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What is OCDRelated Symptoms & ConditionsCan an identity crisis be treated? A therapist’s approach

Can an identity crisis be treated? A therapist’s approach

9 min read
Jessica Migala

By Jessica Migala

Reviewed by April Kilduff, MA, LCPC

Sep 18, 2023

It would be great if we all went through our lives and had a clear picture of who we were and our goals for the future—and felt confident, happy, and content with it all.

But life can be a confusing mix of twists and turns. We’re not all on a clear, organized path. And there may come a point where you question yourself, your choices, and where your life is going. One common type of identity crisis? The midlife crisis, in which pop culture would have you believe you reach a certain age, randomly buy a new sports car, change up your wardrobe, and get a new haircut.

But an identity crisis can also be a sign of something more. In some cases, it may be linked to certain subtypes of obsessive-compulsive disorder, or OCD. When an identity crisis is the product of OCD, there are effective treatments that trained therapists can offer you. 

Here’s what you need to know about what is an identity crisis, how to know if it’s an indication of a mental health condition like OCD, and how therapy may be able to help you feel more confident in how you view yourself.

What is an identity crisis?

Identity is defined as a “a set of physical, psychological, and interpersonal characteristics that is not wholly shared with any other person and a range of affiliations (e.g. ethnicity) and social roles,” according to the American Psychological Association (APA).

Here’s where the APA’s definition is key: Your identity is tied to you feeling as if you are the same person today that you were in the past. Of course, there’s room for learning and growing or an aging physical appearance, but when you have a firm sense of identity, you still understand who you are.

While “having an identity crisis” might be a term that gets thrown around a lot (he’s totally having an identity crisis dating someone half his age! Look at what she’s wearing–it’s a total identity crisis!), the truth is that it’s not a psychological diagnosis. 

“This is a pop psychology term,” says Patrick McGrath, PhD, Chief Clinical Officer at NOCD. You might think of an identity crisis as “a change in your life that you’re having trouble adjusting to,’” he says. This could happen at different points in your life, like turning a certain age, becoming a parent, or a job change or loss.

There is also a diagnosable disorder called “adjustment disorder,” says Dr. McGrath. The trigger here is a stressful life event (death of a loved one, illness, trauma, divorce) that you just can’t seem to cope with, which stirs up feelings of sadness and hopelessness, according to the National Library of Medicine. Adjustment disorder is a short-term diagnosis that can be addressed with talk therapy, Dr. McGrath explains.

Identity crisis doesn’t have to be an adjustment disorder, and you don’t need a diagnosis to have one. “It can be a time in your life of confusion about what you believe or think or how you act,” says Dr. McGrath.

Can OCD cause an identity crisis?

First, before diving into how OCD and an identity crisis might be linked, it’s important to understand what OCD is. Obsessive-compulsive disorder is a mental health disorder characterized by two main groups of symptoms: obsessions and compulsions.

Obsessions are recurrent and persistent thoughts, urges, feelings, sensations, or images that are intrusive, and distressing. Because obsessions create such anxiety, you attempt to get rid of that distress by performing certain thoughts or actions according to often rigid or ritualistic rules, which are called compulsions. A compulsion can include things like ruminating, checking, counting, arranging things “just right,” or seeking reassurance from loved ones, among many others. Having OCD generally means that you find these obsessions and compulsions distressing, and that they interfere in your day-to-day life.  

OCD is a rather clever condition, and can morph into many different subtypes of OCD, with common themes ranging from Contamination OCD and Harm OCD to Relationship OCD and Existential OCD. It loves to latch onto things that feel like “worst-case scenarios,” calling into question your safety, values, morals, and even personality. 

And that’s where an identity crisis may come into play.

OCD can take hold of your life in many different ways, but two types of OCD that may be most likely to lead to an identity crisis are sexual orientation OCD and existential OCD. Here’s more about each:

Sexual orientation OCD

Imagine for a moment that you’ve idolized a certain celebrity for years. Usually they’re in the news for a new project or because they’re dating a fellow celeb. Today, though, they’re in the news for an entirely new reason: They’re dating someone of a different gender, when they’ve previously identified as gay. Suddenly, everything you knew about them feels uncertain. 

This is where OCD can step in: Are you living a lie in your life? Can you ever actually feel certain about your identity? “This can cause people to start wondering about themselves, asking ‘what if’ questions, like what if they didn’t know that their sexuality was different from how they’ve always identified,” explains Dr. McGrath. “They may ask themselves if they’ve lived a lie their entire lives,” he says. 

This is an example of sexual orientation OCD. If you have this type of OCD, you have fears surrounding your sexual orientation, asking yourself if you’ve been in denial of your true sexual orientation or worry that your sexual orientation can suddenly change, just like that celebrity whose identity may not have been precisely what you thought. Quickly, you may feel that if you aren’t always 100% certain about your sexuality, then you can’t be comfortable in your identity at all.

