What is TOCD?

About Transgender OCD (or Trans OCD)

With the recent media attention and ongoing conversations regarding gender identity, many people with OCD are now struggling with intrusive thoughts and uncertainty in how they identify their gender. This form of OCD is called Transgender OCD (TOCD).

TOCD is not limited to cisgender people. Transgender people can also have obsessions relating to whether they are cisgender, although this is less common.

The core fear behind TOCD is not whether being transgender is bad, but rather, the confusion and questioning behind the thoughts and obsessions. The worry that they aren’t who they thought they were. The worry of what friends and family will think.

Obsessive-compulsive disorder (OCD) is a brain-based anxiety-related mental health disorder that causes a great deal of suffering and impairment.

What are common TOCD symptoms?

Common obsessive thoughts and intrusive images in TOCD:

• Being afraid that they are trans/cisgender
• Constantly questioning their sexuality
• Fear of sending out unintentional signals that they are trans/cisgender
• Ruminating on what it might mean to be trans/cisgender
• Playing out scenarios from their past (for example, a young boy dressed up in his older sisters' dress, and wondering if he liked it at the time)
• Being worried about finding more intrusive thoughts or triggers (for example, hearing a transgender person share their story on TV, or in a magazine, and wonder if they are transgender, too).

Obsessive-compulsive disorder (OCD) is a brain-based anxiety-related mental health condition that causes a great deal of suffering and impairment.

People struggling with TOCD may have some of the following compulsions and rituals:

• Searching online: “Am I transgender?” “How to know if you are trans?”
• Asking for reassurance from family and friends
• Trying on clothes of the opposite gender
• Avoiding social events
• Using logic to reassure themselves
• Looking through old journals and photographs and asking their family and friends if they ever noticed anything earlier in their life that may confirm that they are transgender
• Looking online for communities of people expressing the same symptoms
• Examining some of their own body parts and try to determine if they are masculine or feminine (e.g., a male looking at his calves and wondering if they look feminine)

How does TOCD impact a person's daily life?

The impact TOCD has on an individuals' day to day life is much like the impact that people who suffer from other forms of OCD deal with on a day-to-day basis.

Obsessive thoughts and compulsion rituals can take up large chunks of time in a person’s day and cause severe anxiety and stress.

Over time people that struggle with TOCD may isolate themselves and avoid social gatherings. They may constantly ask and need reassurance that they are not transgender/cisgender.

Case Example of Trans OCD

Doctors at Stanford University described the case of a queer 20-year old college student who did not know he had TOCD. He presented for an evaluation for sexual reassignment surgery due to severe, anxiety-producing doubts about his gender identity. His worries started abruptly after the use of marijuana, at which point he began to question whether or not he was happy being a male. He suffered from paralyzing obsessions of being transgender that caused him great distress, and as a result he engaged in mental and behavioral compulsions such as "testing" his reactions to certain thoughts or images and reassurance seeking. He also experienced problems in school, depression, and even suicidal thoughts (Safer, Bullock, & Safer, 2016).

There is hope!

To a person struggling with TOCD, it may seem hopeless. But there are treatments that can give people relief.

ERP, the gold standard treatment for OCD, is the most effective way to combat obsessions, intrusive thoughts, and compulsions.

Are you struggling with TOCD? Contact us today to find a therapist to help you.

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Research Articles

Aboujaoude, E. & Starcevic, V. (2021). Case Report: Doubts and pre-occupations about being transgender: Questioning one’s gender identity or a case of obsessive-compulsive disorder? Frontiers in Psychiatry, 12, 644114–. https://doi.org/10.3389/fpsyt.2021.644114

Safer D.L., Bullock K.D., & Safer J.D. (2016). Obsessive-compulsive disorder presenting as gender dysphoria/gender incongruence: a case report and literature review. AACE Clinical Case Reports, 2, e268-e271.

Williams, M. T., & Ching, T. H. W. (2016). Transgender anxiety, cultural issues, and cannabis in obsessive-compulsive disorder. AACE Clinical Case Reports, 2(3), e276-e277. https://doi.org/10.4158/ep161356.co