LGBTQIA+ people can experience OCD in ways that are often misunderstood—here’s what that actually looks like and how to find affirming care.
Living with a mental health condition can impact every part of your life—work, school, daily activities, and relationships. Obsessive-compulsive disorder (OCD), a condition characterized by a cycle of intrusive thoughts and compulsions, often targets what matters most—including your sexual and gender identity.
Sexual orientation OCD (SO-OCD) involves fears and doubts about your sexual orientation. Gender OCD (GOCD) centers on obsessive questioning of your gender identity. These themes are often misunderstood—even by clinicians, who may mistake them for identity confusion rather than signs of OCD.
Too often, the way we talk about SO-OCD and GOCD centers only on cisgender, heterosexual experiences. But you can be gay and have SO-OCD. You can be transgender and have GOCD.
When these conversations leave out LGBTQIA perspectives, people can feel unseen or excluded.
In this article, we’ll reframe these conversations through a more inclusive, LGBTQIA+-affirming lens, with help from Michelle Forcier, MD, MPH, a clinician at FOLX Health, and Michelle Anderson, MSW, LCSW, a therapist at NOCD, the leading provider in virtual OCD treatment.
LGBTQIA+ Discrimination and Erasure in OCD Treatment
The erasure of the LGBTQIA+ community is very prominent in American culture and is particularly damaging when it comes to the healthcare system. LGBTQIA+ adults are more than twice as likely as heterosexual adults to have a mental health condition. And while queer and trans people use mental healthcare more often than heterosexual people, they’re still at a higher risk of experiencing fear, shame, discrimination, and adverse and traumatic events while seeking care.
When it comes to OCD, information on SO-OCD and GOCD often uses examples like “What if I’m gay?” or “What if I’m trans?”
There are several issues with this type of framing:
- It assumes the reader isn’t already part of the LGBTQIA+ community.
- It reinforces stigma that already exists around queer and trans people—making these identities seem “taboo.”
- It contributes to misinformation in clinical settings and online content—for example, GOCD was once dubbed “transgender OCD,” and SO-OCD was called “homosexual OCD.”
Aside from content, this framing can also affect OCD treatment. Exposure and response prevention (ERP) therapy—the most effective treatment for all forms of subtypes—involves exercises that involve facing your fears head-on. In the context of SO-OCD, that often means learning to sit with the discomfort of not knowing your sexual orientation with absolute certainty.
Some clinicians have used exposures like encouraging straight-identifying clients to enter queer spaces as a way to “test” their reactions. While this may have been more common in earlier ERP approaches, it can be problematic if it reduces LGBTQIA+ identities or communities to something to fear or “overcome.”
“I don’t want to tell someone to go into queer spaces or interact with a queer person as if to just ‘try it out’ if they aren’t sure they’re queer,” Anderson says. “There are other ways to approach it.”
That’s where justice-based ERP comes in. This approach considers not just the techniques used in exposure, but the ethics—ensuring that treatment doesn’t reinforce stigma or treat marginalized identities as props. That said, it’s important to note that people who are questioning their gender or sexuality absolutely belong in queer spaces. Being uncertain doesn’t disqualify someone from community, support, or exploration. Justice-based ERP supports that process by helping clients engage with curiosity and care, not avoidance or compulsion.
In practice, justice-based ERP might involve:
- Writing out feared scenarios like “What if I’m faking being nonbinary?” or “What if I realize I’m straight after coming out?”
- Reading LGBTQIA+ stories without analyzing whether they “fit you”
- Observing your own thoughts about identity without checking for certainty
These exercises help clients live alongside uncertainty—without reinforcing the idea that queerness or transness is something to fear.
What OCD Actually Looks Like for LGBTQIA+ People
Queer and trans people also experience OCD, but the way it shows up can sometimes look different.
Here are some examples of how OCD might manifest in LGBTQIA+ individuals:
- What if I’m actually straight and just pretending to be gay?
- What if I’ve been lying to myself and I’m secretly attracted to the opposite sex?
- What if I wake up one day and I’m no longer attracted to the people I’ve always been attracted to?
- What if I’m not really trans and am just doing this for attention?
- What if I’ve been faking nonbinary this whole time?
- What if I detransition and everyone finds out I was never “really” trans?
- Mentally replaying past relationships to “check” for attraction or signs you weren’t truly queer.
- Seeking reassurance from friends or partners about your identity being “real.”
- Avoiding queer spaces or dating to escape triggering intrusive thoughts.
- Over-researching labels, identities, or gender terminology in an effort to find the “perfect fit.”
When it comes to OCD, it’s crucial to distinguish genuine identity exploration from obsessive doubt. “With queerness, there’s always going to be a certain questioning aspect,” Anderson says. “One of the key things we notice with OCD is that there tends to be an urgency attached to it—a need to immediately figure this out.” That urgency, paired with distress, is often what sets OCD apart from natural self-reflection.
