Can OCD cause intrusive dreams?

You’re riding a dinosaur through the hallways of your middle school when your teeth begin falling out one by one. A deceased relative links arms with you so you can fly through the night sky together. Suddenly, you’re hurtling toward the earth, and before you hit the ground, you open your eyes and find yourself in bed, your heart racing. You try to understand how these odd, stressful scenes fit together, but the details seem to dissipate into the morning air before you can figure them out. 

For most people, shrugging off an utterly bizarre dream like this one is easy. Like an intrusive thought, a dream—even a distressing one—can be dismissed by most as just a strange phenomenon that our brains occasionally send our way. But for people with Obsessive-Compulsive Disorder (OCD), these dreams can be intensely worrying, triggering fears about what they mean, what they say about a person’s identity or values, and whether they could be connected to other distressing, intrusive thoughts in daily life.

In this article, we’ll examine whether OCD could cause intrusive dreams, discuss triggers that might make intrusive dreams more likely, and discover how a type of treatment specifically made to treat OCD can reduce the power these dreams have over people with the condition. 

How can OCD affect your dreams? 

While the most prominent theory is that our dreams are a way for our brains to process and consolidate information from our daily experiences, their exact purpose remains unclear. What we do know is that everybody dreams, and the majority of our dreams take place when we are in REM sleep, a sleep stage that makes up around 20-25% of a good night’s rest.

An intrusive dream is a vivid and often disturbing dream that occurs during sleep and intrudes upon one’s thoughts and emotions even after waking up. Anyone can have an intrusive dream, but according to NOCD therapist Lisa de Guzman, LCSW, PPSC, intrusive dreams can be particularly vivid and distressing for people with OCD. 

“Aspects of what we do in our day-to-day lives often show up in our dreams,” she says. “It stands to reason that if someone is spending so much of their waking life trapped in the OCD cycle, echoes of their obsessions, anxieties, and compulsions will show up when they’re asleep.” 

The OCD cycle refers to the pattern of thoughts and behaviors that people with OCD experience. This self-perpetuating, four-stage cycle looks like this: 

1. Obsession: An intrusive and persistent thought, image, or urge that creates significant distress. The obsessions are typically irrational, unwanted, and inconsistent with the person’s values or beliefs. Common obsessions include fears of contamination, doubts about safety, or concerns about harming oneself or others.
2. Anxiety. The presence of obsessions triggers intense anxiety or fear. 
3. Compulsion: People engage in compulsive behaviors or mental rituals to alleviate this distress or prevent something unwanted from happening. Examples include excessive hand washing, checking, counting, or seeking reassurance.
4. Temporary relief. The compulsions provide short-lived relief, reinforcing the person’s belief that performing the compulsive behaviors is necessary to prevent harm or alleviate anxiety. The cycle then repeats, stronger than before.

Meeting the diagnostic criteria for OCD entails spending a good portion of your day—at least an hour—stuck in this distressing cycle, with impairments to your normal routine, how you function at work or school, and how you show up in your social or romantic life. If, as is widely thought, dreams are the brain’s way of sorting out what we’ve experienced that day, it’s easy to see how OCD makes its presence known when people with the condition are asleep. 

While someone’s obsessions can impact their dreams, people’s dreams can also lead to new obsessive thoughts about their dreams. Especially since we aren’t able to control our dreams directly, it can be tempting to think that our dreams mean something essential about who we are or what we believe. Here are some examples of ways OCD latches onto the way we think about dreams:

That last thought can make intrusive dreams particularly distressing for people with OCD. “I work with a member who has OCD themes around incest and bestiality,” says de Guzman. “She often wakes in a panic because the condition has her searching her dreams for significance, just as it compels her to look for meaning in the obsessive thoughts she wrestles with throughout her day.” 

Either on their own or with the help of others, humans have sought to analyze their dreams for thousands of years. However, just like intrusive thoughts, no scientific data links dreams to anything meaningful in our daily lives. They aren’t a window into our souls, or a cipher for our innermost desires, even when we have physiological responses to them.

“If someone with, say, pedophilia OCD (POCD) wakes up aroused after a dream about engaging in sexual activity with a minor, they may take it to mean that this is something they want,” says de Guzman. “In fact, the dream is just an expression of their biggest fear and has nothing to do with their reality.”

Still, anxiety around dreams’ ability to reveal some truth about their desires is enough for some people to engage in a range of compulsions, including: 

• Delaying sleep (avoidance)
• Researching scientific basis of dreams
• Rumination about what previous dreams mean and/or how they may relate to reality
• Mental review about most recent and old dreams 
• Seeking reassurance from loved ones or others who are thought to have insight into dreams
• Confession about an action or decision made in a dream 
• Tracking dream content 

How intrusive dreams can affect your waking life 

Intrusive dreams can have profound psychological and emotional consequences for people with OCD. Upon waking, the residual anxiety, fear, and distress from the dreams can linger, impacting their emotional well-being throughout the day. 

