Austin Gross
Glossary of Sexual Doubt / HOCD and the Everyday Lives of Psychopathology
ISSUE 1 | VALENTINE’S DAY | FEB 2011
Alexander Graham Bell kissing his wife Mabel Hubbard Gardiner Bell, who is standing in a tetrahedral kite, Baddeck, Nova Scotia, 1903
To the HOCD community: both parts of this article require a disclaimer. The case studies are sometimes graphic; their purpose is to introduce non-HOCD readers into a (non-exhaustive) range of HOCD experiences. People who are already familiar with HOCD can skip it, especially because it might be too close to home.
The second part of the article is a glossary. The two conventional terms, “repression” and “in denial,” are always spike-risky because of their menacing skepticism. The rest of the words come from the HOCD community itself, so they’re safe for most HOCD people. HOCD readers should not take my particular interpretations of these words too seriously, unless it helps them. They know more than I could about their own HOCD and how to help themselves.
(For everybody else: “spike warning” is a convention that developed, among other places, on the NeuroticPlanet discussion board for Sexual Obsessions and Compulsions. It’s an adaptation of the “spoiler alert” found on Wikipedia and the “trigger alert” with which discussions of sexual assault are sometimes prefaced. What “spikes” and “HOCD” are will become clear below.)
* * *
I should warn queer and gay readers that, due to the nature of HOCD, the idea of homosexuality is an object of panic and shame in these stories. This is not because members of the HOCD community find homosexuality abhorrent or are invested in the privileges of heteronormativity. Rather, the same tactics of catastrophization (to borrow a word from OCD therapeutic discourse) that are instrumental to anti-gay politics make HOCD so virulent, tenacious, and isolating. The HOCD community and broader queer experiences may have a lot in common, and I hope this piece will be an invitation to mutual support, both ideological and in action.
1. “Don’t be so ~!”
Person is unable to have fun or break rules.
Person should go drinking.
2. “~ desire” (or esp. “~ homosexuality”)
Something is building inside person.
Person is going to explode.
Related words: latent, in denial, closeted (in a derivative sense)
Cases
A woman gets back together with her boyfriend. She doesn’t tell him about the thoughts she has been having. It is a morning in late March and still cold. They have sex in her apartment. She’s afraid he can see her blushing, even when she isn’t blushing. She can’t tell when she’s blushing any more. She catches herself pacing around and instead goes to the bathroom. Every time he looks at her she panics and thinks he’s about to ask her what’s wrong. She says she needs to take a walk. On her way out of their apartment she takes a big breath. She walks to the promontory. At the edge of the water she clambers down a shelf of rock to a place where nobody will see her. She settles into the hollow between two rocks. It is medium-cold. She takes off her hood so that her hot neck and face can begin to recalibrate. She looks roughly in all directions. After a couple minutes, she nods off.
* * *
(The online forums that were my main source are private places. In most cases, to adapt stories directly from these forums might have been alarming to the people who told them. Except for the most lighthearted fragments, what appears below should be unrecognizable.)
* * *
At 4:54PM in the month of August, a man under the username filmbuff59 posts a very long message to an online forum. On such forums, the longer messages usually say how it can start. It is difficult to estimate how much time has passed. He begins with high school. He was skinny, unlucky, and very devoted to masturbating. He says he asked a girl out who he sat next to on the track bus. This backstory, his readers understand, is proof that he liked girls.
* * *
At college filmbuff59 completely changed. He worked out and ate two-tray meals in the dining hall. In his dorm, he was reputed to be “chill.” He often had people over for hookah and toweled the door. He got kicked out of housing the second time he ever got high. Unperturbed. He was benching 200lbs. He started dealing. He met a girl that way. When he lost his virginity, she didn’t ask if it was his first time, and he didn’t tell her. He didn’t know what people were supposed to think about while getting head. She asked him how much he liked her, which surprised him. It was very easy to like her, but partly it was so unexpected, dating anybody at all. He tried to make a bigger point of telling her how he felt. It felt funny to cry in front of her. He liked being with her more than with his dorm friends. Their relationship only lasted about a month. She started hooking up with someone in her dorm. He stopped going to the gym. His academic advisor asked him about his grades and arranged for him to see a therapist. He was prescribed an antidepressant.
