Gender Identity & SO-OCD

Gender Identity and Sexual Orientation Obsessive-Compulsive Disorder (SO-OCD) are specific subtypes of OCD that center around compulsive doubt and ego-dystonic obsessions related to one’s sexual orientation or gender identity. Intrusive, distressing thoughts characterize these subtypes that conflict with an individual’s sense of self, leading to repetitive behaviors or mental acts aimed at reducing anxiety. 

It’s important to distinguish these forms of OCD from gender dysphoria, or the process of exploring one’s sexual orientation or identity. Unlike gender dysphoria, which involves discomfort or incongruence with one’s gender, or exploration of one’s orientation, SO-OCD and Gender Identity OCD are defined by obsessive, ego-dystonic thoughts that cause significant distress and are typically about establishing certainty.

At Compass Health Center, we recognize that intrusive thoughts about gender and sexual orientation can be symptoms of OCD, and create overwhelming anxiety, self-doubt and emotional distress, often rooted in an obsessive fear of not having certainty about who you really are. Our approach integrates personalized, compassionate care, using evidence-based therapies to help individuals navigate these concerns.

Understanding OCD in a Broader Context

Can OCD make you feel like a different person? Obsessive-compulsive disorder can profoundly affect an individual’s sense of self. It often manifests as intrusive thoughts that conflict with a person’s core beliefs and values. We all experience thoughts we find intrusive or unwanted from time to time. However, for sufferers of OCD, excessive meaning gets attached to these thoughts, causing people to question “Who am I, and what does it say about me that I have these thoughts? 

This experience can be especially intense when OCD revolves around morality, relationships, gender identity, or sexual orientation. In these cases, individuals may feel OCD “redefines” them in ways that seem alien. It’s essential to recognize and address these challenges through tailored, evidence-based treatment approaches. By doing so, individuals can work toward reconnecting with their authentic selves and rebuilding a stable sense of identity. 
It’s important to recognize that OCD doesn’t discriminate and can affect anyone, regardless of background. By further studying and understanding its impact and how it manifests, we can better treat the symptoms.

What is OCD?

Obsessive-compulsive disorder is a mental health condition that shows up in various ways, through obsessions and compulsions. These patterns can influence every aspect of life, including connections with gender identity and sexual orientation. While OCD can be challenging, you’re not alone in this journey. If you or someone you know is navigating OCD, support is available. 

Obsessions and compulsions are two key features of OCD. Let’s take a closer look at these important characteristics to better understand their impact on individuals living with OCD. 

Obsessions

Obsessions are persistent and repetitive unwanted thoughts, ideas, urges or images that cause distress to the person experiencing them. Obsessions can also lead to fear and anxiety. At Compass Health Center, we’re here to help you navigate your feelings and provide the understanding you deserve.

Compulsions

Compulsions are repetitive behaviors or mental acts that an individual uses to ease symptoms of anxiety caused by obsessive thoughts. For example, a person with OCD might replay past events in their mind to establish certainty they did nothing wrong. Obsessive-compulsive disorder can be confusing. It’s often referred to as the “doubting disease” because it causes people to question their own thoughts, needs, and preferences. This is how gender identity OCD and sexual orientation OCD can manifest.

Living with OCD can be challenging. It’s important to reach out and connect with others who understand what you’re going through.

Can OCD Make You Feel Like a Different Person?

Yes, OCD can make you feel like a different person. OCD involves intrusive, unwanted thoughts, and compulsive behaviors to try and neutralize the distress from said thoughts. Being trapped in this cycle is stressful, time-consuming, and often pulls people away from the things that are most important to them.

OCD and Loss of Identity

OCD can cause a loss of identity as ego-dystonic thoughts arise. Ego-dystonic thoughts refer to those that clash with an individual’s self-identity and core values. These thoughts can sometimes feel dangerous or frightening. They make individuals with OCD question their identity, as they experience increasingly negative views of themselves. For an individual with OCD, experiencing thoughts that go against their values can lead to severe anxiety and emotional distress.

For instance, a person might imagine committing a violent act, something they would typically reject. In this scenario, it would likely lead to feelings of guilt, confusion, and anxiety, as well as questioning, “Why did I imagine this? What does it mean that I was able to imagine this?”

Understanding these thoughts is important, as they can create distress and uncertainty. Our commitment to mental health care involves recognizing the complexities of these experiences and providing support that empowers individuals to navigate their feelings in a compassionate and informed manner.

What is Sexual Orientation OCD?

This subtype of OCD focuses on ego-dystonic thoughts and questions regarding one’s sexual orientation. They could experience doubt, confusion, and obsessive thoughts about their sexual orientation, which can develop into compulsions to try and navigate the anxiety.

