Fighting HOCD (progression?)

So, I'm back on the forums after my first post a week ago or so. I believe I'm suffering from HOCD and at times TOCD.

If you haven't read my first post, feel free to do so. So, a week or two ago things turned bad again, I was back at the start and I highered my Zoloft dose from 50 to 75mg. After a week of taking it I must say I feel better. I no longer cry and get depressed 24/7, but thoughts and checking are still present. Although, when I get a thought in my head I feel like I can let it go quicker and not ruminate for hours.

So here's where things get a bit complicated. When I check out guys, I still don't know what I feel. Is it attraction, anxiety, whatever? I still can't exactly tell what I am and I still don't want to be gay/bi/trans. However I feel like I just don't think about it as much. I still never feel like the thoughts have left me, I still sense them in the back of my head all the time, if you know what I mean. But because of this I feel like sometimes I ruminate whether I'm gay or whatever and not feel as much anxiety as I used to. Now this worries me, even though I don't get panic attacks, I don't feel good, because I still don't want to be gay, but I don't feel repulsed and this scares me, because I feel like I would be okay being with a guy and really don't want to. One night I went to sleep quite confident I'm not gay, but when I started checking I was no longer sure about it.

I feel like the medication has helped me immensly, but not to the point where I would not get at least a bit anxious over the thoughts, and it still feels real. Just less ruminating and panicking. I guess it helped me with the anxiety/depression and not so much with OCD.

What do you guys think? Is this normal? Any experiences with SSRIs and OCD? Am I getting better or am I in denial still?

Thanks for your answers.

I have no experience with HOCD, but I know studies show that meds work best when combined with exposure and response therapy (whether CBT or ACT). Are you seeing a therapist trained in that? If not I'd recommend going online and researching one that might be a good fit.

That said, if Zoloft is giving you significant mood improvement after only one week then you're reacting very well to it. It takes a bit longer to kick in fully, so if all continues to go well it should start alleviating your OCD symptoms within a month or two. Even if that's a bust, as I'm sure your psych could tell you, you'll still have plenty of options for medication. This sort of thing is often a long trial and error process. If the panic you mention comes in sudden spikes you can consider asking your psych for a benzo, such as lorazapam, for emergencies.

Finally if your financial situation allows it, you might also consider a psychodynamic talk therapist, though only as a *supplemental* therapy to the ERP! Studies show talk therapy does very little if anything for OCD on its own, but I've found it to be a helpful secondary resource for making sense of the emotional issues that having a chronic and disorienting condition brings on.

Having, as said, a different stripe of OCD that's pretty much all the advice I can give. But best of luck to you!

Thanks for your answer, Bert. I had an appointment with the psychiatrist today and she highered the dose to 100mg and we will begin with CBT therapy next week. To be honest, I'm scared of it, because I could find out that I'm actually gay and I still find it very disturbing and real. Also, I'm going back to school in 2 days and I'm a bit feared of how I will react, since I've been mostly hiding at home since this started, but when I did go out, it usually got worse because of checking. Hopefully everything will be okay and as it used to be ~2 months ago. I've had enough of emotional breakdowns and being scared, anxious and depressed 24/7. It's really hard.

Wonderful, I'm glad you're on to CBT. Being scared is fine, I'd be more worried if you weren't, as I'm sure you've been warned it can be very unpleasant. But the first few sessions usually aren't so rough, so you'll should have some time to test the waters before the swimming lessons start.

Returning to the outside world after a rough patch can be hard, so I'd caution you about raising your hopes to high. It'll be what it'll be. But it sounds like you're responding quite well to meds, and have ready access to CBT, so I'm optimistic that for you what it'll be for you is, at least eventually, far and above where you are now.

And the non-stop emotional roller coaster sure does take it's toll, mentally and even physically. So I feel you there. It can be even worse than the immediate symptoms if only because there's so little escape. But at least in my own experience at least that kind of non-stop misery can't sustain itself more than a few months; eventually you just sort of run out. At that point an OCD trigger will still provoke a panic response, but after you come back down you'll probably find yourself returning to a much more reasonable emotional baseline.

