By the LGBTQIA+ Special Interest Group
As we continue to celebrate Pride Month in 2025 and beyond, one of the missions of the International OCD Foundation’s LGBTQIA+ Special Interest Group (SIG) is to provide insights on how clinicians serving queer clients with OCD can offer affirming and effective care. Additionally, another mission is to give a voice to the queer individuals out there diagnosed with OCD and offer them a sense of community.
As a collective, the SIG, consisting of both queer people with OCD and mental health providers (some are both), came together to discuss the top questions we receive regarding the queer and OCD community. We hope this blog offers additional insight to mental health providers who want to ensure their LGBTQIA+ clients are receiving the best possible care, as well as to people with OCD in the queer community on ways to advocate for better mental health treatment.
Sexual orientation OCD (SO-OCD)
Sexual orientation OCD, once named homosexual OCD (HOCD), is when someone with OCD is questioning their sexual orientation. This subtype also affects queer people, hence the name change. For instance, someone gay may question if they came out prematurely and are really either straight or bisexual.
One difficulty many in the SIG expressed is that OCD hates uncertainty; it wants you to pick a side or fit neatly into a box. However, we know that sexual orientation and gender identity do not always fit into a rigid paradigm. Some queer people are bisexual, non-binary, and other identities that do not fit the two options society influences: gay or straight. Often, clients with OCD feel they are “fencing” and must pick a side. A clinician can help normalize not fitting into the specific categories OCD prefers and that compulsions are often enacted as a way to pick a side. Instead, these compulsions usually lead to more confusion and doubt. Also, a clinician can advise the person with OCD to live in the moment, and they do not have to decide their sexuality right now.
One SIG leader, Chris Trondsen, LMFT, shared his experience of when Playboy Magazine was erroneously delivered to his house as a young teen, and he found himself sexually aroused when looking through the magazine. However, as he got older, he found he had sole attraction to men. Often, his OCD would plague him and ask him if he was really gay and why he was looking through the magazines when he was younger. OCD wants perfectionism and clear labels when sexual orientation is more complex than that.
What is the Difference Between Genuine Identity Exploration and SO-OCD and Gender Identity OCD?
Another question many in the SIG are asked is how to tell the difference between genuine curiosity and exploration around one’s sexual orientation and gender identity versus when it is instead OCD. One distinction the SIG made was that the questioning and exploration were seen as desired and valued forms of self-growth, and the experience was important for them as they began to identify within the queer community and form relationships. Often, the fear and distress came from external sources, such as unsupportive family members and negative societal attitudes toward the LGBTQIA+ community. The fear was outside of themselves, with members scared of how everyone would react. However, when they explored it themselves, they enjoyed the idea of being in a relationship with someone they loved and being part of a community of like-minded people.
However, when OCD was involved, the exploration process was not welcomed. Instead, OCD created a lot of fear and confusion. Not of what others might think, but more so, what if they never fully figure out their sexual orientation and gender identity, or what if they get it wrong? The OCD dominated the internal conversation, and there was an urgent and distressing pressure to have answers and certainty. Often, the “discovering process” with OCD was filled with a lot of fear, confusion, and ritualized compulsions instead of joy as one was trying to get to know oneself.
When it was not OCD, the process was viewed as a journey of discovery rather than a pressing problem that had to be solved. Whereas when OCD was involved, it felt less like an organic contemplation and more like a worst-case scenario outcome that had to be prevented.
Do You Need to Work with a Queer Clinician to Get Better From OCD?
The SIG consensus was that it depends. Ultimately, when finding a therapist to help you get better from OCD, you need to find someone you are comfortable with. It is essential to be completely honest with your treatment provider, and often, we are more likely to open up about our taboo and unwanted thoughts if we connect with the person we are working with. It will help you drop barriers and be open with your therapist if you bond with them. So, find someone you are comfortable with, and if that person is a queer clinician, then go for it!
Mike Vatter, a member of the SIG, weighed in on the question of whether it is important to tell your provider that you are queer? In his opinion, he felt it was. "Your therapist needs to know the whole of you in order to treat you. You need to be honest with your therapist to ensure you are receiving the best possible treatment. You wouldn't keep your diabetes from your doctor, and you would not hide from your hairdresser that you die your hair." Your therapist must understand the key aspects of you to provide holistic mental health treatment.
Questions to Ask a Provider to Determine if They Are LGBTQIA+ Affirming
Although you do not need to work with a queer clinician to receive excellent OCD treatment, the SIG unanimously agreed that your clinician must affirm and respect your identities. If you do not feel comfortable asking a therapist directly about their LGBTQIA+ support, you can review their website to see if they have any information on the site that indicates they are affirming. Additionally, asking them about the organizations they are affiliated with can often provide a clue. If those affiliations are affirming or LGBTQIA+ organizations, this may be an indicator that they support the LGBTQIA+ community. Also, look at the specialties they treat. Do they indicate anywhere that they work with the queer community? For instance, when a provider is listed on the IOCDF's 'find help' section of their website, they have the option to mark that they are an affirming provider to the queer community.
