You may be hearing more about intrusive thoughts recently, and that’s a good thing. Everyone has these thoughts, and they can be a central component of very serious conditions like obsessive-compulsive disorder (OCD). But the exact nature of these thoughts can be unclear: are all seemingly “random” thoughts intrusive? Are all intrusive thoughts bothersome?
As a rule of thumb: if you find yourself wondering at length if a random, distressing thought is intrusive or not, it probably is. People don’t tend to sit around and ponder whether an intentional or enjoyable thought is somehow “wrong” or means something about their core identity. Nonetheless, there is a lot more to learn about how you can identify intrusive thoughts and distinguish them from others.
Identifying intrusive thoughts & accepting uncertainty
If you have OCD, you might be wary of such a simple rule—after all, if it makes me feel better about my thoughts, couldn’t it just be reassurance? That’s a great question, and it’s important to note that you’ll never be 100% sure that any thought is intrusive. After all, our memories are far from perfect, and we can never be perfectly certain about our own values or identities, either. As with all things, people with OCD can recognize that a thought is likely intrusive, while learning to accept uncertainty about their thoughts and live true to their values.
But what are intrusive thoughts, exactly? Simply put, they’re unwanted thoughts that are ego dystonic, meaning that they don’t align with your values, intentions, or identity. They may come in response to specific situations, or they can seemingly pop up out of nowhere. Sometimes, especially in people with OCD, intrusive thoughts also bring a lot of distress and anxiety with them. Everyone—people from all different backgrounds, ages, beliefs, cultures, regions—has intrusive thoughts. Intrusive thoughts, on their own, are not a sign of any mental health condition.
A person can have intrusive thoughts and not have OCD. It’s just that some people—especially those with OCD—are especially distressed by these thoughts to the point that they become obsessions. People without OCD may experience the same random, ego dystonic thoughts, but they are able to move on fairly easily. They will not obsess over what the thought was, why it was present in the first place, or what it might mean about them. Sometimes they won’t even notice the thoughts for more than an instant—their brains are able to sort out these unhelpful thoughts as unimportant.
A key distinction in determining whether or not a thought is intrusive is whether or not the thought aligns with a person’s beliefs or intentions. Do they try to get rid of or push those thoughts out of their mind? Do they feel upset by the thoughts? Or, on the contrary, do they enjoy the thoughts, welcome the thoughts, or willingly indulge in them? Let’s look at two very different presentations.
Intrusive thoughts in OCD: Tasha has been diagnosed with OCD and has struggled with this condition most of her life. It has impacted her functioning so much that it has been difficult to hold a steady job. She avoids large crowds of people, and really avoids doing much of anything that could potentially trigger what she refers to as “the scary thoughts.” She describes these thoughts as menacing and unacceptable.
Usually, these images are about hurting those she cares about the most, like her parents or close friends, but sometimes they are about random people. She also sometimes has thoughts about sexually assaulting people, or worries that she may have done so in the past and doesn’t remember. She admits it is often easier to just not leave her house to keep the thoughts at bay.
In this example, we see all of the trademark characteristics of OCD. Tasha doesn’t enjoy these thoughts, she is absolutely tormented by them. These thoughts are not in alignment with her values, how she views herself, or how others view her. She goes out of her way to avoid anything or anyone that may trigger them, and this avoidance interferes with her ability to live her life. These thoughts have caused her to have severe impairments socially, emotionally, and in her career.
Ego-syntonic thoughts not related to OCD: Sean has always had a vivid imagination. Even as a child, he was lost in daydreams. As a child he was kind of a bully, often picking on other children. His parents tried to teach him about empathy but to little avail. Sean was able to control his behavior when it suited him, but his behaviors remained, to a certain extent.
As he grew older, his internal world became darker, more detailed, and more violent. One thought in particular that he spends a lot of time on is the idea of sexually assaulting random girls that he meets at local bars, and he comes up with very detailed plans. He hasn’t done it yet—not because he feels bad or because he thinks it is wrong, but because the opportunity hasn’t presented itself yet. Sean doesn’t feel guilt, shame, or any remorse for thinking about these things.
Sean enters treatment because of issues related to alcohol and traffic incidents, and during this treatment he discusses his thoughts. Sean is subsequently diagnosed with Antisocial Personality Disorder, but he feels largely unaffected by this diagnosis. When it is explained to him, he agrees that it sounds a lot like him. Sean is uninterested in treatment to stop these thoughts and fantasies, as they don’t conflict with his own intentions or self-identity.
It is important to recognize that no matter the reason why the intrusive thoughts are present, there is help available. If you or someone that you love is struggling with unwanted thoughts, there is treatment available to help. Even in the case of Sean, treatment would be available and could potentially be helpful if Sean wanted or saw a need for personal change.
ERP can help you take the power away from intrusive thoughts
If you’re struggling with OCD and want to change the way you respond to intrusive thoughts and manage your OCD symptoms, NOCD can help. Our licensed therapists deeply understand OCD and are specialty-trained in treating OCD with ERP. 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. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment.