Sometimes it can feel like you have no control over your thoughts. Maybe you’re driving your car and a thought pops into your head out of nowhere: “What if I abruptly hit the brakes and allow the oncoming traffic to hit me?” When completely out-of-character thoughts arise on repeat—particularly if they’re disturbing in nature—they definitely get your attention. You might be asking yourself: Is this an impulsive thought or an intrusive thought? And why, exactly, is it happening?
Intrusive thoughts and impulsive thoughts are often conflated—but in reality, they are not the same. What’s more, they can sometimes signal a mental health disorder, like attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD)—so distinguishing the two can be crucial.
Keep reading to understand the difference between impulsive thoughts and intrusive thoughts, what could be causing them, and how to get relief. Impulsive vs Intrusive Thoughts: What’s the Difference?
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What are impulsive thoughts?
Impulsive thoughts are sudden, intense urges or desires to act on a whim, often without considering the potential consequences. These thoughts arise spontaneously and can be powerful and compelling, prompting people to make decisions in the heat of the moment without adequate planning or reflection.
While impulsive thoughts can be a normal part of the human experience, they can become problematic when they lead to impulsive actions that negatively impact your life or well-being.
Here are some examples of impulsive thoughts:
- “Quit your job today!”: feeling a strong urge to quit a job without considering financial implications or alternative employment options.
- “Buy that bag right now”: making spontaneous and potentially regrettable purchases due to a desire for immediate gratification.
- “Yell ‘you’re so slow’ at the barista making your coffee”: exhibiting abrupt verbal outbursts in social situations, or expressing feelings without considering appropriateness or potential harm.
Impulsive thoughts can be associated with the following:
- ADHD: characterized by difficulties focusing, hyperactivity, and impulsivity that make it difficult to function in a way that most people think of as neurotypical or “standard.”
- Borderline personality disorder (BPD): a serious psychological condition characterized by unstable moods and behavior. BPD often involves impulsive actions that are driven by especially intense emotions.
- Antisocial personality disorder (ASPD): a mental health condition that can lead to recklessness and impulsivity, often accompanied by a lack of regard for others’ well-being.
If you believe that your impulsive thoughts are a symptom of any of these disorders, it’s important to seek an evaluation from a mental health professional.
What are intrusive thoughts?
Intrusive thoughts are thoughts, images, sensations or urges that pop into your mind, uninvited, often causing significant distress or discomfort. They’re a natural part of human cognition and are experienced by virtually everyone at some point in their lives.
“By nature of its definition, an intrusive thought is unwanted,” says Taylor Newendorp, the Network Clinical Training Director at NOCD. “You’re trying to focus on something else, trying to concentrate, have fun with their friends, family—whatever it may be—and all of a sudden, this unwanted, usually disturbing thought or image is just there in their head. It’s really distracting and really upsetting.”
Here are a few examples of intrusive thoughts:
- “What if someone I sit next to on the bus has an illness and now I’m going to get it and give it to my kids?”: thoughts of causing harm to loved ones
- “What if I push this stranger onto the train tracks?”: visualizing violent acts despite abhorring violence
- “What if I go to hell for not praying enough?”: distressing thoughts that are religious or moral in nature
- “What if I’ve been living a lie being married to this person?”: doubts about one’s sexual orientation despite a firm sense of identity
- “Did I just feel aroused walking by these children at the playground?”: thoughts about inappropriate or taboo sexual acts or experiences
- “I always say the wrong thing and make people feel bad.”: worries about making mistakes or causing harm
- “What if I just took this knife and instead of chopping up these carrots, I stab myself with it?”: images or thoughts of self-harm when there’s no intention to act on them
Many people ask the question: Do my intrusive thoughts mean anything? Experiencing intrusive thoughts does not indicate a desire to act on them. They are a product of the complex workings of the human mind and are not indicative of one’s true intentions or character. In fact, they often directly contradict your values—that’s what makes them so disturbing.
While these thoughts can be distressing, they are a common phenomenon and do not necessarily signify the presence of a mental disorder. However, it’s important to know that in some cases, these thoughts can be a symptom of a larger mental health issue.
What mental health conditions are related to intrusive thoughts?
Research shows that there are some illnesses linked to frequent, disturbing intrusive thoughts. These include the following:
Depression
Depression is a mood disorder that affects how you feel and think, according to the National Institute of Mental Health (NIMH). Intrusive thoughts in depression may include thoughts of self-harm or negative statements about yourself or life.
PTSD
Post-traumatic stress disorder can occur after going through something that’s shocking, scary, or dangerous—or being a witness to something that is—according to the NIMH. With PTSD, intrusive thoughts can come in the form of flashbacks where you relive your trauma or even as intrusive dreams.
Anxiety
While there are many different types of anxiety disorders, generalized anxiety disorder, or GAD, is one in which you have intense worry or anxiety that you just can’t shake. These feelings can pop up in the form of intrusive thoughts: What’s going to happen in the future? What if I lose my job? What if that bump under my skin is cancer?
