Fears about being transgender

What is Trans OCD (TOCD)?

People suffering from Trans OCD struggle with constant obsessions involving a need for certainty about their gender and fears of what it means if they cannot be certain. For most with fear of being transgender, the idea of not having certainty about one’s true gender is what is frightening, rather than a specific fear of having any particular gender or identity. Indeed, most people experiencing TOCD are allies of transgender and gender non-conforming communities.  TOCD is fundamentally different from being transgender. Many transgender people experience gender dysphoria, which occurs when an individual feels a disconnect from their assigned gender at birth. Some people describe it as a mismatch between their physical body and who they are on the inside. Often, people with gender dysphoria will decide to transition to the gender that is their own. Having intrusive thoughts, images, or urges triggers anxiety and fears is not easily dismissed by the sufferer. This leads one to engage in compulsive behavior in an attempt to reduce or eliminate doubt, uncertainty, and anxiety. Unfortunately, compulsions only lead to a temporary reduction of anxiety and distress, creating a vicious cycle that maintains and strengthens anxiety and uncertainty while making one dependent upon compulsions. Struggling with gender themes in OCD does not mean, however, that one necessarily does or does not have a certain gender identity. It simply means that the uncertainty one feels around their gender causes great distress and results in compulsions that are burdensome and can make that distress worse over time.

Trans OCD – Common obsessions

• Reviewing any past instances that may reveal their true gender identity
• Avoiding any movies, books, shows with transgender themes to avoid feelings of confusion
• Questioning their sexuality
• Ruminating on what it means if they are transgender
• Internet searching for stories that will confirm if they are transgender
• Asking others their opinion on one’s true gender 
• Avoiding spending time with people of a certain gender

Common compulsions performed mentally or physically by people with transgender fears

• Reviewing any past instances that may reveal their true gender identity
• Avoiding any movies, books, shows with transgender themes to avoid feelings of confusion
• Questioning their sexuality
• Ruminating on what it means if they are transgender
• Internet searching for stories that will confirm if they are transgender
• Asking others their opinion on one’s true gender 
• Avoiding spending time with people of a certain gender

How to treat fear of being transgender

Trans OCD is treated the same way any presentation of OCD is treated, with Exposure and Response Therapy (ERP). ERP is considered the gold standard treatment for OCD.  ERP therapy consists of working with an ERP therapist to engage in exposures that trigger gender-related fears while resisting completing compulsions during and after the exposures. Over time, with consistency and repetition, the brain creates a new response to the obsessions as it learns the thoughts, images, or urges are not dangerous, and that uncertainty can be tolerated.  People will often experience a gradual reduction in anxiety, and may eventually feel only minimal anxiety in response to previous triggers. ERP is about learning how to tolerate distress and live in uncertainty. OCD thrives on demanding certainty—in order to get better, we have to learn how to stop answering it.

Example exposures for TOCD include:

• Watching movies, shows or reading books with transgender content. 
• Reading stories of people coming out as transgender.
• Writing an imaginal script of coming out as transgender.

If you’re struggling with OCD, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

We look forward to working with you.