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I have been dealing with homosexuality for many years and, through Project Gay, that has been online for more than 10 years, I often had the opportunity to exchange e-mails with gay guys of all ages and to chat with them many times also in person, however It should be emphasized that a substantial proportion of the mails I receive, about 30%, do not come from gay guys, but from guys with gay-themed obsessive compulsive disease (gay-themed OCD).
I must point out that I am neither a psychiatrist nor a psychologist but only a person who has met many gays and who full-time looks after gays, often for many hours a day and even on holidays. The guys with gay-themed OCD who contact me are looking for my knowledge of the gay world because they feel obsessive doubts about their sexual orientation and compulsions that push them to test themselves to verify their sexual orientation and therefore want to have a comparison on these elements.
With some of these guys I have been exchanging literally hundreds of mails, even ten on the same day, when the OCD became more aggressive.
It is certainly not my task to talk about diagnoses and diseases and, obviously, when the problems become serious, it is useful and appropriate to contact specialists, but the fact remains that, in general, in situations of gay-themed OCD, an objective comparison with people who know well the homosexual reality is very useful because this way, guys with OCD are able to know of the weak aspects of their obsessive thinking. I will avoid any general discourse on the OCD and I will immediately and specifically deal with of the gay-themed OCD.
I start from some statistical observations.
In the experience of all (or almost all) guys with gay-themed OCD there is a heterosexual past free from OCD, often it is a non-linear past but still objectively and strictly heterosexual. Let me explain better, the guys who present a gay-themed OCD have lived the emotional, effective and even sexual experiences typical of heterosexual guys, that is they have been attracted in a clear way by girls, they have fell in love with girls, without ever questioning the fact of being heterosexuals, they have masturbated thinking about girls, very often they have had a girl and have had sexual intercourses with her, sometimes they have had more than one girl and a more complex sexual life but always heterosexual.
In the vast majority of cases sexual relationships of these guys were very strong and very engaging but the emotional dimension, in many cases, was marginalized, the dialogue with the girl was considered secondary compared to having sex with her. Sometimes and not rarely, performance anxiety phenomena are found. The absence of dialogue with the girl often led to the end of the relationship, followed by a sense of frustration.
It should be emphasized that for younger guys, who have never had sexual experiences, the picture, although essentially projective, often repeats models similar to the one just seen: I fall in love with the girl but in the end I'm afraid she doesn’t want me, doesn’t understand me. In this case, however, the dynamics are all internal.
In the experience of many straight guys there are sometimes memories of childhood or early adolescence linked to exploratory games with sexual background made with their mates, memories that generally don’t create any embarrassment and that are often completely archived because clearly not significant, when heterosexual attraction develops as adolescence progresses. Boys with a gay-themed OCD tend to improperly give those memories the value of an indicator of sexual orientation.
The gay-themed OCD emerges almost always in a sudden and totally unexpected way, very often because the guys, in the use of pornography, let themselves go to watch gay-themed videos and on that occasion they feel like they are experiencing some curiosity, some interest, or even at least a partial erection. It is common to hear phrases like: "If I had not gone to see that gay porn, all this disaster would not have happened!"
The gay-themed OCD as all the forms of OCD can present at different levels and the mails of the guys reflect the degree of obsessiveness of their thinking. Some mails are very articulate, deal with several issues and then address the topic of the OCD, others are clearly monothematic, in the sense that from the beginning to the end they speak only of OCD or better of the belief of being gay, others show signs of panic at the limit of loss of control. But one thing should be emphasized: guys with gay-themed OCD, in practice, never undertake homosexual experiences and don’t even have casual homosexual intercourses, all of their speech is independent of real relationships with real boys, both sexually and on an emotional level.
I try to clarify the concept: a gay guy falls in love with a real guy, a friend of his, a colleague of studies, in other words, his sexual interest is directed towards a well identified person, so it is a fact, not a mere hypothesis. A guy with a gay-themed OCD fears he can get excited about homosexual content, the concern is only about the technically sexual aspect. There is the fear of reacting sexually with "a guy" who is never a concrete guy but a generic male person. So these are abstract fears, which at most can be connected to a gay video, but never to a real person. In gay-themed OCD we find both obsessive, intrusive, recurring thought, and the compulsion to test to get a definitive answer about sexual orientation. Testing means practically verifying one's sexual reaction (partial erection, hard erection, ejaculatory stimulation and more or less complete voluntary masturbation in the face of gay sexual content).