It’s also important to remember that intrusive thoughts are a universal human experience. “Intrusive thoughts do not represent a person’s character or priorities,” Dr. Forcier says. “They are thoughts only—and they do not mean that they will happen.”
Finally, queer and trans people with OCD aren’t only affected by sexuality- or gender-related themes. They may also experience other subtypes, like relationship OCD, contamination fears, or harm OCD, just like anyone else. Identity may be part of someone’s OCD, but it isn’t the whole picture.
The Importance of Affirming Mental Healthcare
Queer and trans people experiencing SO-OCD, GOCD, or any subtype for that matter, can benefit from ERP therapy—an evidence-based treatment helps people confront their fears without relying on compulsions.
But ERP is most effective when it’s delivered through an LGBTQIA+-affirming lens, especially when addressing sexual orientation and gender-related fears. “When someone has multiple stigmatized identities, such as being a gender or sexually minoritized person and having a mental illness, the issue of safety and support matters that much more,” Dr. Forcier explains. “Affirming and inclusive mental healthcare provides that safe space and comprehensive perspective that can help foster healing and growth.”
Part of delivering affirming care means clinicians must screen for OCD without pathologizing LGBTQIA+ identities. This involves focusing on the form of the distress, rather than just its content. Instead of assuming that intrusive thoughts about gender or sexuality mean a person is confused or in denial, clinicians delivering justice-based ERP should ask whether the thoughts are unwanted, repetitive, and driven by a need for certainty. Queer and trans people may say things like, “I know I’m gay, but what if I’m faking it?” That’s not exploration, that’s OCD.
Anderson says it’s essential to validate the natural complexity of identity while helping clients relate to obsessive doubt in a different way. “Sexuality is a spectrum—there’s some fluidity in it as well,” she says. “There’s a broad experience even with gender. When it comes to OCD, I try to bring it back by asking them what kind of life they want to live, or what kind of person they want to be. We try to focus a lot on the uncertainty of never completely knowing your sexuality, because, at the end of the day, I want people to live the life they want to.”
How to Find an LGBTQIA-affirming Therapist
If you’re seeking a therapist who truly understands and respects who you are, here’s how to start your search for affirming OCD care:
Tip #1: Start with LGBTQIA+-specific Directories
Consider platforms such as FOLX, the National Queer and Trans Therapists of Color Network (NQTTCN), or the Gay and Lesbian Medical Association (GLMA).
Tip #2: Use the IOCDF Directory—and Filter with Care
The International OCD Foundation (IOCDF)’s provider directory lists therapists trained in ERP. While it doesn’t filter for LGBTQA+ identity or experience, you can scan bios for affirming language or contact providers directly to ask.
Tip #3: Explore NOCD’s Therapist Network
NOCD offers virtual ERP with over 650 licensed clinicians trained in OCD. Many therapists, like Anderson, also have experience supporting LGBTQIA+ members, and you can request affirming care during intake. NOCD is making OCD treatment more accessible than ever, now accepting most insurance plans that cover over 155 million Americans.
Tip #4: Know What Affirming Care Feels Like
Affirming care isn’t just about a provider saying the right things—it’s about how safe and supported you feel. Do they respect your identity without second-guessing it? Are they focused on your values, not pushing you toward certainty or labels? You deserve a provider who respects your identity, validates your experience, and helps you navigate OCD without shame or stigma.
How to Get Support for OCD
If you’re queer or trans and navigating OCD, finding the right provider can make a world of difference—not just in how you feel, but in how effective treatment is. Affirming care isn’t just about being LGBTQIA+-friendly. It means being seen, respected, and treated as a whole person, not a puzzle to be figured out.
Here are some potential questions to ask a provider:
- What’s your experience treating OCD with ERP?
- Are you familiar with justice-based ERP?
- Do you have experience working with LGBTQIA+ clients?
- How do you approach OCD themes related to identity, like gender or sexuality?
- What does affirming care look like in your practice?
Once you’ve found a clinician who delivers affirming and inclusive OCD care, here’s what you can expect:
- Your identity won’t be treated as a fear to confront.
- You won’t be asked to “prove” or justify how you identify.
- Your ERP therapist will help you learn how to sit with uncertainty, rather than pushing you toward any specific label or conclusion.
- Treatment will focus on your values, not assumptions about what’s “typical” or “normal.”
If a provider invalidates or pressures you to engage in exposures that don’t feel right, it’s okay to speak up or find someone better suited to support you.
In addition to therapy, there are several support groups you can join. FOLX Health has a community platform for its members, while NOCD offers support groups for LGBTQIA+ and people with OCD themes with sexual content as part of their membership. The IOCDF also has a LGBTQIA+ Special Interest Group that’s open to everyone.
A note for clinicians: Affirming care starts with listening. Never assume a client questioning their gender or sexuality is “confused” or “exploring,” as it might be OCD, or might not be. Either way, trust and safety come first. Let the person’s distress guide your understanding, not just the content of their thoughts.
