The human brain is really weird. It can create the most off-the-wall, puzzling thoughts that seem to come out of nowhere.
What if I just took this knife, and instead of chopping up these carrots, I stabbed myself with it?
What if my husband leaves for work and gets into a four-car pile-up?
What if I push this stranger onto the train tracks?
What if someone I walked past on the street had measles, and I get it and give it to my kids?
These are all examples of intrusive thoughts, which are ideas, images, sensations, feelings and/or urges that are unwanted and distressing. The “intrusive” aspect of these thoughts means that they’re not something you really want taking up space in your mind. But intrusions do anyway—and they can be particularly loud and powerful.
Keep reading to learn more about intrusive thoughts, including why these anxiety-provoking thoughts pop up, if they actually mean anything, and their link to obsessive-compulsive disorder (OCD) and other mental health disorders.
Why do I have intrusive thoughts, and are they normal?
Know that having intrusive thoughts is completely normal. “We have so many thoughts daily,” says Monique Williamson, LMFT, a licensed therapist at NOCD. “Some are good, some are bad, and some make us uncomfortable.”
Because everyone will sometimes talk to themselves in their head, the content of some of those thoughts will inevitably be weird, awkward, or make you feel uneasy. In fact, research suggests that people who have these rich inner lives tend to have more of these intrusions.
Intrusive thoughts can have a range of themes, including:
- Violence. What if I stab my husband with a pair of scissors?
- Sexual. What if I’m not actually attracted to my partner?
- Religious. Did I do something that angered God?
- Self-doubt. I don’t think I’m good enough.
- Contamination. What if I use the public bathroom and catch a disease from sitting on the toilet?
- Health-related. What if I die from cancer and ruin my family’s life?
- Public humiliation. What if I say something inappropriate in front of my co-workers?
- Memories. Did I actually hit someone during my road trip last year and forget about it?
When working with kids, Williamson might dub intrusive thoughts as “yuck thoughts,” a description that people of any age can probably relate to. After all, an intrusive thought can make you scared and ashamed, and you may even question who you are and if you’re a bad person. In all honesty, no one else could possibly have the fleeting thought of pushing someone onto the train tracks, right? Wrong. You actually have a lot more in common with other people than you might think.
When do intrusive thoughts become a mental health concern?
Intrusive thoughts come and go for most people. One might pop into their heads, and they might think, “Wow, why’d I just think of that?” But they can then release that thought and move on with their day. For others, however, these intrusions seem to make a long lasting residence in their brains.
People dealing with mental health problems may face some difficulty letting these intrusive thoughts go. If this is your situation, you may feel the need to find out why you had that thought, prove that what you’re thinking doesn’t reflect who you are, and then try to stop the thoughts from happening again. When you’re constantly ruminating on your dark thoughts, it could be a sign of a deeper mental health problem. If that’s the case, it’s probably worth exploring why these thoughts are causing you distress.
Which mental health conditions cause intrusive thoughts?
Although the existence of dark thoughts doesn’t necessarily mean that you have a mental health condition, research shows that there are some illnesses linked to frequent, disturbing thought patterns. 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). To be diagnosed with major depression, your symptoms—feeling hopeless, having brain fog, having sadness that doesn’t go away—must have persisted for at least two weeks and affect your ability to perform daily functions. Intrusive and unwanted thoughts in depression may include self-harm or negative self-talk about yourself or your life.
Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) can occur after going through something shocking, scary, or dangerous, such as war, an assault or abuse, a natural disaster—or being a witness to one of these events—according to the NIMH. With PTSD, intrusive thoughts can come in the form of flashbacks where you relive your trauma or as an intrusive dream.
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. There’s endless things to be anxious about, and 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? What if something happens to my kids? Are they in danger?
Of course, some amount of anxiety is normal—it allows you to think two steps ahead and keep you and your loved ones safe. But GAD is more about intense, severe anxiety that makes it difficult to focus, increases irritability, and causes you to lose sleep.
Obsessive-compulsive disorder (OCD)
Obsessive-compulsive disorder (OCD) is 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). Once you perform a compulsion, your distress lifts, and you temporarily feel better. If OCD is left unmanaged, you can get stuck in the vicious obsession-compulsion cycle that can be difficult to escape without proper treatment.
