Questioning your gender identity is completely normal, and many people explore these questions at some point in their lives. But for some, this questioning can become obsessive, potentially leading to intense, recurring anxiety. In these instances, excessive fears about gender identity may be a sign of obsessive-compulsive disorder (OCD), specifically a subtype known as gender OCD, or GOCD.
With GOCD, the issue is not about honoring who you are—it’s about trying to get absolute certainty.
Keep reading to learn more about GOCD, how it’s different from gender dysphoria, and how treatment can help you move forward.
What is gender OCD?
Gender OCD is a subtype of OCD characterized by a cycle of obsessions and compulsions centered around gender identity. Obsessions are intrusive thoughts, images, urges, feelings, or sensations that cause significant distress and anxiety. Compulsions are physical or mental actions performed to relieve distress or to stop something bad from happening.
GOCD is often mistaken for gender dysphoria, but they’re separate experiences. Gender dysphoria refers to the distress a person experiences when their gender identity doesn’t align with the sex they were assigned at birth. “People who have gender dysphoria feel like they’re in the wrong body and identify more as a different gender, which is very different from OCD,” says Tracie Ibrahim, LMFT, CST, NOCD’s Chief Compliance Officer.
People with gender dysphoria are seeking to live their lives as their authentic selves. In contrast, people with GOCD aren’t distressed about living as a different gender—they’re troubled by the uncertainty about what their true gender identity is. They seek 100% certainty and never quite get it.
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Signs of gender OCD
People with GOCD may experience intrusive thoughts and engage in compulsive behaviors to find certainty.
Below are some common symptoms of GOCD:
Common GOCD obsessions:
- How can I know for sure that I am the gender I was assigned at birth?
- What if I’ve been the wrong gender my entire life and just didn’t realize it?
- What if I transition and regret it—or what if I don’t transition and regret that?
- What if I never figure out my true gender?
- How can I know for sure that I’m transgender?
Compulsions in GOCD:
- Mentally reviewing any past events that may reveal your true gender identity.
- Avoiding specific people, places, and things that might trigger your obsessive thoughts.
- Seeking reassurance from others that the gender you’ve been assigned at birth is your true gender, or that you are actually transgender.
- Ruminating for several hours on the meaning of certain feelings or reactions.
- Engaging in excessive online research about gender, dysphoria, or other people’s experiences.
What to do if you have gender OCD
If you resonate with the symptoms of GOCD, know that there’s help available. The most effective treatment for GOCD, and all forms of OCD, is a specialized type of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP) therapy. Over time, ERP teaches you how to sit with the discomfort from obsessions without falling into compulsions.
With the help of an ERP therapist, you’ll gradually confront your fears while resisting the urge to seek certainty. Together, you and your therapist will create a personalized treatment plan that addresses your specific fears about gender identity. ERP exercises can include writing an imaginal script about coming out as transgender or “putting on clothes that are traditional of a different gender and walking around your house,” explains Ibrahim.
Other exposures can include:
- Reading stories of people coming out as transgender.
- Watching movies, shows, or reading books with transgender content.
Ethical OCD specialists avoid using real LGBTQIA+ spaces to practice ERP exercises. “We don’t ask people to go to trans clubs and pretend to be trans,” says Ibrahim. “That’s not how it works. We don’t go out and use them for our exposures.”
Although ERP can be challenging, if you stay consistent and do your homework outside of sessions, you can see a change in your symptoms over time.
If you’re unsure of whether you’re dealing with GOCD or experiencing gender dysphoria, there are OCD specialists—some within the LGBTQIA+ community—who can help you figure out the difference between obsessive thoughts and valid identity questions. While it can be helpful to find a therapist who specializes in GOCD, Ibrahim says that working with any qualified OCD specialist can still help you get your symptoms under control.
Bottom line
Many people question their gender identity at some point in their lives. For some, that exploration may indicate gender dysphoria. But if you’re feeling significant distress about your gender and are trying to gain complete certainty, you might be experiencing gender OCD. If you’re ready to break free from the cycle of intrusive thoughts and compulsions, consider reaching out to an OCD specialist to get symptom relief.
Key takeaways
- Gender OCD (GOCD) involves intrusive doubts and compulsions centered around gender identity, driven by a need for certainty.
- GOCD is distinct from gender dysphoria—people with GOCD fear uncertainty, not expressing a gender different from their assigned sex at birth.
- Exposure and response prevention (ERP) therapy is the most effective treatment for GOCD and helps reduce compulsions over time.
- OCD specialists, including those in the LGBTQIA+ community, can differentiate between obsessive fears and valid questions about gender.