Can intrusive thoughts appear as images?

“I think I’m experiencing intrusive thoughts, but they show up as images in my mind rather than words or phrases—are intrusive images even a thing?” Can intrusive thoughts appear as images?

That’s a common question, and the answer is yes. Intrusive thoughts can take many forms. They can be just that—a thought—or they can be a memory, sensation, urge, feeling, or an image.

It’s important to know that passing intrusive images affect almost everyone from time-to-time, and they’re completely normal. However, when they occur regularly and cause significant distress or anxiety, they may signal a mental health condition such as obsessive-compulsive disorder (OCD).

Keep reading to better understand what intrusive images really are, what might be causing them, and what—if anything—can be done to stop them from happening. 

What are intrusive images?

If an image appears in your mind “out of nowhere” and it’s unwanted and bothersome, it may be an intrusive image. Often, these unwanted images depict scenes that are difficult to talk about—because they’re disturbing, taboo, sexual, or what we think of as “gross.” 

Intrusive images are different for each person. After all, whether or not someone considers an image to be disturbing depends on each person’s relationship to its subject matter. “Take whatever you wouldn’t want to have happen, and intrusive images are often the visualization of that fear,” says Patrick McGrath, PhD, Chief Clinical Officer at NOCD.

For instance, someone with relationship anxiety and fears may find themselves picturing their spouse’s sex life with past partners. Likewise, someone with extreme fears about illness might get intrusive images of, for instance, a loved one in the hospital. Essentially, anything about which you’ve formed a disturbing narrative in your mind can become an intrusive thought, which may manifest as an intrusive image.

What causes intrusive images?

Intrusive images—just like intrusive thoughts—don’t always have a cause. Often, they occur randomly, wandering into your mind just as quickly as they exit. 

That said, intrusive thoughts can also be related to an underlying mental health condition, such as post-traumatic stress disorder (PTSD), OCD, or anxiety just to name a few. 

A mental health condition may impact the type of intrusive images you see, as well as how you respond to them. For example, intrusive images caused by PTSD are often related to trauma you have experienced, according to Dr. McGrath. Your mind gravitates to visions of the traumatic memory that you’d rather not think about.

With OCD-related intrusive thoughts, however, intrusive images often don’t have a “logical” explanation—in other words, it’s not necessary that you actually experienced something in the past, and now you can’t stop visualizing it. OCD is a chronic mental health condition in which a person experiences recurrent and unwanted thoughts, urges, feelings, sensations or images that cause distress (a.k.a. obsessions)—and they can truly be about anything.

Intrusive thoughts and images vs. OCD

Since it’s entirely possible to experience intrusive thoughts or images without an underlying mental health condition like OCD, how can you tell if the two are related?

The best way to know if OCD is the root cause of your intrusive images is to get an evaluation from an OCD specialist. That said, there are a few clues to be aware of. Here are some signs that your intrusive images could be a symptom of OCD:

• You believe intrusive images mean something. For individuals without OCD, intrusive thoughts and images come and go without much introspection. But those with OCD have a tendency to attribute meaning to whatever random images appear in their mind. (In reality, your intrusive images are not your secret fantasies. The reason these images are so distressing is that they are ego-dystonic, meaning they go against your true desires or values.)
• You perform compulsions. What characterizes an intrusive thought or image as a component of OCD is how much emotional distress these thoughts cause you and whether you try to alleviate that anxiety via compulsions. Compulsions are repetitive behaviors or mental acts that are done in an attempt to neutralize the intrusive thought or image, or ease discomfort. 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 picture that in my mind again, the worse it gets.”
• Intrusive thoughts and images mess with your ability to function. If you’re constantly ruminating over intrusive thoughts and images, your work, school, and/or social life may be affected. 

Common examples of OCD-related intrusive images

The possibilities of what the mind can envision are endless, but these are some forms intrusive images can take:

You see images of dirt and germs, or someone getting sick.

Some people regularly experience intrusive images of dirt or contamination, or they see mental images of others (or themselves) getting sick. Images of this nature can be related to Contamination OCD—a subtype of OCD marked by intrusive thoughts about becoming contaminated or contaminating others. The images can still lead to compulsive behaviors, such as excessive cleaning or washing. 

Examples:

• Picturing germs and bacteria on surfaces you touch every day, like door handles
• Visualizing yourself throwing up after getting food poisoning
• Imagining cockroaches crawling around your kitchen

You imagine yourself harming yourself or someone you love.

You may imagine yourself committing acts of violence against people you love, or being harmed yourself. Sometimes, these images can include forms of sexual harm. These intrusive images are a common manifestation of Harm OCD, a subtype of OCD where intrusive thoughts revolve around harming oneself or others.

Examples:

• Visualizing yourself swerving your car into oncoming traffic or driving off a cliff 
• Picturing yourself cutting off your finger while chopping vegetables
• Imaging dropping your baby and seeing them in pain

You see flashes of sexual images that feel “taboo” or “wrong.”

Sexual intrusive images can occur about people who you are not attracted to. Often, these images center on scenes that are taboo. Again, because OCD often targets themes that mean the most to people, these images may seem completely out of line with your true character. For instance, someone who has devoted their life to working with children, such as a school teacher, may experience intrusive images related to pedophilic OCD, a subtype of OCD that revolves around unwanted sexual thoughts about children.

Examples:

• Picturing yourself having sex with a gender you’re not attracted to
• Visualizing yourself making sexual advances on someone inappropriate, such as a co-worker or neighbor
• Imagining acts of incest or sexual violence, like rape or sexual assault

You picture scenarios that directly go against your faith or spirituality. 

It’s also possible for intrusive images to revolve around an individual’s religion or spirituality. These images may be related to Religious or Scrupulosity OCD, an OCD subtype involving religious or moral obsessions. “I’ve worked with people who thought about having sex not just with their god, but the devil or something of that nature,” Dr. McGrath says. 

Examples:

• Seeing yourself eating something that goes against the rules of your religious practice
• Visualizing yourself committing a major sin
• Imagery of hell or other religious punishments

How do I “get rid” of intrusive images?

While it’s normal to want a way to ward off these intrusive images, unfortunately that’s not possible. Rather than fighting them when they occur, it’s better to learn to identify them. Say to yourself, “That’s just an intrusive image. It doesn’t represent anything about who I am and what I want to happen.”

It’s also important to reserve any judgment about yourself. Remind yourself that you’re not a bad person based on the contents of your intrusive images.

Keep in mind, however, that if your intrusive images are connected to a mental health condition, it’s important to seek treatment for that condition. 

For intrusive images related to OCD, exposure and response prevention (ERP) therapy is most effective. ERP is backed by decades of clinical research and can drastically help people with OCD reduce the cycle of obsessions and compulsions. In other words: You won’t spend all your time obsessing over an unwanted image that popped into your mind, then doing compulsions to cope with your distress about it.

So how does ERP work? Let’s say you have an intense fear of being killed, and frequently picture yourself being stabbed. Your therapist may start you off with an exposure that involves simply looking at a picture of a knife and examining how sharp it is. Once you’re able to tolerate this exposure with less anxiety, you may move onto a more difficult exposure, like actually holding a knife.

Your ERP therapist will never force you to do anything that you aren’t ready for. Instead, they will guide and support you at your own pace. With their help, you can get to a place where distressing images enter your mind and breeze right on through. You’ll be able to let them come and go, knowing they don’t represent who you are or signify anything meaningful. 

Bottom line

While everyone has the passing intrusive thought or image, if you’re experiencing them frequently, and they’re causing you distress or interfering with your daily life, it’s important to seek help from a mental health professional.