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Homosexual panic is a familiar clinical term whose roots seem uncertain but probably originated in early psychoanalytic writings. Its manifestations are signs and symptoms of moderate to severe anxiety generated by the recognition of ego dystonic homosexual thoughts or feelings. When homosexual panic presents in its most severe form, the patient might be agitated, violent, and/or psychotic. If psychotic, the patient will project his/her homosexual thoughts or feelings onto others who are then perceived as wishing to entice or attack the projector.
A deeper appreciation of homosexual panic has been offered by Ovesey, who points out that homosexual thoughts or feelings frequently do not involve motives which are sexual but instead motives related to dependency and power needs (1, 2). In the management of a patient in homosexual panic, the clinician can benefit not only by reassuring the patient of his/her sexual identity but also by utilizing Ovesey's notions about “pseudo-homosexuality” to reframe the issues at hand to be related to dependent or power yearnings and not sexual ones.
In this paper, the case history of an ego syntonic homosexual patient who recognizes certain distressing heterosexual thoughts and feelings with associated anxiety symptoms will be presented. The term heterosexual panic is coined to describe this phenomenon. Based upon an understanding of this phenomenon from the perspective of self psychology, certain management guidelines will be presented.
Mr. R. is a 29-year-old white male homosexual who presented with the chief complaint of anxiety attacks. These anxiety attacks began about one month ago and consisted of feelings of doom, palpitations, diaphoresis,