Have you ever had an unwanted thought seemingly appear out of nowhere? Maybe you were crossing a bridge and all of the sudden the thought of driving over the edge pops into your mind. These thoughts can be frightening, leaving you to wonder, “Where did that come from?”—especially when the nature of the thought is entirely out of character.
It’s important to know that almost everyone experiences unpleasant thoughts they would rather not have. “It’s a normal part of being a human,” says Dr. Patrick McGrath, PhD, and Chief Clinical Officer at NOCD. But when these unwanted thoughts become persistent and feel unmanageable, they may be connected to obsessive-compulsive disorder (OCD).
If you have no desire to act on them—and they’re not interfering with your daily life—intrusive thoughts usually aren’t concerning as they don’t have any particular meaning. On the other hand, when intrusive thoughts aren’t just a blip in your day, but instead something that takes up a lot of your attention, there could be a reason to investigate further.
What is an intrusive thought?
Intrusive thoughts, images, feelings, sensations, and urges are mental experiences that are unpleasant or distressing, happen against your will, and do not align with your true feelings or values. They can be brief, fleeting thoughts such as “What if I knock over this vase of flowers?” or more alarming ones like “What if I drop my baby?” or “I’ll be contaminated if I touch this door handle with my bare hand!”
There’s really no topic that’s off-limits for intrusive thoughts. Some examples include:
- Sex/sexuality: “What if I’m attracted to members of my family?”
- Self-harm: “What if I were to drive my car off the road?”
- Relationships: “What if I don’t really love my significant other?”
- Religion: “What if I’ve lost my religious faith?”
- Morality: “What if I’m a bad person?”
Intrusive thoughts differ from impulsive thoughts, which are sudden, intense urges or desires to act on a whim, often without considering the potential consequences. While impulsive thoughts also arise spontaneously, they’re usually related to an action that you actually want to do in the moment. Whereas, intrusive thoughts are ego-dystonic, meaning they are not in line with what you truly believe, desire, or value.
What is OCD?
OCD is a mental health condition that occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are recurrent intrusive thoughts, urges, sensations, feelings, and/or images that lead to compulsions, which are ritualistic behaviors or mental acts done in an effort to alleviate distress and/or to prevent a feared thing from happening.
According to the The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the official manual for classifying mental health conditions, an OCD diagnosis requires the presence of obsessions and/or compulsions that:
- Are time-consuming, meaning they either take up at least one hour per day or considerably interfere with a person’s normal routine
- Cause significant distress
- Impair one’s ability to function at work, social situations, or other important areas of functioning
How intrusive thoughts show up in OCD
When you have OCD, intrusive thoughts take up a lot of your mental space. You may fear these thoughts won’t cease until you can find a way to relieve yourself of the distress that they cause.
Intrusive thoughts can lead you to spiral and draw conclusions that are baseless. For instance, after an unwanted thought about dropping your child, you might think: “What if I really am a bad parent? What if Child Protective Services takes my baby away?” Generally speaking, intrusive thoughts in OCD center around something that matters deeply to you—the consequences are devastating, which is why they can feel so alarming.
When intrusive thoughts lead to compulsions
With OCD, intrusive thoughts become unsettling to the point where you feel you must find a way to eradicate them through taking action. Here’s where compulsions come into play.
There are many types of compulsions. One common compulsion is reassurance-seeking. You might find yourself spending hours on Google trying to figure out how to know whether you’re a good mother, or asking your partner if you’re a good parent. Unfortunately, the nature of compulsions is that they only bring temporary relief.
Here’s a few other common compulsions:
- Repeatedly checking stoves, doors, locks, etc.
- Excessive cleaning
- Repeating acts (e.g., walking back and forth through a doorway multiple times)
- Mental compulsions, including rumination and compulsive prayer
- Needing things to be symmetrical or “just right”
- Hoarding
- Counting
- Mental review (e.g., constantly replaying past conversations in your head to internally assess how you came off)
- Avoiding particular places, people, media, or situations
Intrusive thoughts vs. OCD
It may feel tricky to tell when intrusive thoughts are connected to OCD. Here’s a few ways to tell when they are a symptom of OCD:
- You believe intrusive thoughts mean something. For individuals without OCD, intrusive thoughts come and go without much introspection. But those with OCD have a tendency to attribute meaning to whatever random thought appears in their mind. They may think these thoughts signify that something is wrong, because why else would they appear? For example, let’s say you get a thought about slapping your partner. With OCD, you might believe that you’re an abusive partner just because that thought showed up—even if you would never act on it.
- You perform compulsions. What characterizes an intrusive thought as a component of OCD is how much emotional distress these thoughts cause you and whether you try to alleviate that anxiety via compulsions. People with OCD get “caught in this loop of believing that they can neutralize intrusive thoughts and make them go away,” Dr. McGrath explains. “The more they say ‘I hope I don’t think about that’, the worse it gets.”
- Intrusive thoughts mess with your ability to function. If ruminating over intrusive thoughts is taking up huge chunks of your day, your work, school, and/or social life may be affected.
Why do we get intrusive thoughts?
If you’re struggling with intrusive thoughts, you may be wondering why we’re subject to them in the first place. “Everybody wants to put a meaning on to something that pops into their head,” Dr. McGrath says. There’s no real clear-cut answer, it’s just the way our minds are constantly reacting to our surrounding environment.
Our brains are an electrical activity beehive, right? It’s always running and it’s always reminded of things,”
Dr. Patrick McGrath
“You can smell something that reminds you of an experience you had 50 years ago and it will flash you back to that experience,” Dr. McGrath says.
We tend to place a lot of significance on random thoughts, images, and/or urges that we view as negative, but not so much for what we label as happy or neutral. “Everybody has random stuff that pops in their head all day long and almost all of it gets absolutely no attention paid to it whatsoever,” Dr. McGrath says.
How to treat OCD intrusive thoughts
It might seem like intrusive thoughts will always be running your life, but there are treatment options available. OCD is best treated with exposure response prevention (ERP), an evidence-based therapy that helps you face distressing thoughts without trying to escape from them by performing a compulsion. Dozens of clinical studies have demonstrated the effectiveness of ERP.
How does ERP work? A specially trained therapist helps you intentionally expose yourself to what triggers your intrusive thoughts. It’s a gradual process, meaning you start with triggers that only bring a low amount of distress. Once you’ve mastered those, you work your way up to more challenging fears. Your therapist will teach you how to resist the urge to react with compulsive mental or physical behaviors. As you continue your ERP sessions, you’ll find that over time the intrusive thoughts don’t have the same power over you.
Remember that while intrusive thoughts happen to everyone, they affect people in different ways. If your intrusive thoughts feel unmanageable and you think they may be connected to OCD, there is specialized care accessible to you.