Obviously, as is typical of the OCD, the test "never" provides a satisfactory answer and this leads to the endless repetition of the tests itself. The tests tend to reproduce the situations that characterized the first manifestations of the OCD. In practice, during masturbation dedicated to a girl, or in front of a hetero porn, there is an intrusion of disturbing contents of homosexual type. I emphasize that these contents are not conceived as pleasing but as intrusive and capable of destroying the pleasure of heterosexual sexuality.
In the mails of the guys with gay-themed OCD there is almost always a loving attitude towards the girls who are described with tenderness, though often the real emotional relationships with those girls have been problematic, despite the intensity of sexual relations, in other words there is an involvement towards the girls well beyond the sexuality elementarily understood, these guys feel the emotional need of the girls, even if often they struggle to build truly gratifying emotional relationships with girls. These are problems typical of hetero sexuality but they are interpreted on the basis of a scheme suggested by the OCD: I cannot build an emotional relationship with a girl because maybe I’am gay! 99% of the problems of heterosexual couples have nothing to do with homosexuality and the difficulties of certain guys to create emotional relationships with girls does not depend at all on a hypothetical homosexuality but probably depend on the obsessiveness itself (which also manifests in heterosexual relationships), which the girl feels and pushes her to distance. A classic mechanism of "substitution" is realized, the true motivation of the problems of heterosexual couple is replaced by the idea that the motivation is just one: the homosexuality. It is very significant that guys with gay-themed OCD tend not to ask themselves questions about their unsatisfactory hetero affective relationships and shift their focus exclusively to the hypothetical homosexuality.
It has happened to me several times to have the impression that for these guys it is extremely difficult to accept the idea that their emotional relationships with girls can be problematic for reasons completely alien to homosexuality, it is as if the gay hypothesis were the only possible motivation of the difficult emotional relationship with girls.
I also often thought that these guys tended to give sexuality without affectivity (both hetero and gay) an excessive meaning, as if a couple's relationship were just the sum of two single sexual entanglements, or rather the sum of two sexualities in which each of the two partners finds in the other the realization of his/her sexual fantasies, without the creation of a couple unity that goes beyond sex.
Another fundamental question is linked to the fact that the guys suffering from gay-themed OCD are brought to consider themselves gay repressed, or latent gays, or bisexuals. All this is significant because in practice they never identify themselves as strictly gay, but as guys who have "even" gay interests. For a guy strictly gay being gay is a value, a characterizing element that does not conflict with anything, except with the ignorance of families and of the social environment. A gay guy does not in any case tend to safeguard his more or less hypothetical heterosexual dimension, simply because that dimension is completely absent. Obviously the categories of repressed gays, latent gays or bisexuals have nothing to do with OCD. Let us now try to understand why.
A gay repressed is a gay to all effects who tends to repress his homosexuality almost always for environmental and educational reasons, but he is a 100% gay, he can practice gay masturbation with the sense of sin and transgression, but certainly does not feel it as something alien and disturbing, does not certainly feel it in conflict with a hypothetical hetero sexuality, which does not exist at all for him. A repressed gay guy can also come to "want" to experience heterosexual sexuality, either in masturbation with hetero fantasies or with videos of girls, or even with heterosexual relationships, but these things constitute a forcing, absolutely not spontaneous and certainly not gratifying, it is obvious that these forced attempts at hetero sexuality are self-imposed and have nothing to do with the true sexuality.
The concept of latent gay deserves a separate discussion. Latent gay means a guy whose homosexual interests are hidden, but not in the sense that they are hidden from others but well present to that guy, but in the sense that they are unconscious, that is, that boy has no awareness of them. A latent gay does not consider himself gay, he feels heterosexual and does not even consider the hypothesis of being homosexual. Latent homosexuality becomes concrete, beyond the hypotheses, when the guy leaves the latency period, which can last many years, and there is a real homosexuality, but these are rare cases. I add that one can "suspect" a latent homosexuality through symptomatic elements of a discomfort in heterosexual relationships, that may be not always fully satisfactory. Obviously those elements of discomfort can be interpreted also in quite different ways and it makes sense to refer to latent homosexuality only when, after the latency phase, a true homosexuality has occurred.
