Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Beyond Just Thoughts: Intrusive Images, Urges and Feelings in OCD

7 min read
Stacy Quick, LPC

Many people with OCD are already familiar with the concept of intrusive thoughts, but unwanted images, urges and feelings also play a large part in OCD, and the ways that these disturbing ideas manifest and appear differs from person to person. Someone may get the recurring flashes of a disturbing image, a feeling of fear or disgust triggered by something completely mundane, or the sudden urge to throw themselves off a cliff—even though they aren’t depressed. 

However, by recognizing some of the different ways that these intrusive triggers can manifest and interfere with someone’s life, you can learn to manage them—even the ones you think that you couldn’t possibly tolerate.

Intrusive images

Sam, a college student, is studying to get his degree in theology. He has always valued the importance of his beliefs and works hard to live out his dream and become a priest. Lately, he’s found himself struggling significantly. He’s embarrassed and guilt-ridden, ashamed and unsure of what to do. Every time he attends church services his mind is flooded with what he considers vile, disgusting images: he pictures the priest naked. He doesn’t want to—it just happens, and he can’t seem to get rid of the images. The more he tries not to think about them, the more they seem to pop up. On several occasions he’s skipped out on church, leaving him feeling even more guilty. He wonders what could be wrong with him. 

Allison works at a preschool and has recently started to have the most unthinkable images come into her head, seemingly out of nowhere. She can be in the middle of a lesson or just at recess watching the children play and images of terrible things happening to the children bombard her mind. She pictures school shootings in sickening visual detail. She feels horrified and desperately tries to figure out why these images are there. She wonders if she’s a bad person or if she did something to deserve this. Her stomach hurts and she feels sick. She even considers quitting her job because the fearful images are just so intense.

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OCD sufferers cannot control the images that pop into their heads any more than they can the thoughts. People without OCD experience images that they consider to be inappropriate or strange come from time to time as well. However, they can easily shrug these images off as unimportant and meaningless. For people with OCD, those images tend to get “stuck,” leading to an intensive need to find out why the images are there or what they mean. 

Intrusive urges

Jon used to love traveling. He spent his weekends going on long rides through the countryside. It was his therapy and what he did to unwind. Recently, however, it has become more of a nightmare than a way to relax. It all started a few weeks ago, when he was out riding his motorcycle and suddenly felt the strange urge to drive off the mountain he was on. It took him by surprise. He isn’t depressed and had never even considered ending his life. Immediately he was overcome with anxiety. Ever since that moment, he hasn’t been able to figure out why the urge was there in the first place. Now, every time he prepares to go riding this feeling creeps up in him. He worries “What if I act on this urge?” He thinks about all the ways he could end his life if he wanted to. Sometimes he feels the impulse to drive into oncoming traffic. He knows that he doesn’t want to end his life. Still, the urge to do something shocking keeps sneaking up on him. It’s getting to the point where he’s thinking of selling his bike, feeling more and more terrified by the activity that once brought him so much joy.

About a year or so ago, Jamie’s life turned upside down. Her left arm was injured in a machine she had been working on. After several intense surgeries and therapies, she was able to fully recover—at least physically. However, her mental health has declined. She has always had anxiety and been prone to compulsions. Recently, though, she has felt the urge to do everything with her right arm, instead of her left arm. She can’t put it into words, but it just feels “right.” If she doesn’t do this, she feels anxious and worries that something bad will happen to her right arm. This has become so time-consuming that she fears she’ll lose her job because she can barely complete her daily tasks. She is also extremely worried that her co-workers may start to notice. Sometimes her behaviors are so apparent that she has to come up with excuses as to why she’s acting the way she is. She’s noticed that now, even the simplest of tasks are becoming more and more difficult. 

Many of us have experienced something similar at some point. How many people have been high up on a tall building or looking over a mountaintop and had the urge to jump? Of course that doesn’t mean that they want to, but the urge may still be there. The difference is that someone without OCD doesn’t get caught up in why they had that urge in the first place. They can say to themselves “that was weird, but it probably didn’t mean anything,” forget it pretty quickly, and carry on with their day. It’s not that people with OCD are any more likely to act on these urges—they typically struggle with compulsiveness, not impulsiveness. It’s their inability to let go of these meaningless urges that ends up interfering with their life.

Intrusive feelings

For as long as Lydia can remember, the color red has always meant danger. It ‘s hard to describe, but touching red items, wearing red shirts, and buying any item that has red on it has been “forbidden” by her own mind. It was as if one day her mind just said “Red is bad, and you must avoid it.” So she did. The feeling was relentless—she tried to fight it at first, but found that it was just too difficult. The what-ifs seemed unimaginable. The feeling of imminent danger when she’s near the color red is one that she just can’t shake. Lydia recently accepted a new job, but soon found out the shorts she’s required to wear are red, an idea that feels entirely overwhelming. She knows that these aren’t logical feelings, but they feel so real. 

Often in OCD, intrusive feelings are linked to magical thinking. This can include feeling like one’s own actions can control the outcome of the physical world. It’s tied to a sense of over-responsibility. The person with OCD often feels that if there is even a small chance that doing something or not doing something can prevent or cause danger in some way, they must act in that way to protect themselves or others from any possibility of danger. 

ERP treats intrusive thoughts, images, urges, and feelings

Are you struggling with intrusive thoughts, images, urges, or feelings? You can learn to manage them—even the ones you think that you can’t possibly tolerate. You can learn that you don’t need to do anything to rid yourself of the distress that comes from these experiences, and that they can pass on their own. You can learn that there is no immediate danger, even when it feels like there is. 

Effective, specialized OCD therapy is here

Learn more

Are you ready to stop giving so much importance to the random impulses of your own mind? Our licensed therapists at NOCD deeply understand OCD and are specialty-trained in treating OCD with Exposure and Response Prevention (ERP) therapy. We work side-by-side with the OCD experts and researchers who designed some of the world’s top OCD treatment programs – and that means the best care for our members. You can book a free 15-minute call with our team to get matched with one and get started with OCD treatment.

NOCD Therapists specialize in treating OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

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