By Meredith A. Hettler, MS, LMFT, CCATP
National Director, OCD and Anxiety Program, Newport Healthcare
The period of adolescence through young adulthood is a time of significant transition. As psychologist Erik Erikson explained in his theory on the stages of development, the goal of adolescence is to develop a sense of identity that is defined by one’s values and feelings of personal worth. Erikson referred to this as “identity vs. role confusion.”
As many of us can recall, establishing your identity is no easy task. This period of time can be simultaneously exciting, scary, and stressful. Young people are learning who they and paving the road towards adulthood. And that can come with some level of stress and worry. However, for teens and young adults who struggle with sexual orientation OCD or gender identity OCD, identity exploration can become a distressing obsession.
Key Takeaways
- The adolescent and young adult years are a time of intense identity development, including development of one’s gender identity and sexual orientation.
- Teens with sexual orientation OCD experience obsessions about who they are or are not sexually attracted to, while teens with gender identity OCD worry about whether they are cisgender or transgender.
- To cope with these intrusive thoughts, teens may engage in compulsions or avoidance behaviors.
- Exposure and Response Prevention (ERP) therapy is the gold-standard treatment for sexual orientation and gender identity OCD, as well as other forms of obsessive-compulsive disorder.
Identity Exploration in Adolescents
During the adolescent and young adult years, young people often question various elements of their life, and “try on” different identities in search of what feels most authentic to them. Religion, political beliefs, and career aspirations are some common identity-oriented themes that youth explore. Through this exploration, they may learn to feel more comfortable with parts of themselves that they perhaps already knew to be true. Or they may discover untapped areas within themselves to explore.
Sexual orientation and gender identity are two primary parts of the self that adolescents and young adults typically focus on during this stage of identity development. Some young people may already be sure of their identities and orientations at this age, while others aren’t as clear. In either case, the role of parents, caregivers, and mentors is to support this journey, and to give teens and young adults the space to explore and develop an authentic sense of self.
When OCD Interrupts the Search for Self
The path of identity exploration is a natural part of a young person’s growth as they age into young adulthood. However, the types of obsessive-compulsive disorder (OCD) known as sexual orientation obsessive-compulsive disorder (SO-OCD) and gender identity OCD can interrupt this stage of adolescent development.
For a young person with one of these forms of OCD, thoughts about sexual orientation or gender identity are unrelated to the developmental process. Their obsession with their sexuality or gender doesn’t help them to access their true self. Rather than uncovering their authentic identity, they become stuck in a cycle of OCD obsessions and compulsions.
If you haven’t heard of SO-OCD or gender identity OCD before, you’re not alone. These forms of obsessive-compulsive disorder are not as well-known as other types of OCD. Media depictions of OCD typically portray it as germaphobia or a desire to be organized. But OCD can manifest in many different ways.
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In addition to SO-OCD, the subtypes of OCD include harm OCD, the fear of hurting oneself or others; perfectionism OCD; and real event OCD, or real life OCD, an obsession with a past event or situation. Another type of OCD is relationship OCD, centered around fears and doubts about one’s relationship.
What Is Sexual Orientation OCD and What Is Gender Identity OCD?
OCD is defined by intrusive, unwanted thoughts or obsessions that cause significant distress. To alleviate those thoughts, people with OCD engage in compulsions or rituals. For an individual experiencing sexual orientation OCD, obsessions take the form of excessive worry about whether they are attracted to a different gender than they thought they were.
This could mean that a person who identifies as heterosexual questions whether they are gay. It could also mean that someone who identifies as gay questions whether they are straight.
People with SO-OCD may also experience unwanted sexual thoughts, images, or fantasies about people of the gender they’re not sexually attracted to. Or they may notice that someone is attractive and become fixated on what that means about their orientation. For example, a boy who is straight may have a thought about another boy being good-looking, and then become obsessed with the fear that they are gay. Research shows that about 12 percent of people with OCD experience sexual orientation obsessions, and males are twice as likely to have this type of obsessive thoughts.
Similar to SO-OCD, gender identity OCD involves confusion and uncertainty about one’s gender. People with this type of OCD worry about whether they are cisgender (gender assigned at birth) or transgender. And they become obsessed with the idea that they will never be able to figure out the truth.
Symptoms of Sexual Orientation OCD and Gender Identity OCD
SO-OCD and gender identity OCD obsessions can take the form of questioning, such as:
- “Am I acting straight/gay?”