As for the bisexual category it must be said immediately that a bisexual guy experiences both heterosexual and homosexual interests, often in different degrees, with the prevalence or of the heterosexuality or of the homosexuality, but the guy experiences both considering each the two forms as a positive experience, none of the two forms of sexuality is seen by bisexual guys as a disturbing element of  the other neither is accompanied by anxious manifestations or compulsions.
In practice, the totality of guys affected by gay-themed OCD tend to identify themselves with "a gay who does not accept himself" and the ambiguity of this concept favors this identification. A gay man may have a big grip on declaring himself publicly gay, given the widespread ignorance about sexuality, that can cause unpleasant reactions in the family or in the social environment, but the prudence in external behavior has nothing to do with sexual orientation. A gay guy who is not publicly declared and does not behave externally in ways that allow him to be identified as gay, is just a wise gay guy, he's not a gay guy who doesn’t accept homosexuality, he's not a gay guy fighting against his gay identity. There may be times when a gay guy tries to suppress his sexuality to adapt to what the society and the family expect him to be, and in some cases gays also get married, but they remain gay guys that have forced themselves to a hetero life, they are not hetero at all, because they, also as married guys,  maintain an exclusively gay masturbation, that is, they have sexual intercourses with their wives, but when they experience sexuality freely in masturbation they clearly manifest their true sexual orientation.
Guys affected by gay-themed OCD, for what I can see, never show forms of homophobia, have or have had gay friends, they recognize to gay people the same rights of heterosexuals and also have a deep respect for homosexuality that disturbs them not as such, but only as an element that manifests in an intrusive and obsessive way in their hetero sexuality and in this sense conditions them, proposing them obsessive models of behavior that are alien to them, are unnatural, not against nature in the abstract, but against their individual heterosexual nature.
It must be clearly underlined that guys with gay-themed OCD have a decidedly unrealistic picture of the gay world, which does not come from their personal experience, because they are not gay, but from mass media and so it is built on stereotypes often very far from reality. I try to list some of these stereotypes: gays think only or especially about sex, they are sexually interested in all men and all guys, or at least in all gay men and all gay guys, gays are naturally effeminate, they dress so flamboyant, they only practice anal sex and tend to put it into practice with anyone, gays do not like team sports, have no friends, are melancholic, etc. etc..
Guys with gay-themed OCD tend to identify themselves as gay on the basis of their presumed conformity to these stereotypes and when, talking with me, they know that homosexuality is something quite different from what they have imagined, they experience moments of perplexity.
An important reflection must be made on the different frequency of gay-themed OCD cases in the various countries. It should be kept in mind that the OCD tends to polarize obsessive thoughts on a content that is particularly anxiogenic for the person affected by the OCD itself. The gay-themed doc is very rare among mature men or among the elderly who experience other types of obsessive content, while it is common in young people, this is certainly not surprising because for young people sexuality is a fundamental theme. We are instead struck by the fact that the gay-themed OCD is widespread especially in southern European countries (Italy and Spain), where the integration of homosexuals is still problematic, it is much less common in Germany, in the North of France and in England, where the culture of integration is much more widespread (especially in large cities) and is practically absent in the Scandinavian countries, where a precocious and well-managed sexual education allows a real integration of homosexuals who are no longer considered as a human category to watch with suspicion or concern.
From this reasoning it turns out that the real problem of gay-themed OCD is not being or not being gay, because the obsessive doubt about one's sexual identity is substantially inspired by social intolerant attitudes towards homosexuality, the real problem is represented by obsessiveness in itself and by compulsiveness in itself.