The criteria for being diagnosed with OCD is that you spend at least an hour a day experiencing these symptoms. That can be easy to do if you have OCD because you’ll continually loop back to your intrusive thoughts, says Williamson. “You might engage with those intrusive thoughts by asking yourself questions about them or trying to reason with yourself,” she says.
So, if you find yourself ruminating about why you had that thought, try to reason your way out of the thought that popped into your head, and are just generally having an internal battle with yourself about a bad thought—you could be dealing with OCD. Plus, this rumination has been shown to make intrusive thoughts worse and more persistent—like a mosquito bite you can’t calm by scratching.
How to stop intrusive thoughts
Not to be a bearer of bad news, but there’s no way to stop intrusive thoughts completely. However, a good starting point is to understand that these unwanted thoughts really don’t mean anything, so you don’t need to worry about them. “You’re under no obligation to take your intrusive thoughts seriously,” says Williamson. “These thoughts do not need to be evaluated or dug into deeper. They don’t deserve time, effort, or attention.” It’s okay to acknowledge their presence, skip self-judgment, and then let them go.
The problem is not that you have an intrusive thought—it’s your relationship with that thought. In other words, research says that if you interpret them as being threatening to your sense of self, read into their supposed meaning, or try to block them and push them away, you may actually feel a greater sense of distress, fear, or guilt.
What that means is that the more you deny them or don’t want these bad thoughts around, the stronger they become. It’s like that “don’t think of a pink elephant” example. (You just thought of a pink elephant, didn’t you?)
Sometimes, there may be more going on that triggers these intrusions, such as depression, anxiety, PTSD, or OCD, so “letting them go” may seem impossible. So, the first critical step is to receive the correct diagnosis, which will inform you of the proper treatment. In the case of depression, for example, talk therapy may be recommended.
Exposure and response prevention (ERP) therapy for OCD
If you have (or suspect you have) OCD, the most successful treatment is a form of behavioral therapy called exposure and response prevention (ERP) therapy, which was developed specifically to treat OCD and is clinically proven to be highly effective. If you have PTSD and OCD—two disorders that may occur together—or an anxiety disorder, ERP therapy can also be valuable. ERP aims to break the cycle of obsessions and compulsions through evidence-based exercises. You’ll collaborate with a licensed therapist specializing in ERP to create a personalized treatment plan that addresses your triggers, intrusive thoughts, and compulsions.
ERP therapy is divided into two parts: exposures and response prevention techniques. Your therapist will gradually expose you to your triggers and then teach you strategies to help you refrain from compulsions in response.
For example, maybe you think that going to a grocery store will cause you to catch an illness. An exposure might involve getting a cart and not wiping it down with a disinfectant wipe.
From there, you’ll learn response prevention techniques. Williamson helps people process these intrusive thoughts in several ways, such as using uncertainty statements. When OCD is looking for an absolute answer—100% assurance that you won’t catch a virus while shopping—you will give it a question mark, she explains. You’ll tell yourself something like, “I may or may not get sick from running this errand.”
Another is acceptance. You might get sick, but you can go to the doctor if needed. Life is full of uncertainty, and you can learn to accept or even embrace it.
Understand that ERP is not a quick and easy fix to managing intrusive thoughts, as you’ll still have intrusive thoughts that pop up now and then. However, if you stick to ERP and do your homework outside therapy sessions, you’ll have the tools to leave them by the wayside and go about your day.
The bottom line
Remember that intrusive thoughts are normal and happen to most people at some point. When one creeps into your head, the best thing you can do is let it float on by. Know that these intrusive thoughts—no matter how disturbing they are—do not reflect your morals and values.
However, in some cases, some people may face difficulty dismissing these thoughts—and that’s completely understandable. Mental health conditions like depression, GAD, PTSD, and OCD can allow these thoughts to ruminate in your mind. If you’re experiencing significant distress from your intrusive thoughts, don’t hesitate to reach out to an ERP therapist. They can work with you to identify the underlying mental health problems and develop a treatment plan that addresses your symptoms.
