Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Can Intrusive Thoughts Be Images?

6 min read
Stacy Quick, LPC

When you hear the term “intrusive thoughts,” what comes to mind? You might know that intrusive thoughts are one of the most well-known symptoms of obsessive-compulsive disorder, or OCD. You might also know that they’re often described as words or sentences in a person’s mind, but did you know they can take the form of unwanted images?

Like any form of unwanted thought, these visual obsessions are difficult to dismiss. Intrusive images can vary greatly in their content, but share the quality of causing significant anxiety and discomfort to the person experiencing them. Learning the ways that these images may appear can provide a better understanding of this experience, as well as give insight into how this type of intrusive thought can be managed.

What do intrusive images look like?

Intrusive images will be different for each person. Whether or not someone considers an image to be disturbing will depend on how they feel about its subject matter. Individuals with OCD may also find that they experience multiple varieties of intrusive images, as it’s not uncommon for OCD themes to shift over time. While OCD can latch onto anything, here are a few of the many subjects for these visualizations:

Images of dirt and germs: Some people may constantly visualize dirt or contamination on things within their environment. This is not based on what they are actually seeing, but rather an exaggerated level of contamination that they’re picturing in their heads. Images of this nature can be related to Contamination OCD. Individuals dealing with this type of intrusive image will often know on some level that their fears are illogical, however, they are still compelled to seek immediate relief through compulsions, such as washing or cleaning behaviors.

Images of harm or violence: For others, intrusive images may focus more on harm or violence. They may picture terrifying and horrific scenes happening to other people or themselves, their imaginations running rampant with all of the worst-case scenarios. These visualizations can also take on taboo forms that individuals may find difficult to disclose. More commonly than once thought, these images can revolve around sexually harming others. 

However, the content of these images can include anything a person would find especially repugnant. Some people experience violent images when they are driving. They may visualize themselves swerving the car into others or driving off a cliff. The possibilities of what the mind can envision are endless, and in these visualizations, the person is often able to see the horrific fear played out in great detail, creating intense feelings of guilt.

Images related to religious or spiritual beliefs: It’s also common for images to revolve around an individual’s religion or spirituality. They may see gruesome visions of things related to their beliefs, or envision religious figures in inappropriate ways. These images may be related to Religious or Scrupulosity OCD, an OCD subtype characterized by obsessions of a religious, moral, or ethical nature. Religious and spiritual beliefs are of great value to people, so these images can be particularly debilitating.

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Why am I having these thoughts?

It’s incredibly important to make the distinction that these thoughts are not things a person is fantasizing about. The reason these images are so distressing is that they are ego-dystonic, meaning they go against a person’s true desires or values. Individuals experiencing these intrusive images are tormented by them, and often go to great lengths in their attempts to rid themselves of the images in their minds. Trying to alleviate the distress they feel, they will often engage in compulsions like avoiding triggers, seeking reassurance, and mental reviewing, to name a few.

The cruel irony of this is that the more that they try not to think about these things, the more they end up thinking about them. Each time a person engages in compulsive behavior, they unconsciously train themselves to do the same behavior the next time that image comes into their mind. However, it’s possible to break this vicious cycle.

How do I “get rid” of the images?

As surprising as it may seem, getting rid of these images is not the goal. The goal is to learn to sit with the discomfort they create. One of the false messages that OCD tells us is that we cannot tolerate uncomfortable feelings. We call this distress intolerance. Distress intolerance continues the OCD cycle by driving people to engage in compulsions. One of the most important parts of OCD treatment is teaching people that they can, in fact, tolerate anxiety and distress.

When you have OCD, it is important to recognize that the images in and of themselves are not dangerous. They do not say anything about who you are as a person, or what will happen in the future—or anything at all, for that matter. They do not need to have any meaning attached to them. And while we cannot suppress the images that pop into our heads, we can control whether we engage with them.

Controlling how we engage with these images doesn’t mean ignoring them entirely. By noticing the images, feeling the discomfort they create, and letting them pass, we are retraining our brains to understand that an image, even a scary one, is just that. It can be present and we don’t need to address it. The process of sitting with these difficult feelings helps us to build confidence. We learn that we can choose to keep moving towards our values, even when we’re faced with discomfort. We can keep living our lives despite the images.

ERP can help you manage distress caused by intrusive images

If you want to start building your tolerance for distress and anxiety, but aren’t sure where to begin, exposure and response prevention (ERP) therapy can help. In ERP, a specialist will help you gradually face the intrusive images and fears that are holding you back from living the life that you want to live. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

At NOCD, all therapists specialize in OCD and receive ERP-specific training. They deeply understand all themes of OCD, and if you’re worried about discussing your symptoms and thoughts, keep in mind that a NOCD Therapist will never judge you. They will never ask you to do things that go against your values or that will cause you or others harm, nor will they force you to do anything that you are unwilling to do. Instead, they will guide, support, and motivate you.

If you have any questions about starting ERP therapy or need more information, please don’t hesitate to book a free 15-minute call with our team. On the call, we’ll assist you in either getting started with a licensed therapist at NOCD who has specialty training in OCD and ERP, or connect you to other resources that might be helpful.

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ERP therapy was developed specifically to treat OCD and has helped many people who struggled with the condition regain their lives. All therapists at NOCD have specialty training in OCD and ERP.

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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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