Almost everyone experiences unpleasant thoughts they would rather not have. But how can you tell when intrusive thoughts are an everyday part of life or a component of obsessive-compulsive disorder (OCD)?
Intrusive thoughts are unwanted thoughts, images, or urges that pop into your head and can occur out of nowhere. They can be brief fleeting thoughts such as “What if I drop this glass of water?” or more distressing ones like “I’m an awful mom” because you aren’t 100% interested in playtime with your child, or “I’m contaminated after touching that public bathroom door with my bare hand!” These thoughts might be about a hypothetical violent scenario, for example, you might find yourself wondering, “What if I pushed this guy next to me in front of the oncoming train?”
Intrusive thoughts can be about relationships, such as wondering if you’re a good partner, safety, fear of death, or protection of a loved one. Everyone has intrusive thoughts, and usually, they leave your mind as quickly as they come, and you don’t identify with them as something that makes you a bad person.
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For people with OCD, it’s more complicated. People with OCD may experience intrusive thoughts more often and may become more worried by them than people without OCD. The thoughts latch onto your mind, and you often fear they won’t cease until you can find a way to relieve yourself of the anxiety. You start thinking more and more about this initial thought, and suddenly it grows in your head. What if I really am a bad mother? What if I never want to play with my own child again? Generally, the thoughts center around something that matters deeply to you where the consequences are devastating, which is partially why it can feel so distressing.
When you have OCD, these thoughts become distressing to the point where you feel you must find a way to eradicate them through taking action.Here’s where compulsions come into play. For someone with OCD, it can feel impossible to let these thoughts go, no matter how irrational they seem, and they lead you to engage in compulsions in order to alleviate the intrusive thoughts. For example, you might find yourself spending hours on Google trying to figure out how to know whether you’re a good mother. What makes a good mother? How can you tell if you are a bad one or a good one? This might lead to a downward spiral that won’t stop until you have enough reassurance against what you’re afraid of.
The compulsions could also be mental, where you find yourself thinking about particular anxiety for hours on end about something that happened in the past. For example, you can’t stop remembering all the times you babysat kids and gave them baths but not being 100% certain you didn’t touch them inappropriately. You might replay these memories for hours until you feel reassured enough for these thoughts to temporarily loosen their grip on your mind.
What characterizes an intrusive thought as a component of OCD is how much emotional distress these thoughts cause you and whether you try to neutralize these thoughts via compulsions.
Even if it might seem like these intrusive thoughts will always be running your life, fortunately, there are treatment options available to people suffering from them. Exposure Response Prevention (ERP), a type of Cognitive Behavior Therapy, can help you gain some distance from these thoughts so that they no longer control your actions. Rather than trying to get rid of the intrusive thoughts completely, which isn’t possible, ERP can help you alleviate the distress these thoughts cause.
An ERP-trained therapist can help by reviewing which intrusive thoughts are causing you anxiety and then work with you to come up with a specialized treatment plan to help alleviate them through gradual exposure. For example, a therapist might have you write down an intrusive thought that is causing you anxiety, and work towards exposure until these thoughts are no longer as triggering or the urge to use compulsions lessens.
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If you’re interested in learning more about ERP, you can schedule a free call with the NOCD clinical team to find out how this type of treatment can help you. All of our therapists specialize in OCD and receive ERP-specific training. ERP is considered the gold standard for OCD treatment and has been found to be 90% effective.