Obsessive-Compulsive Disorder Presenting as Gender Dysphoria/Gender Incongruence: A Case Report and Literature Review

ABSTRACT Objective: With the intensified public awareness and media coverage of issues concerning gender identity and gender incongruence, distinguishing true gender dysphoria or incongruence from the sexual obsessions of obsessive-compulsive disorder (OCD) is especially important. Although intrusive sexual obsessions are not uncommon in OCD, obsessions concerning sexual content are more difficult for clinicians to identify as OCD than other types of obsessions (e.g., obsessions concerning contamination). Making the correct diagnosis helps ensure that appropriate clinical treatment can be offered. Methods: We present a case report of a homosexual, single, young male with new-onset intrusive repetitive obsessive thoughts that he was transgender. The case report is accompanied by a review of the pertinent endocrine and psychiatric literature. Results: A Yale-Brown Obsessive Compulsive Scale indicated a significant negative impact of the patient's symptoms. Conclusion: To our knowledge, this is the first case report of an OCD patient whose symptoms include the unwanted, intrusive obsessive thought that he was transgender. The described case and associated review highlight the characteristics that distinguish the distress in patients with OCD who present with obsessions concerning being transgender relative to patients who are transgender or gender incongruent who present with gender dysphoria. The case illustrates the importance of considering OCD as a potential diagnosis in patients who present with new-onset obsessions regarding gender identity and the importance of establishing the durability and pattern of gender identification and obsessions before embarking on treatment. Abbreviations: DSM = Diagnostic and Statistical Manual of Mental Disorders OCD = obsessive-compulsive disorder Y-BOCS = Yale-Brown Obsessive Compulsive Scale