* * *
After Christmas, he started having sex with another girl. He was unable to orgasm a lot of the time, especially from oral sex. He stopped seeing her.
* * *
Winter was dim and shitty where they were. Then it was spring and he felt life welling up in him. New friends were smoking cigarettes on the grass. He talked about movies with an openly gay student named Martin. Martin said he was trying to see everything on the AFI Top 100. filmbuff59 said he wanted to too. Martin and filmbuff59 became friends. One afternoon they ran into each other on the way to class and decided to hang out instead, and milled about on the grass outside, smoking cigarettes and a couple joints. At dinner they ate free food from a student organization’s meeting. Martin invited filmbuff59 to lift some weights with him. filmbuff59 benched 160lbs, feeling good. He and his friend went back to his apartment and had some beers. His friend saw Rebel Without a Cause lying out and said, god how he wanted to fuck James Dean. filmbuff59 laughed and made a joke the concept of which was James Dean being dead. That night he had a dream about his ex. It started off him having sex with her, but then she started to tell him something, about another guy. While he was home for the weekend he heard about a kid from high school. This kid had dated girls but came out after a month in college. Back at school he kept hanging out with Martin, but noticed a new feeling of uneasiness. Once, while they were standing by his movie collection, the thought crossed his mind of kissing him. He was able to dismiss it.
* * *
A couple days later he ran into his ex-girlfriend and invited her to coffee, but she was uninterested, and he guessed he wasn’t that interested either. But he felt a little depressed about it so he called some people. Martin was the first to pick up; he was at a dive bar with a bunch of gay friends, and invited filmbuff59. Martin introduced filmbuff59 as a “friend” and made a place for him beside himself. filmbuff59 sat down. Martin told the man to the left of filmbuff59 that filmbuff59 was also a film buff. The man acted skeptical. filmbuff59 relaxed. The man to his left sometimes touched his shoulder when they were talking, and was patronizing and flirtatious about filmbuff59’s movie tastes. Martin didn’t seem to be paying any attention to them, except to advise him loudly, “Quentin only likes weird foreign movies.” Everyone laughed. For a moment, says filmbuff59, Martin was touching his arm. For the next couple hours he drank and talked and listened to the others talk.
* * *
In the bathroom, while staring at the reflection of the soap dispenser in the side of the mirror, filmbuff59 sobered up. He wondered if anybody thought he and Martin “had something.” He felt uneasy about Martin and noticed a strange and possibly positive feeling at the thought. He analyzed this feeling as semi-repressed attraction. He felt dully alarmed, and clenched his abdominal muscles. When he got back he started talking about his ex. It fit his mood, which was no longer convivial. The people around him were annoyed. He went home.
* * *
The next day he woke up earlier than he wanted to (nine or ten) and felt shitty and hungover and remembered the bar. He made instant coffee. Air came in an open window and he recalled that it was spring. He remembered hanging out with his friends. He felt glad. Suddenly, he felt aroused. BANG! He remembered thinking about kissing his friend Martin. He sat. He did not have the energy to stop thinking about it, about leaning over to him and kissing him, standing by his movie collection. He thought he might have a half-erection. He was tense all over. He stared ahead to the left of the TV and felt dizzier and felt “it” growing. He thought about his sex drive lately and about oral and about not orgasming and also the thought, “Putting the pieces together.” Which was not exactly something he thought; he didn’t think really these were pieces to put together. “Why am I thinking so much about this,” he considered. He thought he might be talking himself into having a crush on this guy. He thought, if that’s possible, what’s the difference? It shouldn’t matter whether you talk yourself into a feeling or not, the feeling is the feeling. He felt nauseous and, to his horror, excited. Had he been thinking about a girl, he thought, he might have interpreted this feeling as “butterflies in his stomach.” He had a headache.
* * *
Another person’s story: “I distinctly remember the moment HOCD struck me. I was working at a Jimmy John’s, during my senior year of college. For whatever reason, as I sat there, bored out of my mind, I thought, ‘What if I’m gay?’”
