Defining and treating sexual orientation OCD and gender identity OCD

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By Jennifer Park, PhD, executive director of clinical services and Tarik Hadzic, MD, PhD, assistant medical director, California clinics

While compulsive checking, cleanliness, and perfectionism are commonly associated with obsessive compulsive disorder (OCD), there are many other presentations of OCD which are lesser known, but considered by professionals to be typical for OCD.

All types of OCD involve intrusive or unwanted thoughts that are obsessive in nature, or compulsive behaviors or mental acts that are performed to reduce anxiety or distress caused by those thoughts. People with OCD experience an increase in anxiety and distress generally due to the obsession, then a decrease when they act on the compulsion.

Sexual orientation OCD (SO-OCD) involves significant doubt regarding an individual’s sexual orientation. A person may experience intrusive and distressing thoughts questioning whether they are gay or straight, or for those who identify as heterosexual, may fear being or becoming gay/lesbian/queer.

Gender identity OCD is lesser known, but very similar in that it involves significant doubt and uncertainty as to whether the individual is cisgender (gender assigned at birth) or transgender. A person with gender identity OCD experiences obsessive thoughts that they may be, or will become, transgender. With both SO-OCD and gender identity OCD, often the underlying fear driving the OCD is the uncertainty of not being sure of one’s identity. Those who experience these types of OCD presentations may question themselves – “if I don’t know this core aspect about myself, then I can’t be sure about anything else.” Uncertainty and the destabilization of one’s identity causes a lot of distress for people with these types of OCD.

Individuals who experience SO-OCD or gender identity OCD are not homophobic or transphobic, although the distress that these individuals experience from their thoughts may lead others to believe otherwise. OCD often latches onto ideas or fears that may be associated with social stigma and the potential adverse reactions of being part of discriminated and marginalized groups.

How are gender identity OCD and sexual orientation OCD treated?

The gold standard treatment is exposure and response prevention (ERP), which is a type of cognitive behavioral therapy (CBT). ERP involves gradually exposing someone to their obsessions and fears, while also preventing them from engaging in rituals or compulsions that decrease anxiety in the short term, but keep OCD symptoms present in the long term. ERP has been very well established through hundreds of research studies across many different types of populations. Studies have shown that the majority of those who receive ERP treatment for their OCD respond well with improved symptoms.

For those who have moderate severe to severe OCD, the recommended treatment is ERP in combination with medication, specifically selective serotonin reuptake inhibitors (SSRIs).

Rogers treats OCD in a growing network of communities nationwide, including residential, partial hospitalization, and intensive outpatient levels of care.

Additional resources

iocdf.org

San Francsico University’s Family Acceptance Project®

American Psychological Association