Some members indicated that it is difficult to find an affirming OCD specialist in their area due to local and statewide politics. What worked for them was having affirming support from their queer community while getting OCD treatment and then switching to a queer-affirming therapist once the OCD was managed. However, it is essential to weed out someone who may cause harm.
Members of the SIG also mentioned that being queer does not always mean they are a good provider and that not being queer does not mean they are a bad provider. You want to make sure that you feel comfortable with them and that they specialize in evidence-based OCD treatment modalities. Lastly, one SIG member, Casey Knight, LCSW, said you could ask the treatment provider 'how do you feel about queer stuff?' if you feel comfortable being that direct.
Additionally, Casey Knight notes that if you are looking for a queer therapist or queer-affirming therapist, you may need to ask questions like:
- "What specific training or experience do you have working with LGBTQ Issues?"
- "What are some ways in which you have supported Queer clients in the past?"
- "Are you comfortable working with clients who identify as clients who identify as —--?"
Casey goes on to say that while good vibes, visual appeal, similar lifestyles, and values may make a good match for a therapist in some regards, this is not the case when working with OCD. When we find the perfect person to spill with, we talk, and talking can actually hinder healing. Talking or talk therapy increases the spinning or popcorning of thoughts. Talking increases rumination, which is a mental compulsion, the "C" of OCD. Casey Knight goes on to add that: most talk therapists have no idea that this is the case for OCD. We mean no harm in our exploration of what we believe to be generalized anxiety; we ask more questions and genuinely try to help you identify and learn practical skills to address your challenges. Yet, this may prolong the ruminations.
With OCD, it is more important to find a provider who is trained in effective and specialized evidence-based treatment for OCD rather than finding somebody who looks like, sounds like, or has the same identities as you have. While it is essential to have community and supportive people in your life who share similar identities and experiences and validate you for who you are, these individuals can be family members, friends, or community members. When looking for somebody to treat your OCD, I urge you to find somebody who can provide you with evidence that they have been trained in modalities that are specific to OCD.
SIG member, Mike Vatter, wanted to remind you that you can "break up" with a therapist who ends up not being queer affirming. Mike would like to remind people that the therapist works for the patient, not the other way around. You pay the therapist to work with you and help you get better. Just like any other service, if it isn't working, it needs to stop, or you need to change providers. Mike also stated that you must be your own advocate.
Faith, Religion, OCD, and Queerness
As part of a holistic approach to mental health, some may find spirituality or faith an essential part of their OCD recovery. However, due to sometimes harmful messaging about the LGBTQIA+ community from many faith leaders and organized religions, a client may face complex changes in their lives as they begin to change churches or move from a less affirming faith to a more affirming one for this reason. Some queer people may choose to leave organized religion behind and instead explore affirming theology and find spaces that resonate with them, allowing them to be themselves and practice their beliefs.
Members of the SIG discussed how exposure and response prevention (ERP), the frontline treatment for OCD, helps aid them in connecting deeper with their faith, with one LGBTQIA+ SIG member stating that faith is not the absence of feeling uncertain. Faith is going forward through the uncertainty.
Many in the queer community feel as if they must practice a specific faith because of family, societal, or cultural pressure. Due to the often problematic relationship between faith and the queer community, many SIG members stated that they do their own thing for their faith and spirituality outside of organized religion. Additional perspectives on faith from members of the SIG included that many churches are inclusive, regardless of the branch of religion they are part of. They recommended that each person conduct their own research to find a faith that supports their mental health journey and celebrates who they are.
Scurpulosity OCD can often be part of a queer person's experience with the disorder. There was discussion about how many experienced moral scrupulosity, feeling guilty that they were queer because they knew their family did not accept their sexual orientation and that this caused their family member’s pain. Others questioned whether they will ever go to heaven or if God loves them because of being queer. As a SIG, we all agreed that it was crucial to separate the OCD from religion, focus on the OCD component in treatment, and then find a faith that celebrates who you are. Many religions, faiths, and churches do not have harmful rhetoric around queer people and instead welcome them into their churches!
A Final Message
In conclusion, the LGBTQIA+ SIG's parting message for queer people with OCD is that you must find specialized treatment to get better from OCD and that the clinician treating you must support and affirm you as the client. For providers, we hope that this blog has given you insight into why it is important to understand and affirm your queer clients. Everyone deserves to get better from OCD and feel supported through the process, regardless of who they love or how they express their gender identity, so that they may live a full and fulfilled life in recovery from this disorder.
Signed,
The LGBTQIA+ Special Interest Group (SIG) of the IOCDF
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