In the experience of guys affected by gay-themed OCD very often obsessive elements, ritualisms of various kinds and unmotivated fears appear from childhood or early adolescence. In the approach with Gay Project the guys read that the fantasies that accompany masturbation are the first indicator of sexual orientation and as they experience in their masturbation the intrusion of gay elements are induced to think that those elements are true symptomatic elements of homosexuality. If it is true that masturbation fantasies are the first indicator of sexual orientation, it is not true, however, that all the homosexual contents that can come to mind during masturbation are really masturbatory fantasies. It should be noted that masturbation fantasies should not be confused with two other typical categories of homosexual content, that is, with abstract thoughts and phobic-obsessive contents. Let’s try to characterize these categories in order to make them easy to identify.
1) A sexual fantasy is a fantasy, usually associated with sexual arousal, that is to erection, or which would lead to erection if there was no rational control to repress it. Sexual fantasies are experienced as gratifying, both on a physiological (erection) and on a psychological level. The sexual fantasies are induced by concrete situations experienced as sexually involving or by the memory of similar situations or by episodes that make the memory resurface. Sexual fantasies are cultivated by the subject who spontaneously and voluntarily dwells on it, precisely because he experiences them as gratifying.
2) A masturbatory fantasies are sexual fantasies that accompany masturbation. These are therefore particularly exciting sexual fantasies, in relation to which the erection during masturbation is maintained for a long time. Gay guys who “do not accept themselves”, in spite of everything, perceive their gay sexual fantasies as pleasing on a sexual, physiological and psychological level, see them as fantasies against which they "must morally" resist but towards which there is no feeling of deep repulsion or of spontaneous rejection, I mean that a guy who does not accept or struggle to accept himself not only does not feel repulsion for gay sexuality but is attracted to it. In a sense, he is led to resist "rationally" to the temptation of gay fantasies, which for him have a considerable attraction. The emergence of gay sexuality is experienced by the guy as the realization of something new with which he must deal, but never as a repellent or disgusting reality, much less as a foreign reality that has become invasive and pervasive.
3) An abstract fantasy is a representation of a situation that "theoretically" could result in sexual involvement, i.e. that for other subjects would constitute a sexual fantasy or even a masturbatory fantasy, but that in the present case is not accompanied by any form of sexual excitement. Abstract fantasies are the manifestation of non-repellence towards certain sexual contents, but they do not at all constitute indicators of involvement or sexual orientation. Abstract fantasies are not produced by sexually engaging episodes or by their memory, they are a purely rational birth and do not involve physiological sexuality. It often happens that gay guys who “do not accept themselves” try to validate their hypothetical hetero identity based on abstract fantasies. It should always be kept in mind that abstract fantasies, even if they concern situations potentially involving sex, do not have any specific sexual value for the subject that feeds them. It is evident that abstract fantasies are not experienced by the subject neither as gratifying nor as disturbing, they can at most be reassuring but only at the rational level, generally on an emotional level they do not serve to resolve anxiety.
4) Sexual contents of a phobic or obsessive type are, in fact, contents that occur automatically and uncontrollably in situations or sexual fantasies with which they are not immediately correlated. They are contents that the subject fears, of which, wrongly or rightly, is afraid and which tends to recur in an obsessive and deeply disturbing way. Contents of phobic-obsessive type are not object of sexual fantasies, in the sense that the subject does not deliberately cultivate them searching for gratification, rather sees them as a foreign disturbing element whose presence tends to slowly invade all the sectors of affective and relational life. While sexual fantasies have a deep root in previous experience, the phobic-obsessive contents emerge unexpectedly and tend to stabilize creating states of considerable psychic suffering. The negativity of the obsessive phobic content is often linked not to individual experience but to educational archetypes that have consolidated over time as deeply assimilated prejudices. It should be emphasized that the negativity of such contents when the subject refers them to himself, does not mean at all intolerance or rejection of analogous situations not referred to himself. For example, a straight guy, very open to gays and with gay friends, who therefore does not present any kind of homophobia or social intolerance towards gays, can very well develop phobic-obsessive contents related to fear / conviction of being gay. To clarify the situation let’s examine two examples:
Situation n.1
A 25-year-old guy, who has a clearly heterosexual affective and sexual history behind him, writes: "I'm afraid of being gay because for some time I have gay sexual fantasies, I imagine that a man takes me with violence but for me the idea of being with a man is really repellent. Maybe I'm repressing my homosexuality, but when I’m starting to think about a girl that I like, inevitably the idea that someone is there who takes me by force comes back to me and I cannot even masturbate thinking about the girl because the idea of being gay is taking hold of me, but I never thought of a man as a sexual interest, at any level."
