that is recognized by mental health professionals. OCD can be debilitating and make day to day functioning very difficult for the person struggling with it. Denial on the other hand is a defense mechanism that people use to cope with a challenging situation, feeling or experience.

Negative Effects of Denial

Denial of a person’s identity can deeply impact their feelings, wellbeing, and relationships. Specifically,  denial of one’s sexual orientation or identity can have far-reaching consequences, impacting not only an individual’s sense of their true self but also their ability to form meaningful relationships and live authentically. Recognizing and accepting one’s sexuality is often an extremely difficult, but crucial step towards achieving personal fulfillment and building healthy, supportive connections with others.

How to Help a Person Struggling with their Sexual Identity

Promoting understanding and empathy towards individuals struggling with issues related to sexuality and identity is crucial for fostering inclusivity and support within society. Rather than simply stating they are in denial, here are some strategies to promote understanding and empathy to help them:

Education and Awareness: Encourage education and open dialogue about different sexual orientations and gender identities. Providing accurate information helps dispel myths and misconceptions, fostering a more empathetic understanding of diverse experiences.

Empathy Training: Offer workshops or training sessions focused on empathy-building skills. Teach active listening, perspective-taking, and nonjudgmental communication techniques to help individuals better understand and connect with others’ experiences.

Representation: Advocate for diverse representation in media, literature, and other forms of storytelling. Positive portrayals of LGBTQ+ individuals can help challenge stereotypes and increase empathy by highlighting shared human experiences.

Challenging Stereotypes: Encourage critical thinking and questioning of stereotypes and prejudices. Help individuals recognize and challenge their own biases to foster a more inclusive and empathetic mindset.

Supportive Spaces: Create safe and supportive spaces where individuals can openly discuss their experiences without fear of judgment or discrimination. Peer support groups, LGBTQ+ community centers, and online forums can provide valuable support and validation.

Promote Acceptance: Emphasize the importance of accepting individuals for who they are, regardless of their sexual orientation or gender identity. Encourage kindness, respect, and inclusivity in all interactions to create a more empathetic and supportive environment.

Advocacy and Allyship: Encourage allies to speak out against discrimination and advocate for LGBTQ+ rights. Allies play a crucial role in promoting understanding and empathy by using their privilege to amplify marginalized voices and support inclusive policies and practices.

By promoting understanding and empathy, we can create a more compassionate and inclusive society where individuals feel accepted and supported in their journey towards self-acceptance and authenticity. In terms of OCD, or HOCD,  destigmatizing mental health issues in general is crucial for fostering open dialogue and encouraging individuals to seek help without fear of judgment, ultimately leading to improved access to support and better overall well-being for everyone in society.

Getting Help

If you or someone you know is struggling with any issues related to sexual orientation or identity, there are many resources and hotlines you can call. Click here to find contact info for the National LGBT Help Center

The Trevor Project is a great resource for Transgender issues

Treatment for HOCD

Treatment options for OCD requires the help of a licensed healthcare professional. Treatment will likely involve a combination of psychotherapy, medication, and self-help strategies. Cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), is often recommended to help individuals challenge and change their intrusive thoughts and compulsive behaviors. Medications such as selective serotonin reuptake inhibitors (SSRIs) may also be prescribed to alleviate anxiety and depression symptoms associated with HOCD. Additionally, support groups and online communities can provide valuable peer support and encouragement throughout the treatment process. It’s important for individuals to work closely with mental health professionals to develop a personalized treatment plan tailored to their specific needs and circumstances.


In Summary

HOCD and denial of sexuality represent very different psychological phenomena, each with unique challenges for individuals’ mental health and well-being.

HOCD involves intrusive and distressing thoughts about one’s sexual orientation, often accompanied by compulsive behaviors, while denial of sexuality entails suppressing or rejecting one’s authentic identity out of fear or societal pressure.

Understanding the differences between these two experiences is essential for effective diagnosis and treatment. While individuals with HOCD may benefit from therapy and medication, those struggling with denial may require therapy and/or support in accepting and embracing their true selves. Promoting empathy and education surrounding these issues is vital for creating a more inclusive and supportive environment for all individuals to explore and affirm their true identities.