Existential OCD

You may not have thought of existential questions much in your life, but one day you watch The Matrix or Inception with friends, and you just can’t seem to get certain doubts and worries out of your head. At first the question seems silly to you: “What if none of this is real? What if it’s all a simulation? Worse yet, what if I’ve been in a dream this whole time and I didn’t know? After all, there’s no way for me to prove otherwise.” As these thoughts fill your head more and more, you’re gradually gripped by an increasing sense of insecurity about your life, your identity, and your day-to-day experiences. You start to seek reassurance from the people around you, and you develop ritualistic rules about “testing” parts of your life to confirm you’re not dreaming. Before long, it becomes an existential crisis.

It’s easy to see how that type of identity crisis can grow out of OCD, says Dr. McGrath. “OCD grabs onto what is most important to you,” he explains. 

In both of these examples, an identity crisis can emerge from OCD when something shatters how you view yourself. Sometimes known as the “doubting disorder,” OCD will spread uncertainty about the things that matter the most to you: Are you sure? How do you know with 100% certainty that your sexuality is what you think it is? Can you ever maintain a long-term relationship? Do you actually know who you are at all? If so, why are you having these doubts in the first place?

Thoughts and worries from OCD can quickly spiral out of control, causing extreme distress, leading you to seek relief from compulsions. You might “test” your sexual attraction by watching porn, or erase doubts about your faith by praying for hours on end. Unfortunately, any relief from a compulsion is only temporary. Those fears will pop up again, and you will feel an even stronger need to do these compulsions again and again. 

Treatment for an OCD identity crisis

The first step is to determine the source of your identity crisis. If it’s because of a milestone birthday or life change and it’s causing a problem in your life—you’re acting in destructive ways that affect your relationships or ability to work, or are causing your family or friends hurt—then consider seeing a therapist who can help you work through your feelings, actions, and their consequences.

However, if OCD may be causing you to question your identity and you’re experiencing a cycle of obsessive triggers and compulsions done for relief—such as seeking reassurance from others, avoiding distressing thoughts, or repeatedly “checking” for certainty about your identity—then Exposure and Response Prevention therapy (ERP) is needed.

In ERP, you will work closely with a therapist to identify the situations that cause you anxiety and fear. During a session, you and your therapist will work together to trigger an obsession (this is the exposure part of ERP) and you will make a deliberate effort not to perform your compulsion(s) (this is response prevention). Expect to feel uncomfortable during this process—after all, one goal of ERP is to teach your brain that it can tolerate uncomfortable feelings without seeking immediate relief. But during repeated sessions, you’ll begin to feel less distress when you face your obsessive triggers. In short, by not engaging in compulsions, they will lose their control over you.

So, what might this look like in a session? Dr. McGrath gives an example: suppose you’re avoiding a longtime friend, because being around them makes you worry that you’re actually attracted to them. Avoiding them in the first place is a compulsion, and you might further engage in compulsions like trying to mentally review every interaction you’ve had to see if something you did can be construed as “hitting on them.” As an exposure exercise in ERP, rather than continue to avoid them, you’d actually reach out to them to meet up for coffee, or simply start by sending a text. With these small steps, you’d learn that your fears weren’t reflective of reality, and that you’re capable of tolerating uncertainty about your sexuality—uncertainty that’s a universal part of being human.

That said, questioning your sexuality is a completely valid experience—many people never feel that their sexuality is unchanging or that they fully understand it. But that doesn’t mean your life or identity will be out of control as a result. While OCD tells you that you’re not able to deal with uncertainty, ERP can help you accept those uncertainties. “If you’re in a relationship, continue to date that person, don’t just stop your relationship. Dating with doubts is okay,” says Dr. McGrath. You have time to think and reflect and open up to your partner about how you’re feeling. 

How to get help–starting today

It’s important to point out that having an identity crisis doesn’t mean anything is wrong with you or that you need to suppress anything about yourself. You can show up in the world as yourself, and you deserve to be supported in that. 

However, if you believe that distressing fear and doubt about your identity may be the result of OCD, then it’s worth it to seek help for your OCD. It’s also helpful to remember that your doubt and uncertainty is not the problem in your life—it’s the OCD that makes these things feel unbearable and demands certainty where no such thing exists.

If you have OCD, then seeking out ERP therapy from a therapist who is specially trained in ERP will help you take back your life so you can live in a way that’s true to yourself. Schedule a free, 15-minute call with the NOCD Care team, who have ERP-trained therapists ready to talk to you about if this type of therapy is right for you. 

NOCD Therapists specialize in treating OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

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