* * *
Another user’s HOCD started at high school. He heard a rumor that he was gay. He had said something that sounded really gay at a party, about how he loved pulpy orange juice, how it fills your throat and almost chokes you. People looked at each other and he laughed too because it was actually hilarious. Afterwards he wished he had said, “I see that that sounds really gay,” rather than just blushing. When people teased him about being gay he felt sick and restless, or aggressive in a way he associated with sexual tension. He started catching himself in gay poses or with a melodic “gay” quality to his laugh. When this occurred, he felt a strange aroused feeling, which made him think it was not just a coincidence. This aroused feeling wasn’t really about other men, he knew, but just about the idea of being gay. So he was attracted to being attracted to other men. But eventually he had the feeling about men too. He thought it was probably by association with the idea of being gay, which is what actually (for some reason) aroused him. Did that make sense?
* * *
“I don’t want to feel this,” someone thinks. “Do I feel this?” He thinks, “Does everybody feel this?” “Have I always felt this, but never paid attention?” “Am I feeling this because I am paying attention?” “Maybe other people don’t feel this,” he thinks, “even if they start paying attention.” He reads literally hundreds of coming out stories. The thought of “coming out” gives him “butterflies in his stomach.” He wants to puke.
* * *
One user says these thoughts have been part of his life for several years. He learned to talk about it. He’s gotten used to not knowing whether people understand or believe him. If people want to think he’s “in the closet,” whatever. He’s also used to feeling defensive at weird times, if someone seems to understand too quickly. He almost yelled at one friend for telling him “everybody experiences anxiety.” “It’s not just anxiety,” he tells her. “OK,” she pauses. “But it still seems like anxiety is, like, the main affect.” “No,” he says. “It’s more like, your brain doesn’t work. You’re short-circuited. And you feel autistic.” He thinks about it and then has an idea. “You know what it’s like, actually. It’s like a bad trip.”
* * *
filmbuff59 describes new behaviors from this period: he “got up his courage” to watch gay porn. He thinks he might have felt aroused when he watched. He thinks, if you are aroused, you want to masturbate. But he doesn’t have “the courage” to masturbate. When he walks to class now men catch his eye. Sometimes he looks at them because he wants see if he is attracted. They often notice him looking at them, and make eye contact with him. When their eyes meet, he thinks he feels himself becoming aroused.
* * *
He says he often draws up diagrams of different ways of looking at it. He lists all the things that are evidence that he is gay, all the things that are evidence that he is straight. Evidence that he is straight: he always liked girls; he was in love with his first girlfriend; he was sad afterward; he never had (or had very few) gay thoughts before college. Evidence that he is gay…
* * *
When he is on campus he thinks he sees Martin everywhere. It sends a jolt of adrenaline to his stomach. He tries to think of excuses for not seeing Martin any more. He decides not to see anybody. He pretends to be depressed. He is depressed. When he sees his therapist he lies sometimes, and refuses to answer anything in detail. He hates having to come up with complicated stories. It makes his head hurt. One day at the dining hall a girl says, “Do you think if you knew what someone thought about every single day, you would know something about them?” filmbuff59 feels sick. It would be better to hurt himself or something, make himself puke, smash his head in a door, scream or something. He doesn’t hurt himself, though, because he thinks that might be how people end up OCD. He thinks nostalgically about when he was depressed in high school or when his girlfriend dumped him.
* * *
The whole story falls apart. filmbuff59 doesn’t say what happened to his friendship with Martin. It probably ended. He says he is older now, out of college. On his most extreme days he sits at home with a ruler. He has learned from looking at pictures of various objects that his penis sometimes grows to 5 inches in length at the sight of nonsexual objects or animals and to 7.5 inches in length at heterosexual porn. When he feels himself becoming aroused at a gay thought, he measures right away to get an accurate reading. If it is between 5 and 7.5 inches, he grits his teeth and lies down on his stomach. He has also acquired a detailed knowledge of the types of “positive feelings” he might have about other people. When he feels a positive feeling about a woman, he compares it to his positive feelings about men. He can never decide whether his negative feelings about men count as part of the feelings, or if he should say that he feels the same way about men as about women, with negative feelings in addition, in reaction those positive feelings. His feelings about women are difficult to evaluate, too, because he no longer thinks about women at all except in order to compare his feelings about them to his feelings about men. He knows that his feelings about women used to be stronger, but he has trouble remembering how they felt.
