Trans OCD: Symptoms, Impact, And Treatment

According to research,¹ almost one million people in the United States identify as transgender.

As transgender news continues to gain mainstream attention in the media and political arena, more people are talking about it. With increased awareness, they may begin to question their own gender identity.

This is a typical experience; in some people, it can help them undergo a fulfilling and appropriate gender transition. 

For others, however, this gender identity question may persist and amplify, resulting in a chain of unwanted thoughts and behaviors referred to as transgender obsessive-compulsive disorder (trans OCD or TOCD).

What is transgender OCD?

Transgender OCD, also referred to as gender identity OCD (GOCD), is a condition that causes intense obsession over your gender identity. Once gender-intrusive thoughts take root in your mind, fear, stress, concern, and anxiety overwhelm your body. These emotions trigger you to engage in certain routines, rituals, or behaviors to relieve your mind from intrusive thoughts.

Any attempts to think about your true identity are usually accompanied by fear, doubt, and uncertainty, leading to more obsessions and compulsions. Often, this becomes a never-ending cycle of transgender OCD that causes mental health problems such as depression from the social-occupational impact of the condition.

Some ‌behaviors and actions you’re prone to have with trans OCD are constantly questioning your gender, ‌asking what it would be like to be transgender, searching for reassurance from people in person or online, or repeated evaluation of memories and feelings to ‌establish if you are transgender or not.

Symptoms of trans OCD

Transgender OCD symptoms, just like any other OCD, involve obsessions and compulsions. Urges, feelings, and doubts often characterize intrusive thoughts. On the other hand, compulsions involve rituals or routines that relieve emotions, such as anxiety and fear arising from your obsessions. 

When you have trans OCD, you may spend hours obsessing over questions like:

• Am I transgender?

• Do I know who I am?

• What happens if I’m not who I thought I was?

• Will I have to break up with my partner?

• Can I know with certainty that I am transgender?

• What will my parents and friends say?

You will likely spend hours doing one or more compulsions in response to these obsessions. Some of the common compulsive behaviors you may exhibit include:

• Evaluating emotional responses to specific thoughts and situations (for example, repeatedly assessing how you feel when putting on a lovely dress or wearing lipstick)

• Memory reviewing (recalling your memories many times to help gain certainty over your gender identity)

• Visiting websites, forums, and blogs (looking for information that proves your transgender status)

• Ruminating (thinking about various gender scenarios while trying to “figure it out”)

• Escaping specific people, things, and places that trigger your obsessive thoughts

• Searching for identity reassurance from the LGBTQ community sites and forums

Impact of transgender OCD 

The impact of trans OCD on your daily life is like that of any other OCD type. Once gender obsessions become part of your life, you begin to experience doubts, fears, and anxiety. These unwanted thoughts trigger compulsive behaviors to relieve the emotions caused by your obsessions.

However, research² shows that TOCD routines and rituals are only short-term solutions. Over time, your obsessions will likely come back, causing a repeat of the OCD cycle. That’s why it’s common for people with trans OCD to develop problems at work, in school, or in their social lives. 

Let’s take Brian, a 23-year-old heterosexual man, as an example. 

Brian started questioning his gender identity when he saw a childhood photo of himself dressed up like a girl at a party. Immediately after he saw the picture, an intrusive thought came to mind: “What if I’m really a female?” 

The thought of being a woman without knowing it all his life terrified Brian, and ideas began to race in his head. “Does this picture mean I am a woman? Have I been living a lie all this time? How can I confirm for sure that I’m male? Will I ever know for sure?” 

Such thoughts overcame Brian with fear and uncertainty. As such, he sought to suppress these thoughts with compulsive actions such as trying out women’s clothing. As these obsessions increased, so did the frequency of his compulsions. 

Over time, Brian’s gender identity fixation impacted his overall life. He began to miss family and friends’ events due to fear of criticism and judgment from people. His output at work also dropped, and he was fired as he couldn’t concentrate for long.

Treatment options for OCD

If you have trans OCD, there are several treatment options to explore. The most effective TOCD treatments available today are the following.

Exposure and response prevention

Exposure and response prevention (ERP) therapy gradually exposes you to your TOCD triggers, such as gender identity doubts, fears, and urges. The doctor assists you in resisting the urge to perform compulsive behaviors.

With time, the frequency of compulsions reduces along with the distress from intrusive thoughts.

Medications

In some cases, your doctor may prescribe medications, such as antidepressants. They help manage TOCD symptoms effectively. Talk to a doctor or medical health professional before taking any medications.

The lowdown

Transgender OCD manifests like any other OCD type, only that your unwanted thoughts are about gender identity. The more you perform compulsions for relief, the more aggressive your transgender OCD becomes. If left untreated, the impact of OCD can be detrimental to your social and work life.

Therefore, seeking therapy and taking medications as your doctor advises are essential.

FAQs

How is trans OCD different from gender dysphoria?

Gender dysphoria arises when a person’s gender identity does not match the gender assigned at birth—this mismatch results in significant distress. Taking steps to transition can help reduce these individuals’ discomfort.

Those with transgender OCD are more anxious about the uncertainty of their gender rather than distressed because of their gender. 

What causes transgender OCD?

The causes of OCD are similar to OCD, but they vary from person to person. These range from genetics and environmental factors (trauma) to chemical imbalances (serotonin imbalance).

Which gender is trans OCD most common in?

All types of OCD, including trans OCD, affect males more in childhood while females get it worse in their teens and adulthood.