Thanks again for your reply. Before when I went to the psychiatrist she said "thoughts are just thoughts, they can be very far from reality, and everybody has unrealistic thoughts, they are usually the ones that give us negative feelings". That's true, but I don't know what I feel in real life anymore either. And that's not just thoughts, sometimes it's actual physical and psychological responses that I don't want. At the first meeting I told her about looking at guys to check for attraction/arousal and have no idea if what I feel is anxiety or actual attraction. And I'm still doubting it. I do feel much less depressed and can actually have a laugh, though. She also gave me this work sheet to write down my thoughts and feelings, but she said that if I don't feel comfortable doing it, I don't have to. Thanks for all your kind answers, Bert.

No worries, always happy to help.

Oh, but one more thing you know should know. Convincing, and sometimes elaborate, illusory physical and emotional responses are typical any kind of OCD, as you'll see if you check out other threads on this forum. If you think you're feeling arousal toward guys, view that with same skepticism that you would an OCD hypochondriac who's physically "sure" they're feeling woozy and light-headed from an oncoming stroke, or a religious obsessive-compulsive who's intuitively "sure" that they've offended God.

I guess what I'm getting right now are backdoor spikes. I had a thought where a man's body would touch mine and felt like I could like the feeling or what if I would like to be a hot girl and imagined having female organs and didn't feel repulsed, and therefore got spiked. I want to get repulsed by such thoughts. I feel like I'm bi just because of having these thoughts, a straight man probably wouldn't think that he could like the feeling and would be disgusted and repulsed. In real life I would never be with a man, as I can't imagine being happy with that. But as I'm writing this I'm thinking "what if I would like being with one and am just denying it?". I want to be me again, when I didn't have to think about my sexual orientation, I just found girls beautiful and liked it. But now I keep thinking what if I didn't know I was bi because I didn't think about it? Maybe I always liked girls because that's a norm and not because I really did. Everything I do and the way I move my hands and everything feels like I'm doing it in a gay way. And I was always the "small" guy in school and always had very low self-esteem and still do. I even feel like I have a girl's butt, because it's softer and not masculine and I tried squeezing it to find out I guess. Then I thought "only girls and gay men squeeze their butts". It just feels like everything I do, my brain tries to convince me that it's gay and that I'm gay or bi. I don't even know why I'm writing this, I'm probably repeating myself and it sounds so stupid even to me. I would probably laugh at myself if I wasn't in this position.

I've also always were the one with best grades in school, and now that I think about it, it might be because of OCD. I always had to study and wouldn't do anything else until I was confident that I learnt everything. Otherwise I had that feeling that I need to study and also had a hard time taking a break for lunch, because I wanted to finish studying first. And it was always the first thing I did when I came from school or in the morning on weekends, because I otherwise had the feeling I need to do something and wasn't relaxed until I was done with it. It could be OCD, or I just wanted to get it over with as soon as possible so I could do something I wanted to? I'm looking back at signs of OCD I had before this HOCD started. Because I never had such a severe case of OCD (maybe some signs) and I'm scared that that means it's denial and not OCD.

I feel like I'm spamming the forum right now, but I don't know what else to do. This time I imagined a guy in tight swimwear and felt like I could get aroused by it. Then I thought if I would like being with him and don't know, feels like I don't, but then when I think about it for a while I don't know anymore. I'm feeling so gay at times, it's awful, and I'm beginning to think it's internalized homophobia / denial / scared of society. When I ask myself why I don't want to be gay, I just don't know. I just don't want to be, whatever the reason. But then I start wondering what my dad would say if I actually were and I felt like that's the reason I don't want to be, but I don't want this to be the reason... I'm really doubting everything, everything I do feels gay, the way I talk, move, look, everything. The medication seems to be helping only with the anxiety. I want to delete the past 2 months of my life. Last night I punched the wall a couple of times, because of the thoughts. I just want to be a normal (not that gays aren't normal) man, i always wanted to be like my dad when I was younger. I would feel devastated if I really was gay or bi. This post is pure reassurance seeking, but I can't help it. I don't know what to do if my thoughts are true.

Edit: After writing "not that gays aren't normal", I started doubting that I really mean it and that I am actually homophobic. Everything is ###$.