Intrusive dreams can amplify existing obsessive thoughts and increase overall anxiety levels. The disruption caused by these dreams can lead to heightened stress, irritability, and difficulty regulating emotions. People may experience a persistent sense of unease, apprehension, or foreboding, undermining their overall quality of life. Let’s take a look at how this can play out in someone’s day-to-day life. 

Scenario: Sarah

Sarah is a 28-year-old woman who has been living with Harm OCD. However, the impact of her OCD extends beyond her waking hours and infiltrates her dreams, profoundly affecting her waking life. 

In one particularly vivid dream, Sarah finds herself in a crowded shopping mall. Walking through the bustling crowd, she notices a small child playing near a flight of stairs. Suddenly, her mind is flooded with intrusive thoughts of pushing the child down the stairs and causing irreversible harm. She tries to suppress these distressing thoughts, but they persist and intensify within the dream. Then she starts to walk toward the child…

Sarah wakes up in a cold sweat, consumed by guilt and fear. As she tries to go about her day, the intrusive dream lingers in her mind, replaying like a broken record. She second-guesses every interaction, fearing that her thoughts might somehow influence her actions. The guilt and fear intensify, making it challenging for her to focus on daily tasks and engage in meaningful relationships.

Sarah’s intrusive dream resurfaces throughout the day, leading to heightened vigilance and hyper-awareness of her surroundings. She becomes excessively cautious, constantly checking and rechecking her surroundings to ensure no harm comes to those around her. Her sense of responsibility to protect others weighs heavily on her, as the dream content reinforces her deepest fears. Simple choices like crossing the road or handling sharp objects become sources of immense anxiety. 

Sarah withdraws from social interactions, afraid that her intrusive thoughts might somehow manifest in harmful actions. The dream reinforces her belief that she is a danger to those she cares about, leading to self-imposed isolation and loneliness.

Even though her dream is nothing more than an extension of the fears she feels during the day, Sarah’s compulsive reassurance-seeking, avoidance, and checking make them feel more and more real. By learning to live with her fears while resisting these compulsions, through dedicated practice and professional guidance, Sarah can regain control of her waking life.

How to cope with intrusive dreams 

Before we get into how exposure and response prevention therapy (ERP) can help reduce OCD symptoms—including any influences from intrusive dreams—let’s look at some of the things anyone, with or without OCD, can do to maintain healthy sleep hygiene.

Firstly, maintaining a regular sleep schedule and prioritizing adequate sleep can contribute to overall sleep quality, reducing the likelihood of intense dreams. To facilitate this, creating a relaxing bedtime routine and comfortable sleep environment can also promote more restful sleep. Managing stress and anxiety through meditation, regular physical activity, or mindful journaling before bed can also help calm the mind and reduce intrusive thoughts during sleep. 

Avoiding stimulating substances like caffeine, nicotine, and alcohol close to bedtime can minimize disruptions to sleep patterns. Additionally, limiting exposure to stimulating or distressing content, such as violent movies or news, before bed may help to prevent particularly distressing dreams.

Exposure and response prevention therapy (ERP) 

Exposure and Response Prevention (ERP) is the gold standard in OCD treatment, proven to be highly effective through decades of clinical research. In ERP, people are gradually exposed to situations, thoughts, or triggers that cause distress or anxiety, as they are guided in resisting their accompanying compulsive responses or rituals.

“When you’re doing ERP in your waking life, it’ll also impact how your brain is processing information when you’re asleep,” says de Guzman. “But you can also dip into your ERP toolkit when you wake up from an intrusive dream related to the theme of your OCD.”

“You want to recognize that it’s an intrusive dream, in the same way that you would see an intrusive thought while awake. Let’s say you were aroused when you woke up from the dream. Your ERP sessions will allow you to acknowledge that you feel the sensation, feel the discomfort you have with it and then let those feelings pass.”

People undergoing ERP work collaboratively with a trained therapist, like Lisa. They’ll guide you through exposure exercises tailored to your specific intrusive dreams, gradually increasing the difficulty and intensity of the exposures as you progress. With these exposures, you’ll gain response prevention skills that will allow you to keep intrusive thoughts and dreams from causing so much fear and disruption in your life.

How to access the help you need

If you’re struggling with intrusive dreams and you think you might have OCD, I encourage you to learn more about NOCD’s evidence-based approach to OCD treatment.

Every therapist at NOCD specializes in OCD and receives ERP-specific training. Feeling accepted, heard, and welcomed by others who truly understand what you’re going through and won’t judge you can be absolutely crucial to recovery—especially when most others simply don’t understand what it feels like to struggle with symptoms around the clock (and even overnight). Please know that hope is out there, and effective treatment is available to you.