These compulsions are often used to attempt to find certainty within doubt. For example, a heterosexual female could start questioning whether they’re straight as they’ve always felt, or gay. In the same vein, a homosexual male could begin questioning whether they might be straight or attempt to establish certainty.

These examples are not exhaustive. Individuals of any gender or sexual orientation can experience sexual orientation OCD. Obsessions result in excessive time spent considering doubts, rather than living a safe, happy life. Important parts of life, such as education, careers, relationships, and health, begin to suffer. This is why quality, professional OCD treatment for young adults is so important.

Symptoms of SO-OCD

SO-OCD can present in many ways. SO-OCD is categorized by obsessive thoughts questioning one’s sexual orientation, and related rituals to attempt to establish certainty in this area, or disprove questioning thoughts.

Obsessive Thoughts Related to SO-OCD

Below are some thoughts that an individual may have:

• How do I know if I am attracted to men or women?
• What if I don’t know myself?
• Is it even possible to know who I find attractive?
• What if I never find out who I’m attracted to?
• What if I accidentally act on these thoughts?
• If I like some form of erotic media, does that mean that’s who I am?

Compulsions Related to SO-OCD

• Checking for feelings after seeing a photo
• Avoiding situations that cause obsessive thoughts, such as locker rooms and nightclubs
• Reading or watching sexual material that differs from your preferences to discover other feelings
  • Or, avoiding these in fear of a triggering reaction
• Imagining sexual scenarios that differ from your preferences to check for other feelings
• Reimagining the same sexual scenario constantly to affirm your feelings
• Self-monitoring to ensure you’re not acting in ways you don’t want to
• Avoiding specific words, such as “homosexual,” “gay,” “lesbian,” or “straight”

Compulsions That Can Affect Your Relationship

• Questioning others about how they perceive your sexuality
• Seeking assurance from others constantly, even if they ask you to stop
• Losing a romantic partner because you can’t commit to your own interests
• Avoiding touch from members of the same sex for heterosexual people and opposite sex for homosexual people
• Avoiding people with a different sexual orientation

Symptoms of SO-OCD don’t always have to have a direct correlation to sexual orientation. Other OCD symptoms could be displayed to counter obsessive thoughts, such as unlocking and locking doors, using ritualistic words, excessive hand washing, counting steps, and more.

Gender Identity OCD vs Gender Dysphoria

There’s an important distinction between Gender Identity OCD and gender dysphoria. Notably, OCD does not cause gender dysphoria. But like SO-OCD, there is Gender Identity OCD, which can cause a person to think obsessively about their gender.

The obsessive thoughts that arise through OCD can cause a person to question their gender identity. This also causes confusion, anxiety, and stress, as a person asks if they’re the “right” gender with the “right” sexual orientation for them. Cisgender people might obsess over being transgender, and vice versa.

While Gender Identity OCD is a person’s obsessive thoughts and compulsions regarding who they think they are, gender dysphoria is diagnosed as feeling uncomfortable with one’s physical sex characteristics versus their experienced gender. People with Gender Identity OCD don’t typically want to change their sex characteristics. In both cases, people can experience severe distress.

Treatment Options for Gender Identity and SO-OCD at Compass Health

Exposure and response prevention (ERP) is a valuable cognitive behavioral therapy (CBT) approach for individuals dealing with Gender Identity OCD and sexual orientation OCD. This supportive treatment gently introduces patients to their obsessions and fears, while equipping them with essential skills to resist those short-term anxiety-reducing compulsions. 

By fostering understanding and resilience, ERP empowers individuals on their journey toward healing and freedom from OCD.

Acting on compulsions might help relieve anxiety, but it doesn’t tackle the long-term symptoms of OCD. The good news? Many individuals find success with ERP treatment. Here at Compass Health Center, we empower our patients to tolerate their thoughts and sensations, instead of trying to eliminate them. This approach helps them lead fulfilling lives, with less interference from anxiety.

Additionally, our programs leverage acceptance and commitment therapy (ACT) as well as dialectical behavior therapy (DBT). These programs establish helpful skills and mindsets to overcome obsessive thoughts and compulsions. We understand uncertainty and discomfort are part of OCD and the treatment process, and we’re here to work through it with you and your loved one. 

These treatment plans are available in our Partial Hospitalization Program (PHP) and our Intensive Outpatient Program (IOP) depending on individual needs. Both are group-based therapeutic programs, which are treatment options for individuals struggling with debilitating symptoms of depression, anxiety, OCD, trauma, PTSD, and/or bipolar disorder that interfere with daily functioning.

Get Help for ​​Gender Identity OCD or SO-OCD

Feeling overwhelmed by ​​Gender Identity OCD or SO-OCD? You’re not alone, and support is just a click away. 
Schedule an appointment today to connect with compassionate professionals who understand your journey. Let’s navigate this together.