- “How do I really know if I am gay/straight? What if I’m wrong?”
- “I just looked at that man/woman. Did I find them attractive?”
- “What if I’m really a different gender than I think I am?”
- “What if I never figure out who I’m attracted to/what my gender identity is? How can I know for sure?”
As a result of these obsessive thoughts, SO-OCD sufferers may also engage in rituals or avoidant behaviors, including:
- Asking for reassurance about their sexual orientation or gender identity
- “Checking” to see if they are gay/straight. For example, a person with SO-OCD may look at pictures of people of their preferred sex and internally check to see if they are or are not attracted to them.
- Engaging in sexual activity to see if they enjoy it or not
- Avoiding people who are gay (for those who identify as straight) or people who are straight (for those who identify as gay)
- Imagining sexual situations as a way of confirming who they are attracted to and who they are not attracted to
- Trying to avoid situations in which they are in close proximity to others of the same gender, such as a locker room, if they identify as straight and are obsessed with the possibility of being gay
OCD Fears Are Not Reality
It is important to note that sexual orientation OCD has nothing to do with whether a person is straight or gay. Nor does it mean that they are in denial of their true sexual orientation. Sexual orientation OCD is not the same as the identity development process teens and young adults go through. In fact, symptoms of OCD are ego-dystonic, which means that they do not align with the persona’s actual values or desires. Because of the ego-dystonic nature of OCD, sufferers often feel immense distress as they grapple with these intense thoughts.
Furthermore, people with this type of OCD may confuse physical manifestations of anxiety with the physical sensations of sexual arousal. That’s because the body is able to become sexually aroused even in situations where the brain/mind are not. This experience is scary for someone with OCD, as it can feel like confirmation that their fear is actually true.
Moreover, despite the distress they experience regarding their orientation or gender, people with SO-OCD or gender identity OCD are not homophobic or transphobic. Rather, their distress comes in part from an obsession with the idea of being rejected or stigmatized by society or people they know.
Treatment for Sexual Orientation OCD and Gender Identity OCD
If you suspect that your teen or young adult is experiencing SO-OCD or gender identity OCD, it is important to get them support as soon as possible. Exposure and Response Prevention (ERP) therapy is the gold-standard treatment for OCD. A therapist will work with your loved one to reduce their feelings of distress and anxiety and help them stop engaging in rituals that perpetuate the cycle of OCD. Family members will also learn how to address the cycle of OCD and how to support their loved one in their treatment process.
Finally, if you are unsure of what your loved one is experiencing, it is okay to ask them. Whether their feelings are related to OCD or embedded within the typical process of identity development, you can support them, validate their experience, and remind them that you are there to help no matter what.
Newport Academy’s Specialized OCD Treatment for Adolescents
Newport Academy’s OCD programming for adolescents addresses both OCD and common co-occurring mental health issues, such as trauma, depression, and generalized anxiety disorder. In addition, our program addresses anxiety-related conditions, including severe social anxiety, body dysmorphia, agoraphobia, trichotillomania, and panic disorders.
Our teen OCD treatment include a wide variety of modalities, provided by a multidisciplinary care team. Each teen’s treatment plan for OCD includes 4.5 hours daily of ERP therapy, delivered in individual sessions, group sessions, and exposure homework. In addition to ERP, our OCD treatment for adolescents incorporates psychiatric care and medication management, family therapy, experiential activities like art and music therapy and outdoor adventures, and a robust academic component.
Contact us today to learn more about our specialized teen OCD treatment and schedule an assessment. We also provide OCD treatment for young adults through our sister program, Newport Institute.
About the Author
With over 10 years of experience in the behavioral healthcare field, Meredith Hettler, National Director of Newport’s OCD and Anxiety Program, holds a master’s in Marriage and Family Therapy/Counseling from Central Connecticut State University and an undergraduate degree in psychology from the University of Rhode Island. She started with Newport as a Family Therapist and has since held various leadership positions, including Associate Family Program Director and Clinical Director.
Meredith’s experience in the field includes working with individuals ranging from early childhood through geriatrics, treating a wide array of mental health, behavioral, and relational needs. She specializes in working with adolescents and young adults. Meredith is trained in Exposure and Response Prevention therapy, Attachment-Based Family Therapy, Cognitive Behavioral Therapy, and Dialectical Behavioral Therapy. She is also a certified yoga instructor.
Frequently Asked Questions
Sources
Psychiatry Res. 2011 May 15; 187(1-2): 156–159.
