Barriers to OCD treatment for the LGBTQ community

by Chris Trondsen, AMFT

Finding effective treatment for obsessive compulsive disorder (OCD) can be difficult for many individuals, especially for those living in rural areas and in countries with few specialty providers. For members of the LGBTQ community, finding OCD treatment may be especially difficult due to the unique challenges they face. 

This treatment gap can have harmful consequences. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), suicidal thoughts occur in as many as about half of individuals with OCD, and suicide attempts are reported in up to one quarter of individuals with OCD. This number is significantly higher than individuals in the general population not suffering from OCD. 

On top of this, LGBTQ individuals are more than twice as likely as heterosexual men and women to have a mental health disorder in the first place. Plus, studies show that 40 percent of members of the LGBTQ community have contemplated suicide in their lifetime as a result of harassment, stigma, and other discriminatory factors experienced due to their sexual orientation.

Despite the seriousness of the disorder, it still often takes 14–17 years for an individual to find proper treatment after first showing OCD symptoms. And with the unique challenges the LGBTQ community faces when seeking out mental health treatment, it can take even longer. 

Here are some of the barriers that members of the LGBTQ community may face when seeking OCD treatment:

Financial strain

Nearly 700,000 LGBTQ youth experience homelessness each year. Many are kicked out of their parents’ homes due to their sexual orientation and gender identity. This adds to the fact that LGBTQ individuals are less likely to have both health insurance and parental financial support. Health insurance and having the finances to afford treatment are crucial in the recovery process. Due to these challenges, members of the LGBTQ community often find it difficult to afford the care needed to recover from OCD.

Trouble finding an LGBTQ-affirming therapist

Finding evidence-based treatment for OCD is already challenging. But to members of the LGBTQ community, it is also essential to have access to providers who respect identities and understand sexuality and gender. This can often be evident from everything from intake forms to the therapy itself, such as providing a space where sharing pronouns is the norm for everyone in group and individual therapy. Affirmative therapists create safe environments for LGBTQ clients through their words, actions, and therapeutic approaches — and see being queer as perfectly normal and valid. 

Often, residential treatment centers and inpatient hospitals are gendered, which presents unique challenges to non-binary people and even binary trans people. Additionally, these locations separate the patients into binary groups for either men or women, often forcing non-binary individuals to conform and choose a group they do not identify with. These treatment facilities often leave non-binary people to get the short end of the stick.

Additionally, LGBTQ clients will report that their cis-gendered, heterosexual therapist does not know what to do with LGBTQ-related issues and can even ask abrasive questions out of their curiosity rather than therapeutic care. This is why many individuals in the LGBTQ community seeking out treatment for OCD find it essential to see a specialist who accepts the queer community and works hard to be both an ally and affirming. 

Lastly, many people in the LGBTQ community may have experienced trauma due to the harassment and neglect from society and family members based solely on their sexual orientation and gender identity. LGBTQ people often experience trauma at higher rates than the general population. Affirming therapists must be aware of this and take it into account during the treatment process.

Subtypes: Sexual orientation OCD and relationship OCD

There are also ways that the words used when describing OCD subtypes can make the LGBTQ community feel disregarded. 

Sexual orientation OCD — the OCD subtype that focuses on obsession and doubts around sexual orientation — used to be named homosexuality OCD (HOCD). This subtype focused on straight men and women experiencing obsessions on same-sex attraction and questioning whether they were gay. Additionally, this subtype also focused on straight, cis-gendered men and women questioning if they were transgender. However, the OCD community now recognizes that members of the LGBTQ community can have obsessions around being straight or cis-gender — and the subtype has now been renamed sexual orientation OCD (SO-OCD). Non-binary individuals can also question their gender identity and have reported feeling like a “secret outsider” of the LGBTQ community. 

Additionally, the OCD community is leaning away from emphasizing that being queer is the “worst case scenario” for straight individuals obsessing over their sexual orientation. This often left members of the LGBTQ community feeling as if their identity is someone else’s “worst nightmare.” Now, advocates, affirming therapists, and others in the community will instead focus on straight people accepting the uncertainty around the obsessions involving their sexual orientation instead of treating being queer as a worst-case scenario. 

Also, the OCD community no longer clumps intrusive thoughts in SO-OCD with other sexual intrusive thoughts that focus on bestiality, pedophilia, and incest. For decades, there have been attacks on the LGBTQ community, linking being queer to being sexually attracted to animals, children, and family members. It is vital that the OCD community not repeat these harmful comparisons.

Lastly, when LGBTQ individuals seek treatment for OCD, many find it challenging to open up to their provider when struggling with relationship OCD (ROCD). LGBTQ people may feel as if it is necessary to change the gender of their partner or pretend they are in a straight relationship. This stems from fears that their therapist will negatively judge them, or their treatment will be impacted negatively if the provider finds out they are queer. 

The OCD community is diverse, and considering the specific needs of members in the LGBTQ community with the disorder helps them feel loved and supported. Members of the LGBTQ community with mental health disorders face additional challenges than their straight, cis-gendered counterparts. A supportive OCD community that is welcoming and affirming allows LGBTQ individuals to feel as if they belong and are supported. 

June is Pride month, and it is essential that the OCD community welcomes individuals in the LGBTQ community with open arms and lets them know that they are accepted, affirmed, and loved. Happy Pride!