* * *
A woman in her early thirties has preserved the following memory as the single worst in her life. On Friday night four years ago, people who knew her came over to cheer her up. One of them was a girl she thought she might be attracted to. They had beers. She drank the ones they put in her hand, sometimes making a laugh. She wanted to bite a cloth napkin until it squeaked. She thought, “It is like getting hit in the stomach.” “It would be dramatic if I jumped out of my window.” She didn’t look anybody in the eye. Eventually her friends left.
* * *
“Keep in mind this was back in 1992,” a user remarks. “No internet.”
Glossary
“Textbook HOCD. If there were a textbook, that is.”
– NeuroticPlanet member, 1/25/07
Judging from search volume, the acronym HOCD, which stands for Homosexuality-themed Obsessive Compulsive Disorder, first appeared on the internet at the end of 2004. The concept then developed in a dialogue between a growing online public and the few specialists who took notice.
The proximate sources for the theme seem to be two articles written by therapists specializing in OCD. A brief article on the subject by Fred Penzel called “How Do I Know I’m Not Really Gay?” (which does not yet use the acronym HOCD) is recorded to have been online since May 16, 2000, and has been a linked reference in the Wikipedia article on “Intrusive thoughts” since January 2007. Meanwhile, a short piece by Steven Phillipson called “I think it moved: The understanding and treatment of the obsessional doubt related to sexual orientation and relationship substantiation” was first posted on or before March 22, 2005 at the web page for Phillipson’s New York treatment center. Phillipson’s article does not seem to have been cited early on except on help forums, where his name is well-known. Neither of these articles uses the expression HOCD, whose precise coinage I don’t know.
The forums on BrainPhysics, a professional mental health resources website, were probably the site of the HOCD community’s birth. They existed from late 2005 to mid 2006; the “Sexual Obsessions & Compulsions” forum referred to HOCD in its description since the beginning. Mark, a member of the BrainPhysics forums suffering from non-H OCD, wrote a short piece for BrainPhysics’s main website called “I’m Gay but You’re Not” in August 2005, having been “bombarded… for nine months by threads, private messages, e-mail, and instant messages by straight folks [from the forum] terrified that they are gay (and a very small number of gay and bisexual folks terrified that they, too, are not their real sexual orientation.)” A second piece on HOCD was added to the site, possibly in response to a user-submitted question, in Winter 2006. Mark’s article is still online, and no longer refers to the BrainPhysics forums. In 2006 these forums were transplanted from BrainPhysics’s main site to NeuroticPlanet, where they remain. Google Insights charts a brief increase in searches for “HOCD forum” in fall 2007 and a sustained increase at the end of 2008.
Monnica Williams, who is also involved as a consultant for BrainPhysics and NeuroticPlanet, delivered a talk on HOCD in fall 2008 at the New Jersey affiliate of the Obsessive Compulsive Foundation, which was published that year in Leading-Edge Health Education Issues. In the paper she thanks “the membership of the Neurotic Planet [sic] OCD Discussion Forum” for their contributions. This was, as far as I can tell, the first article on HOCD written exclusively for medical specialists (Penzel’s and Phillipson’s articles being written for sufferers). I know of no further activity among specialists, though OCD treatment centers and medical Q&A sites have continued to treat the subject.
So much for the history of the concept. A word on the demographics of the sufferers. Outsiders to these forums often assume 1) that HOCD sufferers come from religious or right-wing backgrounds, are homophobes, or think that homosexuality is wrong, 2) that HOCD sufferers are male, and 3) that HOCD sufferers are only straight people worried about being gay (as opposed to, for example, gay people worried about being straight.) But
1) Many HOCD sufferers are from tolerant, liberal backgrounds. Though the data’s inadequate, it seems like about the same proportions are urban, suburban, and rural, red-state and blue-state, as America is. (Though not all are American—plenty are Canadian and British—and “TOC homosexualidad” or “TOC homosexuel” return some results on google.fr and .es.)
2) It seems from my very casual research that somewhere from a third to half of sufferers are female. Most people don’t explicitly mention their gender when they post, and adjectives in English don’t reveal it, but once they start talking about the things that scare them it is clear which is the same sex.
3) It can usually be assumed that HOCD people are straight, unless they state otherwise. Nonetheless, all the following groups are represented, if in small numbers:
- straight people worrying that they are gay
- straight people worrying that they are bi
- bi people worrying that they are gay
- bi people worrying that they are straight
- gay people worrying that they are bi
- gay people worrying that they are straight.
