Steven Brodsky, a psychologist who specializes in obsessive-compulsive disorder, says that at any one time he has a "handful" of clients who are straight and suspect that they are gay.
Brodsky, who is the clinical director of his OCD and Panic Center of N.Y. and N.J., said he had one adult patient who was so crippled by obsessive thoughts about being gay that he was unable to live independently and had to move back in with his parents to cope. Brodsky said he determined his patient had OCD associated with homosexuality.
"He had a classic case," said Brodsky. "He had some sort of feeling that he was attracted to other guys."
This patient was straight, according to Brodsky, but he had intrusive thoughts that were not based on any hard reality in his behavior.
Brodsky said a previous therapist had misdiagnosed his patient as gay, and at the patient's request, sent him off to reparative therapy, a controversial method that has not been proven to be effective and can be harmful.
"I have many gay clients and phobia is my business," he said. "I treat them like any client looking for help, and derive great enjoyment in working with them and all my clients."
But, he says health professionals need a better understanding of OCD so patients receive proper treatment for a mental obsession, rather than counseling for a sexual orientation crisis that he says has nothing to do with mental illness.
This type of OCD falls under the category of sexual obsessions, according to Jeff Szymanski, a clinical psychologist and executive director of the International OCD Foundation.
"I have treated this many times," he said. "These individuals suffer from pathological doubt. Even though they know that they are 100 percent straight, not gay, they second guess it. For example, they might think, 'Wait a minute I spent too much time looking at that guy in the locker room. What does that mean?' They get lost in the need to know – the need to be sure."
Szymanski said that in 90 percent of the cases he has treated, the patient is clearly straight. Occasionally, a person learns they are gay. "I say, oh, that's interesting, how do you feel about being gay and what can we do about that?'
He said the obsession is "absolutely common in the OCD world."
"If you contact a general therapist and tell them about something like this – or a person who is afraid they are swearing at God, they would say, 'That sounds weird.' But we specialists see it all the time."
Brodsky argues that today's open acceptance of homosexuality and gay lifestyles can blind therapists to this kind of anxiety disorder in straight men. Therapists can jump to a quick, but erroneous, conclusion that a patient is seeking a way out of the closet and help him "get out there and try it out."
Dr. Jack Drescher, a noted New York City psychiatrist who is considered an expert in gay and lesbian mental health and treats patients for OCD, agreed that "being worried that one might be gay is not the same thing as being gay."
"A person with OCD who has is having intrusive thoughts about whether or not he is gay, is not gay, in the sense that he has not incorporated a homosexual orientation in any minimally affirming way into his identity," said Drescher. "Also, if he is not actually attracted to people of the same sex, does not masturbate to fantasies of people of the same sex, is not really aroused by same sex pornography, then it is hard to make the case that he has a homosexual orientation."
Drescher has treated patients with other obsessive sexual thoughts. "One patient was obsessed about being a pedophile, even though he had never been aroused by children. Another was heterosexual and feared he had HIV.
He agreed with Brodsky that some therapists may miss an OCD diagnosis, but "the most likely cause of that is not that they are too gay-affirming but that they lack training in recognizing the symptoms of OCD."
OCD is an anxiety disorder in which people have recurring and unwanted thoughts and ideas (obsessions) that make them feel guilty or driven to do something repetitively (compulsions), affecting 2.2 million people nationally, according to the American Psychiatric Association. Typical obsessions include concerns about germs, harm or forbidden sexual or religious thoughts.
Brodsky said that a gay person has "pleasant association" with same-sex attraction and a person with OCD does not.
"A person with OCD "can't stop thinking about it and performs compulsions to lay the thought at rest," he said. "Repeatedly, anxiously, reviewing past situations, testing themselves, asking for reassurance, compulsively researching the Internet for gay tests, testing themselves with gay porn or gay people.
"They know they're not attracted to the same sex and are to the opposite sex, but are consumed all day long with this battle," said Brodsky. "They can think of nothing else. A gay person doesn't go through this battle."
Ross Murray, a spokesman for the LGBT advocacy group GLAAD, said he had never heard of this type of OCD, but that Brodsky made sense.
"It sounds exactly like a phobia or fear of snakes," he said. "I can't think of anyone who has that sort of obsessional focus on their own sexual orientation."
"Someone who is gay, but in the closet, is not spending time researching and testing themselves," he said. "They know deep down that is a part of them. Gay people are not looking for any kind of external validation."
Having an obsession about being gay is no different from any other mental obsession, said Brodsky.
"Something they have read or heard initially triggers it," said Brodsky. "A friend might say something and they think, 'Gee, I could be gay or I am doing something a gay person would do."
They might even get subtle body sensations, being aroused by another man. "Certainly that does not make them gay," he said. "It takes almost nothing to arouse a man."
These obsessive thoughts are not rooted in homophobia, according to Brodsky. "That – and even sex – has nothing to do with it," he said. "Maybe they were abused as a kid or heard 'gay' as a taunt. There are other issues in their lives preventing them from having loving, committed relationships."
As for treatment, Brodsky said he would help a patient who was truly gay validate their feelings and attain self-acceptance, "achieving calm and peace of mind."
"This is the opposite of the method of OCD treatment which uses exposure therapy, which tries to actually trigger anxiety and face fears," he said. "Exposure has nothing to with the truth, attaining clarity or self-knowledge … It is very simple, you face your fears and doubts enough times, not reassure yourself, and you physiologically become less bothered by it."
These patients can be successfully treated in the same way other forms of OCD are treated, according to Brodsky. "It's easy and it's effective."
Drescher said that medications are also highly effective, especially in tandem with behavioral therapy.
Determining the cause of the obsession is "never black and white," according to Brodsky. "And you have to look at the entire track record of their behavior... There is a clear difference between OCD and a person who is really attracted to the same sex."