OCD
Obsessive-compulsive disorder (OCD) is a mental health disorder characterized by a cycle of obsessions (intrusive thoughts, images, sensations, feelings and/or urges that cause distress) and compulsions (mental or physical behaviors done to neutralize the distress or prevent something bad from happening).
For instance, someone with Contamination OCD—one of the more widely known OCD subtypes—might have intrusive thoughts about germs, leading them to compulsively wash their hands, even to the point of causing lasting skin irritation and damage. Others with OCD may have intrusive thoughts about causing themselves or others harm, engaging in taboo sexual behavior, or doubting their attraction to their partner.
Whatever the specific nature of someone’s OCD thoughts, they can be profoundly distressing and significantly impact daily life. Fortunately, there’s an evidence-based treatment that reduces the impact of troubling intrusive thoughts, called Exposure and Response Prevention therapy (ERP).
ADHD impulsive thoughts vs. OCD intrusive thoughts
As mentioned above, intrusive thoughts are often (although not always) associated with OCD, while impulsive thoughts can be related to ADHD.
If you have a hunch that one of these diagnoses may be at play, and aren’t sure which, there are a few tell-tale signs, says Newendorp.
For one, unlike intrusive thoughts, impulsive thoughts in ADHD do not cause compulsions. In fact, people with ADHD don’t engage in compulsions at all (unless they also have co-morbid OCD.) Instead, impulsive thoughts may lead those with ADHD to take part in risky behaviors or dangerous situations without thinking about the consequences.
On the other hand, people with OCD may go out of their way to avoid acting impulsively because they’re hyper-focused on the potential outcomes of their actions. For example, someone with Harm OCD may avoid shopping in person because they worry “What if I accidentally steal something?” Someone dealing with impulsive thoughts, on the other hand, might suddenly feel a real urge to steal something, and have a desire to go shopping as a result.
Another distinction is the emotions that arise with symptoms. “With OCD, what people are reporting is just a lot of anxiety, a lot of flat-out distress in response to the stuff going on in their heads,” Newnedorp says. “With ADHD, you don’t always hear as much anxiety—it’s more excitability.” Experiencing frustration and anger is also common for those dealing with ADHD.
Impulsive vs. compulsive behaviors
OCD can be misdiagnosed as ADHD, and vice versa, when impulsive behaviors are confused with compulsive behaviors.
A behavior is compulsive when you have the urge to do it repeatedly—usually to try to rid yourself of anxiety or distress. A behavior is impulsive when you do it without much thought at all, and without considering the consequences.
“With compulsions and OCD, the person literally feels compelled to do it, like they have to do it,” Newendorp says. “With an impulsive action, the person often wants to do it and it’s actually pleasurable or enjoyable for them.”
With compulsions and OCD, the person literally feels compelled to do it, like they have to do it. With an impulsive action, the person often wants to do it and it’s actually pleasurable or enjoyable for them.
Case in point: When someone with ADHD is hyper-focused on something specific, they usually find it to be fun, exciting, or engaging. They may get an impulsive urge to drop everything and work on a task. A person with ADHD might spend hours reorganizing and cleaning their kitchen pantry for their own enjoyment. This might sound like a compulsion, but the critical distinction is those with OCD act out compulsions in an effort to alleviate anxiety or prevent specific outcomes, not because, say, cleaning their desk 12 times a day is particularly pleasurable.
“Compulsions with OCD are not fun,” Newendorp says. “They’re simply going through compulsions in an effort to get some relief.”
How to get help for impulsive thoughts or intrusive thoughts
It’s worth reiterating that both impulsive and intrusive thoughts are a normal part of the human condition. Treatment is needed when these thought patterns interfere with daily life, cause distress, or put yourself or another person at risk of harm.
If your impulsive thoughts or intrusive thoughts are a symptom of a larger mental health issue, addressing the underlying cause is key.
ADHD, for instance, is generally treated with a combination of therapy and medication. Cognitive-behavioral therapy (CBT) is particularly effective, and may be combined with a class of medications known as stimulants, which can reduce impulsivity and increase focus.
And Exposure and Response Prevention (ERP) has proven to be highly effective in helping people manage intrusive thoughts—and other OCD symptoms—over the long haul. ERP involves gradually exposing you to situations that trigger intrusive thoughts (yes—you face them rather than try to suppress them) while teaching you to respond without engaging in compulsive behaviors.
Consider a person with the OCD-related fear of germs. They may repeatedly sanitize their hands, even at home (this is the compulsion part) because of intrusive thoughts that say, “If your hands aren’t clean, you’ll contract an illness and infect everyone you love.” ERP therapy helps you tolerate these thoughts without having to engage in compulsive hand sanitizing. In time, your distress may gradually disappear when you realize that nothing bad happens as a result.
If you’re suffering from both impulsive and intrusive thoughts? “You can work with an ERP specialist for the OCD-related intrusive thoughts while also working with an ADHD coach or another type of therapist that really focuses more on impulse control issues,” Newendorp says.
Most important to know: If intrusive thoughts are causing you distress, and you don’t know for sure if you have OCD, you don’t have to let that stop you from seeking the help of a professional. Often, reaching out is the first step to getting the clarity and support you need.