[Note: See my afterthoughts on this point, especially towards the end; the above table is incomplete.] The sample size is very small for these last three groups. Their behaviors and symptoms seem to be largely the same, though their experience of mainstream discourse on sexuality is bound to be different—that is, different clichés will feel hale or hostile to each group.
In this article I have tried to be careful about gender, but it’s usually too complicated to leave gender and sexual orientation ambiguous at the same time. The vast majority of my examples, too, are of men or women worried about being gay or bi.
Checking describes a group of behaviors common in people with HOCD:
- adopting cadences and “lisps” perceived as gay or as gender-nonconforming in order to see if they fit
- making gestures perceived as gay or as gender-nonconforming in order to see if they are enjoyable
- watching for such gestures; even recording their voice or videotaping their walk
- observing gay people they see very closely, seeing whether they can imagine themselves in their shoes, looking for aspects of the life that fit or don’t fit
- making eye-contact with people of the same sex in order to gauge emotional or physical reactions
- scrutinizing all positive same-sex feelings for traces of desire or romantic love
- asking themselves whether or not their same-sex friendships are “too close,” whether or not their feelings for their friends of the same sex are “platonic”
- watching gay porn to gauge arousal
- looking at people of the same sex as they walk down the street, scrutinizing one’s own reaction (excitement, happiness, affection, crush, arousal, weakness, tingling, fear, anxiety can mean homosexuality)
- looking at asses, crotches, breasts, neck, muscles, thighs, lips of people of the same sex in order to gauge emotional or physical reaction
- trying to masturbate to gay porn
- scrutinizing their heterosexual desire for lack of intensity or genuineness
The word “checking” does not originate in the HOCD community, but its meaning there is different from in general OCD theory. In general, “checking” describes the compulsion to repeatedly check things normally taken for granted: whether the lights are on, or the stove, whether one has left one’s wallet at home, whether the house is unlocked, whether one has hurt one’s child. In the context of certain OCD themes, HOCD and ROCD (Relationship-themed OCD, obsessive doubt of romantic feelings) among others, the checking takes place not externally but introspectively. Sufferers check something much more ambiguous than the position of a light switch. And whereas someone might check the light switch only in order to make sure it’s off, someone with HOCD checks their reactions to homoerotic ideas in order to verify a piece of self-knowledge. If someone gets the “wrong answer,” they may panic. In that case, the checking compulsion and all their other symptoms become intensified; they “spike” (q.v.).
The fact that checking is introspective in HOCD highlights an important difference between this form and others. Phillipson makes the crucial observation that HOCD and ROCD, unlike other themes of OCD, refer constantly to norms of self-interpretation and decision-making completely unproblematic for most sexual or romantic subjectivities. Above all, the emotional heuristics for self-definition and object choice give surprising, contradictory, and unintelligible readings and seem “out of order.” As one HOCD person writes: “I think I’ve broken the psychological mechanism for ‘wanting’ things by scrutinizing it too closely and now nothing is clear.”
It’s misleading to say that HOCD and ROCD are intense and hyperbolic enactments of very normal questions (as opposed to other forms of OCD that thematize in domains less thoroughly covered by our culture’s emotional tutelage.) The truth is that the HOCD subject is completely unable to engage in such questions the way a normal subject would, for two reasons: 1) because the subject’s interpretive activity loses all of the coordinates (liberation, pride, positive curiosity, positively valuated pleasure) of “normal” sexuality; 2) because, for HOCD subjects, the hermeneutic framework of sexual identity decisions has been repeatedly discredited by its extreme inconclusiveness and its tendency to contradict itself.
Most commonly with reference to loss: of e.g. a loved one, a war. People in denial (henceforth PIDs) are, in this usage, in denial about external realities that anybody could verify by a universally recognized, unproblematic procedure.
We also speak about denial when someone refuses to acknowledge, for example, a pattern in their behavior, or refuses to acknowledge that “they need help.” In these examples, people are not really in denial about external reality. It takes interpretation to discern a “pattern of behavior” (some behaviors must be counted as significant, others passed over, and many different actions have to be grouped into a single pattern). The assertion that someone “needs help” is even less neutral.
