I am NO defender of Charles Linden – see for example my colleague Professor Salkovskis ’s blog)
However I am worried that the Buzzfeed article highlights the lack of understanding about the nature of Obsessive Compulsive Disorder (OCD).
Some people with OCD may have obsessional fears about being gay (when they are not). This should not be confused with people who have doubts about their sexual identity. What is required is a good assessment of what the person’s problem is. If it’s OCD then there are good evidence based treatments available, namely cognitive behavior therapy for OCD and sometimes medication. A person with doubts about sexuality needs an appropriately trained counsellor to help them explore their sexuality. For a person with OCD to see such a counsellor to explore their sexuality will make their OCD worse.
People with OCD often experience intrusive unacceptable thoughts or images which are senseless and anxiety provoking. For example, a common theme in OCD is of intrusive thoughts or images about being a paedophile, being violent or blaspheming. These are highly distressing and shameful to individuals who are neither a paedophile nor violent natured. They usually believe that having such thoughts mean they could act upon them, or that it is immoral to experience such thoughts. They may try to suppress such thoughts and images. They may spend many hours trying to reassure themselves that they are not a paedophile, mentally reviewing whether they might have abused a child or physically checking whether they have hit a vulnerable person. They might then avoid being near children alone. It is, however, vital to stress that an individual with OCD experiencing intrusive sexual thoughts about children is at no greater risk of causing harm than is any other member of the public. This is similar to the way a person who is fearful of jumping off bridges is not going to jump off a bridge.
Intrusions are nearly always the opposite of the person’s values. They represent a worry or fear of the very last thing the person wants to do or to happen. Thus religious people with OCD are distressed by intrusive blasphemous thoughts; moral people with OCD are upset by thoughts of acting immorally; peace-loving gentle people with a strong sense of what is right and wrong are upset by sexual or violent thoughts; someone with OCD who is in a perfectly happy relationship can have intrusive doubts about whether they are in the “right” relationship or if they are truly “the one”. Therefore heterosexual people with OCD who desperately want to be in a relationship or want children, tend to have intrusive thoughts about being gay or transgendered. This is all classic OCD. At one level the person “knows” that the thoughts are senseless – for example they are not physically attracted to the same sex, they have never masturbated while thinking of someone of the same sex, they have never had any sexual relationship with anyone of the same sex, and they have no desire for a same sex relationship. The individuals are not homophobic and have no ill feelings against the gay community. Despite this, they are deeply ashamed of such thoughts and images and often panic about experiencing intrusive thoughts and images of being gay. The occurrence of intrusive thoughts and images does not indicate latent homosexuality, any more than thoughts about pushing someone in front of a train when you are standing on the platform means you really want to murder them (but are “just not admitting it”) or that you are going to do so.
It is necessary to understand this to appreciate that if a counsellor were to say to an OCD sufferer, “Well, maybe you are gay” (as if they were counseling someone with sexual identity problem), or worse, anyone were to offer them ‘conversion therapy’, that would increase the intrusive thoughts and images and induce panic – the antithesis of therapeutic benefit.
Members of the OCD community have often felt misunderstood and stigmatized and have used internet forums to talk about their difficulties. Thus some people with OCD talk about Relationship OCD (R-OCD), or Homosexual OCD (H-OCD) and any search on the internet will find many references to them although these are not terms used by professionals. It is all OCD, and the same evidence based treatment of cognitive behaviour therapy (and sometimes medication) is used to help individuals with OCD.
Therapy involves helping a person to develop a good psychological understanding of his or her problem, to normalise their thoughts and understand how their ‘solutions’ (avoidance behaviors, checking compulsions, mental reassurance) in fact maintain their obsessional worries. The problem is not whether the person with OCD is gay, a paedophile, or in the right relationship – the content of the OCD is not discussed in therapy as it’s unhelpful and only provides temporary reassurance. It is rather the meaning the person is attaching to such intrusive thoughts and images and the way they respond to them. It is on this aspect that CBT for OCD is focused. Thus if a person with OCD having thoughts or images about being gay, they are very likely avoiding being in gay company believing that they might suddenly become gay or bisexual. Behavioural experiments might involve visiting gay bars or meeting gay people to test out their fears. The therapy requires enormous courage if the sufferer is to overcome the panic and OCD. What people with OCD really need is greater understanding of, and compassion towards their condition and its impact.