Can intrusive thoughts cause panic attacks?

You’re lying in your bed trying to fall asleep, but an unwanted thought just keeps replaying as if on a loop. You just can’t seem to stop the thought, and you start to feel overwhelmed. Your chest begins to tighten, your breathing feels labored, and you’re sweating. Your first thought might be, “Am I having a heart attack?” Then you realize that what you’re experiencing could instead be a panic attack. 

If you’ve experienced intrusive thoughts as well as panic attacks, you might be wondering how the two may be related. Let’s explore.

What are intrusive thoughts?

Experts in the field of OCD and anxiety often use the term intrusive thoughts to describe thoughts that, quite simply, intrude on our minds. They are unwanted and seem to appear out of nowhere. These thoughts are unpleasant or distressing, happen against your will, and do not align with your true feelings, intentions, or values. 

There’s no one type of intrusive thought—they can be about anything. Here are some examples:

• What if that handrail I touched was contaminated with a deadly disease? 
• What if I took a turn and veered into oncoming traffic right now? 
• What if life has no purpose? 
• What if I’ve done something terrible that I can’t recall and I’m going to be arrested for it?

Can intrusive thoughts cause panic attacks?

Intrusive thoughts can be very unsettling, and when they’re particularly unrelenting, they can begin to be overwhelming. And in turn, one’s distressing emotional response to them may even potentially lead to a panic attack.

What is a panic attack? Most experts define a panic attack as a sudden onset of intense fear. During a panic attack, you might experience both mental and physical symptoms, which can vary from person to person. A racing heart, tingling limbs, tightened chest, and difficulty breathing are just some of the symptoms that can occur. In general, a panic attack can last anywhere from five minutes up to 20 minutes or even longer. 

Many people have just one or two panic attacks in their lifetime. But those who have recurrent panic attacks and spend long periods in fear of another attack may be diagnosed with something called panic disorder, if they meet certain additional criteria.

Do intrusive thoughts mean that I have a mental health condition?

While intrusive thoughts are a symptom of some mental health conditions, including obsessive-compulsive disorder (OCD), having intrusive thoughts does not mean that you necessarily have a mental illness. 

That said, it’s worth noting that people with OCD may sometimes be at higher risk for panic attacks due to the deeply distressing intrusive thoughts that are brought on by this condition. But the correlation also works in the reverse. Let’s explore the connection between OCD and panic attacks a bit further.

What to know about OCD and Panic Attacks

It’s a two-way street: Research has found that people who have frequent chronic panic attacks are at higher risk for developing OCD, and OCD sufferers are at risk of experiencing panic attacks.

People with panic attacks may develop OCD in their desperate attempts to cope with the distress caused by these attacks. Someone who experiences chronic panic attacks may engage in rituals or routines to ease their stress, anxiety, and emotional distress. And what starts as an “innocent” ritual can quickly become an OCD compulsion—a repetitive action or mental exercise that people with OCD perform to alleviate feelings of anxiety.

Is it possible to stop having intrusive thoughts?

Given the fact that an intrusive thought can lead to such distress, it’s normal to want to stop them. Unfortunately, it is not possible to stop having intrusive thoughts altogether. Whether you have OCD or not, you’ll continue to experience them from time to time. 

However, there are several things you can do to decrease the degree to which they interfere with your life and make them less distressing when they do occur. One powerful tool might seem counterintuitive: Instead of trying to figure out where your intrusive thoughts came from or what they mean, just let them be. Trying to come up with a satisfying understanding or explanation for your intrusive thoughts is almost sure to end in doubt and disappointment—and yes, maybe even panic. 

How to cope with panic attacks related to your intrusive thoughts

Panic attacks can be very scary, and if they’re interfering with your ability to function in your daily life, it’s worth considering seeking treatment from a professional. But here are some basic things to remember when facing a panic attack.

• The attack will not last forever (even though it may feel like it)
• You are not dying (even though it may feel like you are)
• Work with a therapist on Interoceptive ERP—a form of treatment designed specifically to help people who have panic attacks and panic disorder

These strategies should not be used to escape or distract from the panic attack, but may be used to help manage an attack as you ride it out. 

How to get help with OCD-related panic attacks

If it turns out that you’re not only coping with panic attacks but you also have OCD, a specific type of treatment will be needed. That’s because your “standard” treatment for panic attacks or anxiety alone will not be effective. 

The most research-supported form of treatment for OCD is called Exposure and Response Prevention, or ERP. It’s considered the gold-standard therapy for OCD, and about two thirds of people see significant improvement in OCD symptoms through ERP. ERP therapy is mainly focused on learning how to respond to OCD fears, without engaging in compulsions that may feel relieving for the moment, but only reinforce your obsessions over time.

I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment if you’re interested in working with an ERP specialist in the NOCD network who can do live face-to-face virtual sessions with you, or they can connect you to other resources that might be helpful.