At the risk of stating the obvious, it can be added that whoever uses this phrase gains authority over the PID. A grief-crazed lover might need to be watched over and taken care of. Someone who “needs help” might need to be yelled at by a large group of friends and/or institutionalized and/or forced to go to rehab.
Denial in sexual orientation is clearly not a denial of external reality; it belongs with the latter examples: denial about a “pattern of behavior,” denial about “needing help.”
All those examples authorize the people around the PID to intervene or at least gossip knowingly about their business. These interventions and this authority are justified by the fact that the PID cannot take care of themselves. But does a gay person in denial need to be committed? Are they a danger to themselves and others? Are they unable to live their own lives? The answer to these questions should be NO, NO, NO. It’s one thing to display support for someone who might be gay, or to invite someone to try out something they might enjoy; such gestures are often worth the risk that they will be unwanted or triggering. But people in our culture seem to think they know better than the PID about the right way of dealing with their sexuality, whether that means embracing a gay lifestyle or just admitting the truth.
HOCD readers may remember a time they tallied up “evidence” that they were in denial, or when someone received their urgent confidences with skepticism. It’s often futile to fight such suspicion, because “denying” is already the accusation. At such times, it might help to temporarily identify as a PID: “I am in denial, and I remain free to live in denial: partially, wholly, or to a normal degree.” Be proud of it, you “hypocrite readers” of sexuality, and sing along with me: “It’s my party / I deny if I want to.”
Here are some selections from the first page of Google results for HOCD:
- “How do I know if I’m gay?”
- “Gay, straight, or HOCD?”
- “help guys do i have hocd does it actually exist”
- “do i have hocd or am i just in denial”
- “How Do I Know I’m Not Gay?”
Browse the NeuroticPlanet forums and you’ll find a huge number of posts asking questions like these. From these and other HOCD forums, it seems like this type of scrupulously honest self-questioning is a consistent feature of HOCD. And these inquiries also follow an extremely consistent pattern:
1. Doubts arise.
2. The HOCD person asks whether or not they are gay. They may ask somebody who claims some kind of authority, or they may try to figure out through introspective checking.
3. They may be given a reassuring answer or come by themselves to a reassuring conclusion.
4. They soon begin to doubt their own judgment or the expertise of whoever gave them the reassuring answer. They reexamine their logic, inference by inference.
The word “reassurance” comes from general OCD therapy where it functions the same way as in HOCD discourse. It is a derogatory word with a disciplinary edge. Users advise each other to “stop looking for reassurance,” or occasionally apologize for doing so themselves during a particularly acute episode.
The concept of reassurance is especially resonant within HOCD discourse, despite originating outside it. For one thing, it’s curiously symmetrical with “denial”; and it has in common with “sexual repression” its futility. Just as the “beast in the closet” will inevitably emerge, the banal rationality of reassurance will inevitably be undone. But it will be undone by still more reasoning. In this way, the concept of reassurance provides HOCD sufferers with an alternate explanation for the persistence of their doubts. This alternate explanation corresponds to a different narrative arc: in place of the “destiny” of latent homosexuality, it proposes a plateau of obsession that might or might not gradually abate, but that in no way terminates in the explosion of sexual “truth.”
Not all of the HOCD community’s terminology is as helpful as “reassurance.” A few words become popular because of their ability to cause dismay (see “spiking”). Every time it appears on NeuroticPlanet’s HOCD board, internalized homophobia is part of an obsessive doubt: “What’s the difference between HOCD and internalized homophobia?” The concept of IH is alarming to HOCD people because it interferes with a popular rule for “distinguishing” between HOCD and homosexuality: that HOCD people suffer psychologically whereas well-adjusted gay people are happy to be gay. Taken seriously, the concept of IH could be an alternate interpretation of the symptoms grouped under HOCD. But in fact it’s just the mainstream interpretation, the only one that was available to HOCD people before 2004, and the one they can STILL expect to receive from the average therapist (see Williams 202: “Because homosexual anxiety is not well-described in the research literature, people with HOCD may have difficulty finding knowledgeable treatment providers.”)
HOCD people, especially with the support of their community, are able to take a stand for the idea of HOCD and against these suspicions. But they should be careful not to impose their self-interpretation on people outside the HOCD community who find the concept of internalized homophobia useful. Everyone in the HOCD community should be careful (as they have been up until now) not to deny the existence of IH. Such an interpretive imposition is exactly what HOCD people suffer at the hands of the mainstream.
