Key Takeaways
- Transgender OCD is a form of obsessive-compulsive disorder (OCD) characterized by ongoing, distressing doubts and fears about your gender identity. People with this form of OCD may fear that they don’t know their “true” gender identity or worry that they’re not living authentically.
- Like other forms of OCD, transgender OCD involves intrusive thoughts and compulsive behaviors aimed at seeking certainty or reducing distress, which can impact daily life and well-being.
- Fortunately, transgender OCD can be managed with the right support. Treatment typically involves therapy like ERP, self-care strategies, and medication, if needed.
Obsessive-compulsive disorder (OCD) is a mental health condition characterized by unwanted, disturbing thoughts (obsessions) followed by repeated, ritualistic behaviors (compulsions). Obsessions and compulsions tend to follow some common themes. In the case of transgender OCD, a person may experience upsetting, obsessive thoughts about their gender. In response, they may perform compulsive rituals in an attempt to confirm their “true” identity.
OCD in all forms is believed to result from a series of genetic, psychological, and environmental factors. But we don’t yet know if there are specific risk factors for transgender OCD. Research suggests that this presentation may be less common than other OCD subtypes. But this may be because there are so few studies on transgender OCD, which can make it more challenging for clinicians to diagnose.
A note on terminology: Research shows that OCD symptoms often follow similar patterns. For example, many people with OCD experience intrusive thoughts related to cleanliness, relationships, religion, etc. People often refer to these different symptom presentations as “OCD subtypes.”
In this piece, we’ll be using the term “transgender OCD” for a subtype of OCD that causes psychological distress related to gender identity. However, we want to be clear that transgender OCD isn’t an official diagnosis. We also want to stress that, as indicated in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gender nonconformity in any form isn’t a mental health condition.
Symptoms of transgender OCD
While there isn’t formal diagnostic criteria for transgender OCD, this presentation of OCD typically involves obsessions and compulsions like:
Transgender OCD obsession examples:
- “What if I’m really trans, but I don’t realize it?”
- “What if I need to end my relationship because I find out I’m trans?”
- “What if my feelings about gender are just confused because of my attraction to people who are not the opposite sex?”
- “Is liking a certain color or way of dressing ‘proof’ that I’m trans?”
- “Do other people think I’m trans?”
- “What if I’ve been suppressing my real gender identity my whole life?”
Transgender OCD compulsion examples:
- Spending an excessive amount of time doing research on gender identity each day
- Repeatedly seeking out members of the transgender community and asking them to confirm your gender identity
- Spending large amounts of time experimenting with different gender expressions (like trying on clothes typically worn by other genders) as a way of “proving” your gender identity
- Examining your thoughts and/or appearance to check for potential signs of gender nonconformity
- Frequently comparing yourself to other people who identify as transgender to see if you have similarities
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Trans OCD thoughts vs. gender dysphoria
Being transgender typically involves a desire to express yourself and identify with a gender that’s different from the one you were assigned at birth. This is part of a person’s authentic sense of self.
When a person experiences gender-related distress related to gender identity, it’s referred to as gender dysphoria (GD). Gender dysphoria is more than just discomfort — it can cause emotional and psychological distress that may impact daily functioning.
However, this isn’t the same as having transgender OCD. People can be transgender and/or experience gender dysphoria without having OCD or another mental health condition. It’s also possible to have gender dysphoria and trans OCD at the same time.
When this happens, the person will benefit from integrated care that addresses both conditions at the same time. The distinction is important, as treatment may differ depending on whether the primary concern is gender identity exploration or intrusive thoughts related to gender.
Support for people with transgender OCD
A therapist who specializes in gender-affirming therapy and OCD treatment can help you manage your OCD symptoms and improve your quality of life. Treatment for transgender OCD is similar to treatment for other forms of OCD and may include:
- Exposure response prevention (ERP): ERP is a form of cognitive behavioral therapy (CBT) that helps people confront triggers gradually and safely. Under the guidance of a trained therapist, a person will face feared situations or thoughts (the “exposure”) without engaging in their usual compulsive behaviors or safety rituals (the “response prevention”).
- Medication: A few medications have been approved for treating OCD. If you’re interested in using medication to help you manage your symptoms, talk to your doctor to see if that’s the right option for you.
- Self-care: While not a replacement for professional help, self-care strategies can help keep your mind and body strong throughout your mental health journey. This can look different for everyone. But try to fuel your body with nutritious food, get plenty of sleep, make time for movement you enjoy, and do activities that reduce stress.
A common challenge is the fear that facing gender-related triggers in therapy will make doubts worse. I help my clients by reassuring them that the goal is not to force change but to gradually reduce the power of these thoughts. I also make sure to offer support and strategies to manage discomfort along the way.
Find care with Rula
People with transgender OCD experience obsessions and compulsions related to their gender. They may constantly worry that they’re not living authentically or that they’re in denial about their true identity. In response, they may engage in compulsive behaviors to reduce their distress. This might include spending hours doing research online or seeking reassurance from LGBTQ+ people. Fortunately, like other forms of OCD, transgender OCD can be managed with the right support.
At Rula, we’re on a mission to increase access to affordable, specialized mental healthcare. So if you need gender-affirming therapy and/or OCD support, check out our therapist-matching program today. You can sift through our network of over 10,000 providers, find the right therapist for your needs, and schedule your first live video appointment for as soon as tomorrow.
About the author
Liz Talago
Liz Talago, M.ed. is a mental health professional turned content writer and strategist based in the Detroit metro area. As an independent consultant for mental health organizations, Liz creates meaningful connections between brands and their audiences through strategic storytelling. Liz is known for championing diverse perspectives within the mental health industry and translating bold ideas into inspiring, affirming digital experiences.
In her free time, you can find her hiking with her two German Shepherds, puttering around her dahlia garden, or spending time with her family.
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