Analysis of the Situation n. 1
a) The guy is afraid of being gay.
b) What he calls sexual fantasies are actually phobic-obsessive contents, absolutely non-gratifying and deeply disturbing, experienced as extraneous elements that invade the field.
c) In conclusion, the picture seems to exclude that the guy is a gay who struggles to accept himself.
Situation n.2
A guy 21-year-old writes: "I've always been hetero, but it's a bit of time that I watch the guys with another eye and such a situation is becoming almost an obsession, if I think I get excited, I try to repress myself in every way but sometimes I cannot do it and I masturbate thinking of a guy and then I feel terrible, because I don’t feel gay and when I think  of my future I see it in my family. And then thinking about my life with a girl makes me feel good, that's exactly what I want."
Analysis of the Situation n. 2
a) Although the guy talks about an obsession or something similar, the thoughts to which he refers are true masturbatory fantasies against which one tries to resist rationally in the name of an alleged heterosexuality.
b) Heterosexuality is present only through abstract fantasies such as seeing oneself in a family in the future or feeling comforted by the abstract thought of the life with a girl.  
c) In conclusion, the picture seems to indicate that the guy is really a gay guy who “does not accept himself”.
Among the most frequent causes of the presence of gay phobic-obsessive content in the sexuality of heterosexual guys can be mentioned:
a) The prevalence of the sexual dimension over the affective one in the context of a heterosexual relationship, which makes the relationship unsatisfactory and fuels performance anxiety.
b) The rejection encountered by girls from whom the heterosexual guy was strongly attracted. Rejection depresses self-esteem.
c) Having spent childhood and adolescence experiencing the discomfort of being held up as gay in a way totally unrelated to reality.
Both in case a) and in case b) the suspicion insinuates that the failure may derive from some form of latent homosexuality emerging. The guy before go to a sexual contact with a girl or before masturbating, feels that the phobic-obsessive contents are there lurking and this fact implies that the sexual experience is heavily conditioned by anxiety with outcomes of failed or unsatisfactory erection and weak emotional participation that contribute to consolidate phobic-obsessive contents.
Sexual tests are also frequent in these situations. The guy tries to test the response of his sexuality in both heterosexual situations and in similar gay situations, tries for example to masturbate with similar fantasies both in the gay field and in the straight one. Since it is not a question of true sexuality because it lacks the spontaneity that is the backbone of sexuality, these tests are also disappointing and sometimes lead to a real rejection of both gay and straight sexuality. In such situations it is counterproductive to push the guy to go deep into the search for causes. It often happens that sexuality is the target but not the cause of phobic-obsessive contents.
If the phobic-obsessive disorders are reactive, that is, they are born by reaction to very anxiety-provoking and stressful situations, they will disappear when the cause that produced them ceases to exist. Classic examples are those of guys who have such disorders when they live in the family and who overcome them when they are for example in a university college. Often causes are to be sought in areas not related to sexuality: loss of work, fear of losing girlfriends, difficult family relationships.
As in many situations of psychological distress, it is advisable to encourage socialization in order to leave as little space as possible to obsessive thinking so that it is not perceived as conditioning for the entire relational sphere. Basically the way to deal with phobic-obsessive content can be summarized in one example: many are afraid of ghosts and because of this they don’t  leave their home, ghosts don’t exist, but the fear of ghosts can be paralyzing. How to cure the obsessive fear of ghosts? The answer is only one: "Experiencing that the ghosts don’t exist!" Bringing back the reasoning to the obsessive idea of being gay that haunts some hetero guys, how is it possible to overcome it? There is only one way to go, that is to say that sexual contents against which guys are fighting are not sexual fantasies, sign of homosexuality, but just phobic-obsessive contents in which homosexuality is present not as such, but as fear of homosexuality. And where homosexuality does not exist in objective terms, it makes no sense to be afraid of it.

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