A spike (the word, like reassurance and checking, comes from general OCD treatment discourse) in one sense means an intensification of all symptoms. The sufferer increasingly believes they are gay (or bi or straight, depending on what they’re fearing), increasingly asks reassurance, increasingly puts themselves and their body through tests, increasingly checks for feelings, reactions, erections; panics; feels nauseous; feels liking/feels a crush; feels tender; feels doomed; feels certain; feels unhinged (bad trip, fevered); asks for help, cries, shouts, or stares blankly; feels aroused; blushes; feels oversensitive; feels overbooked/overclocked. Some members of NeuroticPlanet even report a feeling of bliss and power (see this sometimes very disturbing thread (extreme spike warning), a lesson in the ecstatic/prophetic dimension of catastrophization).
Spikes have some phenomenal overlap with “panic attacks” or “anxiety episodes.” Just as a panic attack is not just a feeling but a dynamic or accent of feeling, a spike is not just a cluster of feelings, mental compulsions, and physical responses, but also the “rise” in the same phenomena. The “groinal” connotations of “spike” may add to its appropriateness to HOCD, more obviously for HOCD males than females.
Spikes are not always dramatic. They can run their course in someone while they watch a film, have a conversation, sit in class or at work, or have sex, without necessarily interfering. Some HOCD sufferers get so used to passing spikes that they don’t even lose their train of thought.
The concept of “groinal response” is sure to be the HOCD community’s most controversial and unintuitive piece of re-interpretation. The fact that many (perhaps most) HOCD people do experience physical signs of arousal as part of their spike or in their daily life (possibly triggering a spike) may be taken by people outside the community as a clear sign that they are really “in denial.” Getting an erection from some thought (though we need to remember that many, maybe even half, of HOCD sufferers are women), for example, would be, for some people, the surest sign of sexual orientation. Even people with HOCD welcome the erections they want to get (around a significant other, for example) as proof that, at least, they still like the opposite sex (or same sex, if they’re gay HOCD sufferers.) But just as HOCD sufferers feel themselves to be atypical with respect to introspection—thus deprived of the ordinary sources of self-knowledge or conscious will—they have experienced something idiosyncratic with respect to the physical signs of their desire. Their groinal responses seems in conflict with other things they know about themselves; they get groinal responses from a set of stimuli or ideas that would also be unusual if they were gay (for example, an HOCD person might note the seeming lack of selectivity in their physical arousal—even at unattractive persons, members of their family, animals, or just everything). Maybe they get groinal responses less in relation to same-sex objects than in relation to the assertion that they are gay.
But of course it is also common to doubt whether one’s groinal responses are that idiosyncratic after all; and if a distinction is made between groinal response and arousal, an HOCD person will almost inevitably question whether or not it actually “counts.” In the end it is often necessary for an HOCD person to give themselves permission to just call whatever they want a groinal response without worrying about whether this interpretation is justified by some kind of two-column chart of the difference between groinal response and arousal. Ultimately such charts are only counterproductive.
“Groinal response” is a flexible category whose most important function is to give the HOCD person leeway in interpreting themselves. The axioms of this interpretation are: that physical arousal is not the expression of a catastrophic, unstoppable desire; that groinal responses do not point to a sexual act; that the failure to engage in this sexual act is neither frustration nor disappointment; that celibacy (of any kind) does not mean an empty or sad life.
* * *
One of my goals in this article was to propose to the HOCD community a few conceptual tools from queer theory. One of the tasks of queer theory is to invent interpretive leeway for people who are excluded or tyrannized by the dominant sexual hermeneutic—something that the HOCD community has learned to do for itself. Even straight HOCD people have a lot in common with queer and gay people: their marginal and difficult subject-position, their shame, their silence, their interpretive creativity (on which they often depend for survival), their exposure to minor narratives of sexuality, their instincts of self-protection. Anyone with HOCD who wants to see what support they can get from or give to the queer community could read the short first volume of Foucault’s History of Sexuality (especially to understand the history and politics of the concept of repression) or something by Eve Sedgwick (Epistemology of the Closet would be particularly germane), or just click around the blogosphere. 
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