This article will discuss OCD and intrusive obsessive thoughts, why we have them, and how to deal with them. It’s important to remember that everyone has intrusive thoughts from time to time, and trying to control or eliminate them completely is not realistic. It’s also not necessary — you can learn not to care so much about these thoughts and focus on other, more important things in your life.
What Are Intrusive Thoughts?
Despite what many people think, having intrusive thoughts is normal. Everyone has weird things pop into their head from time to time. In OCD, however, a person takes these thoughts really seriously, worries about them, and goes to great lengths to try to stop them. For this reason, they usually start to have more of these thoughts and can begin to engage in obsessive thinking, where they become preoccupied with the thoughts and the bad things they think will happen.
Intrusive thoughts are often:
Unwanted: They come uninvited and often cause discomfort.
Persistent: They can stick around and repeat in your mind.
Disturbing: The content of these thoughts can be upsetting or feel very out of character.
Random: They can seem completely random or be triggered by certain situations.
Intrusive: They interrupt your regular thinking patterns and activities.
Most Common Intrusive Thoughts
Repetitive intrusive thoughts are common in OCD. These thoughts tend to revolve around a person's theme (e.g., contamination, harm) and their core fears (e.g., death, suffering, ruin, shame).
Contamination related intrusive thoughts: Intrusive thoughts may revolve around infection, germs, disease, AIDS, COVID-19, or being spiritually contaminated by exposure to ‘bad’ people or content.
Harm related intrusive thoughts: Intrusive obsessive thoughts can include fears of hitting, stabbing, kicking, tripping, pushing, or hurting someone, sometimes involving weapons (e.g., knives) or your car.
Sexual related intrusive thoughts: These might involve inappropriate or taboo scenarios, such as fears of being attracted to someone inappropriate, acting on unwanted impulses, or questioning one’s sexual orientation.
Religious or moral related intrusive thoughts: Intrusive thoughts can involve fears of committing blasphemy, sinning, or being morally ‘bad.’, offending God, not praying correctly, or inadvertently breaking religious or ethical rules.
Relationship related intrusive thoughts: Thoughts may include worries about not loving a partner enough, being unfaithful, or being secretly incompatible.
There are other types of intruvie thoguhts - but the above are some of the most common
Anxiety and Intrusive Thoughts
Anxiety and intrusive thoughts often go hand in hand. This because of the intrusive thoguhts' content: which is usually ugly or painful. As previously discussed, intrusive thoughts relate to pain, death, suffering, ruin, or shameful acts. Until they learn skills through therapy, a person with OCD will usually react with anxiety when these intrusive thoughts pop into their head. In addition, anxiety increases the brain’s focus on perceived threats. This means the person will get tunnel vision and only focus on their intrusive thoughts - which can make them feel even more significant and distressing.
What Causes Intrusive Thoughts?
As previously discussed, we all have thoughts that pop into our heads: this is normal. In the case of OCD, however, the thoughts can happen more often, and be a lot more painful. There are several reasons why this may be the case:
Brain Differences: People with OCD might have differences in the parts of the brain that handle fear and decision-making.
Brain Chemicals: An imbalance in brain chemicals like serotonin can affect thoughts.
Genetics: OCD often runs in families, suggesting that genes play a role.
Behavior Patterns: Trying to control or stop intrusive thoughts through repetitive behaviors (compulsions) can make them worse.
Thinking Styles: People with OCD might feel an exaggerated sense of responsibility or perfectionism and thus view their thoughts as being more significant, leading to more intrusive thoughts.
Trying to Control Intrusive Thoughts Often Makes Them Worse
When a person with intrusive thoughts uses thought suppression—trying to deliberately push away or avoid these thoughts—it can lead to a paradoxical effect known as the "rebound effect." Here’s what generally happens:
Increased Frequency: Instead of diminishing, the suppressed thoughts can become more frequent. Attempting not to think about something can inadvertently make it come to your mind more often. For example, try NOT to think of a ‘black cat’... what did you just think of?
Increased Distress: The effort to suppress thoughts can cause increased anxiety and distress. Because the thoughts keep returning, we might feel frustrated, distressed, and demoralised.
Heightened Awareness: Suppression can lead to heightened monitoring or 'looking out for' these thoughts, which means we become more aware of them, making things worse.
Inadvertent reminders: Trying not to think of something, on some level, requires you to think about it (so you can remind yourself not to think of it). So, in reminding not to think of something, you're thinking of it again.
Research in psychology, particularly concerning OCD, suggests that a more effective strategy is to just leave the thoughts alone (as hard as that is!) so they can float away by themselves.
Treatment for Obsessive Thoughts
People wanting help with intrusive thoughts should turn to treatments that research has shown to be effective. The best therapy for obsessive thoughts is exposure and response prevention (ERP).
ERP Treatment for Obsessive Thoughts:
Exposure: This involves gradually and intentionally exposing yourself to situations that trigger intrusive thoughts. For example, someone with contamination fears might touch a public doorknob without washing their hands immediately after. Then, when the thoughts come on, you can practice leaving them alone. Over time, this should help to reduce your distress about them, and they should start to fade away by themselves and come back less often.
Response Prevention: This is the practice of resisting the urge to perform compulsive behaviors in response to intrusive thoughts. For instance, not washing your hands despite feeling the urge to do so. Doing this, whilst triggered, again allows your brain to get used to the thoughts, which leads to them not being so powerful or recurrent.
By repeatedly facing intrusive thoughts and refraining from engaging in compulsions, ERP helps retrain the brain to tolerate intrusive thoughts instead of fighting them (and giving them power). People also learn to trust themselves more, and their resilience to any remainging intrusive thoughts grows.
Other Strategies
ERP is the most researched treatment for intrusive thoughts. Other strategies that can complement therapy include:
Mindfulness Meditation: Practicing mindfulness can help you observe intrusive thoughts without judgment or engagement.
Cognitive Restructuring: Challenge the beliefs that fuel your OCD, such as the idea that intrusive thoughts are dangerous, relevant, signifcant, and need to be acted on.
Acceptance: Work on accepting the presence of intrusive thoughts rather than fighting them. This can reduce their power over time.
Stress Management: Lowering your overall stress levels through exercise, healthy eating, and relaxation techniques can help reduce the frequency of intrusive thoughts.
Final Thoughts
Intrusive thoughts are a normal part of the human experience, but they can become overwhelming for people with OCD. The key is not to fight them but to learn strategies that reduce their power over you. With effective treatment like ERP, mindfulness, and cognitive techniques, it is possible to regain control over your life and focus on what truly matters.
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