Intrusive thoughts are unwanted and distressing ideas, images, sensations, feelings, and/or urges that appear out of nowhere. While everyone has them now and again, having recurrent intrusive thoughts that disrupt your daily routine could be a sign of a mental health condition like OCD.
Have you ever had a thought or image pop up in your head that made you feel anxious, uncomfortable, or even scared? You might have thought: What if I just took this knife, and instead of chopping up these carrots, I stabbed myself with it? 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, sensations, feelings, images, 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.
While intrusive thoughts can be jarring, they are a normal part of human cognition. However, if anxiety-provoking thoughts are repeatedly causing you distress, or they’re creating issues in your day-to-day life, it could be a sign of an underlying mental health condition like obsessive-compulsive disorder (OCD).
Are intrusive thoughts normal?
Yes—having intrusive thoughts is completely normal. “We have so many thoughts daily,” says Monique Williamson, MS LMFT, a 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 make you scared and ashamed, and you may even question who you are and if you’re a bad person. 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.
Examples of intrusive thoughts
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?
- False memories: Did I actually hit someone during my road trip last year and forget about it?
- “Just right”: If I don’t do this perfectly, something bad will happen or I won’t feel at ease.
- Existential: What if I don’t actually exist?
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What causes intrusive thoughts?
The exact cause of intrusive thoughts is not fully understood—it’s believed that a combination of biological, psychological, and environmental factors contribute to their development. “There is an electro-chemical misfiring in the brain that sets off false alarms of danger,” says NOCD therapist Tracie Ibrahim, MA, LMFT, CST.
There a variety of factors can worsen intrusive thoughts, including stress, lack of sleep, significant life changes, and disruptions in your routine.
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 conditions may face some difficulty letting their 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.
If you’re constantly ruminating on your intrusive 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. 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. 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. However, if OCD is left untreated, 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.
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Can you 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 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.
Exposure and response prevention (ERP) therapy
If you have (or suspect you have) OCD, there is an evidence-based form of cognitive behavioral therapy known as exposure and response prevention (ERP) therapy. ERP 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 let them be and go about your day.
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, 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.
Key Takeaways
- Intrusive thoughts are unwanted ideas, images, sensations, feelings, and/or urges that pop into your mind. Having intrusive thoughts is a normal part of human cognition.
- If intrusive thoughts are causing distress in interfering with daily life, it could be a sign of an underlying mental health condition such as depression, anxiety, or obsessive-compulsive disorder (OCD).
- Exposure and response prevention (ERP) therapy is a treatment for OCD that can help you better manage the uncertainty and doubt caused by intrusive thoughts.
