If you live with OCD, your symptoms may begin to affect your identity — including your gender, sexual orientation, moral beliefs, and more.

Obsessive-compulsive disorder (OCD) is a complex mental health condition.

Its primary symptoms are obsessions and compulsions. Obsessions are unwanted thoughts, urges, or images that cause fear or anxiety. Compulsions are repetitive behaviors done with the purpose of escaping anxiety caused by obsessions.

OCD is sometimes called “the doubting disease,” because it can make you distressing thoughts that won’t go away — including thoughts about your own identity.

And though OCD can affect your identity and how you perceive yourself, managing these symptoms is possible with the right support.

What makes OCD a diagnosable condition is the amount of distress it brings to the people who live with it.

Ego-dystonic thoughts

Part of why those living with OCD often feel so disturbed by their obsessions is because OCD thoughts are ego-dystonic. This term describes when thoughts are experienced as being “out of line” with one’s own identity and values.

If you live with OCD, you may find your obsessions to be repulsive and disgusting. You might think, “I had a terrible intrusive thought about hurting someone and now they’re hurt. It must be my fault.”

Questioning your identity

This can cause a severe negative effect on personal identity. Someone with OCD experiencing ego-dystonic obsessions could have more negative views about who they are and what they stand for, which can lead to severe anxiety and emotional distress.

OCD can have different themes. Any of these themes can affect your identity, but there are some specific ones that can lead to loss of identity.

Harm OCD

Some people with harm OCD experience frequent obsessions about hurting other people, either intentionally or accidentally.

You might harbor the fear that you’re a bad person who wants to hurt others. You might have thoughts like, “I’m a bad person for having such horrible thoughts.”

Harm OCD can make you doubt your identity as a non-violent person.

Pedophile OCD

Pedophile OCD can cause people to have intrusive thoughts about whether or not they have sexual feelings toward children. This isn’t to be mistaken with people who have pedophilic disorder.

These thoughts are often so disturbing to those with OCD, precisely because the thought of having these feelings is repulsive to them and completely out-of-sync with their identity.

Sexual orientation OCD

People with this OCD theme frequently start questioning their identity in terms of their sexual orientation. It’s natural to question your sexual identity, especially as people go through adolescence.

But OCD is a disorder because of the extreme level of anxiety it causes.

Sexual orientation OCD, aka homosexual OCD, may cause you to question your sexual orientation to a degree that you might worry that you’re “in denial” about it. You might also worry that you’ll never know what your “true” sexual orientation is.

Religious or moral scrupulosity OCD

People with scrupulosity OCD commonly become terrified that their actions or thoughts are religiously or morally “wrong.”

You might worry about what your “sins” mean about who you are as a person. It’s not uncommon for people with scrupulosity OCD to fear that their thoughts make them inherently “evil.”

This is disturbing because it’s typically important to people with this disorder to be a “good” person.

OCD can’t cause gender dysphoria. But transgender OCD is an OCD theme that can cause you to question your sexual orientation.

Transgender OCD, questioning your gender, and gender dysphoria are not all the same thing.

If you aren’t sure which you’re experiencing, then it’s important you see a mental health professional who specializes in OCD.

Transgender OCD was first referenced in 2015, and there’s little information and research about it. So, not much about this OCD theme is understood, even within the mental health community.

Transgender OCD

People with transgender OCD often have intrusive obsessions about their gender identity. You may have the thought, “What if I’m in denial about my true sexual orientation.”

So, people who are cisgender might worry about being transgender, and people who are transgender might have thoughts that they’re actually cisgender.

Transgender OCD vs. gender dysphoria

The existence of transgender OCD has led to discussions about how to differentiate this condition from gender dysphoria, the diagnosis used for people who feel uncomfortable that their physical sex characteristics don’t match their experienced gender.

Both these conditions can cause distress but for very different reasons.

Characteristics of gender dysphoria

People with gender dysphoria often have feelings of distress because there’s a difference between their experienced gender and their sex characteristics.

Other features of gender dysphoria can include:

  • a strong desire to get rid of your sex characteristics
  • a strong desire to be perceived and treated as of another gender
  • a conviction that you have the psychological characteristics of another gender

Transgender OCD symptoms

In contrast, people with transgender OCD don’t typically have a desire to get rid of their sex characteristics or to be another gender.

People with transgender OCD usually have obsessions about the possibility that they could be another gender, often experiencing these obsessions as fearful or repulsive.

Questioning your gender with transgender OCD doesn’t usually feel like who you really are is another gender. For people who may question their gender, being of another gender usually feels more natural than the one assigned at birth. Additionally, there’s often a desire to transition.

In other words, these thoughts are ego-dystonic — as OCD thoughts generally are.

As for what causes OCD in general, experts still don’t have a clear answer. Researchers think that several factors can come together to increase a person’s chance of developing OCD, including:

  • genetics
  • brain structure
  • learned patterns of behavior
  • modeled behaviors
  • life events
  • in rare cases, some childhood infections

But there are some more specific reasons someone with OCD might question their identity.

Fixating on things we love

OCD tends to affect the things we value and love most. This can make certain intrusive thoughts much more powerful.

Someone with transgender OCD may not be affected by certain thoughts, while an intrusive thought such as, “What if I’m transgender?” may cause severe distress.

Overcoming identity issues associated with OCD often begins with treating OCD symptoms.

There’s no cure for OCD, but it is highly treatable. With the right treatment plan in place, OCD symptoms can be managed.

Treating OCD

OCD is usually treated through a combination of:

Therapy is often a first-line treatment for OCD, especially a type of cognitive behavioral therapy (CBT) called exposure and response prevention therapy (ERP).

In some cases, selective serotonin reuptake inhibitors (SSRIs) may also be prescribed.

You may also want to consider joining a support group for people with OCD. Support groups can connect you with other people who live with OCD and make you feel less alone.

OCD can sometimes make you have distressing thoughts about everything you hold dear, including something as basic as who you are as a person.

Many themes of OCD can affect specific parts of your identity, such as whether you feel you’re a “good” person or questions about your gender identity.

But symptoms of OCD can be managed with the right treatment plan, and you can learn to cope with identity issues over time.

Treatment plans for OCD often consist of therapy or medication. Contacting a healthcare or mental health professional is often the best first step to managing OCD.

The International OCD Foundation has a great resource directory to help you find OCD treatment specialists and support groups. You can also check out Psych Central’s hub on finding mental health support.