Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Understanding Urges in OCD

By Stacy Quick, LPC

Nov 07, 20237 minute read

Intrusive thoughts can feel overwhelming and anxiety-provoking under any circumstances, but especially when they revolve around doing something you don’t want to do. We often think of intrusive thoughts as verbal or visual experiences, but urges, or strong impulses to engage in a specific behavior or action, are another common way they can be experienced by people with OCD.

To someone without OCD, the urge to swerve their car off the road is usually just a passing thought. They might pause momentarily to think, “Oh, that’s weird,” but are likely to be relatively unphased by the experience overall. To someone with OCD, on the other hand, that urge feels far more serious, as many people with OCD experience intrusive urges and describe them as feeling very real. Learning more about intrusive urges can help you recognize when you may be experiencing them and find support that will help you manage them.

Why do intrusive urges feel so real?

OCD grabs onto an intrusive thought in the form of an urge and attaches certainty to it. It makes the person experiencing the urge feel sure that something bad will happen, or that they will take an action that they don’t want to take. The fear an individual feels around the negative outcome they’re imagining can make them go to great lengths in their attempts to prevent it. As intense as these urges may seem in the moment, they don’t imply action. Like all intrusive thoughts, they’re feelings—and like all feelings, they will eventually pass.

However, this can be hard to recognize amid the distress these urges cause. This is because of the distress intolerance often experienced by people with OCD. Faced with the uncomfortable feelings that accompany an intrusive urge, someone with OCD will likely feel unable to tolerate these emotions, and may turn to compulsions as a way to alleviate the distress they feel.

Because intrusive urges can revolve around actions or impulses that feel taboo or disturbing to the person experiencing them, it’s important to clarify that they are not indicative of anything about someone’s character or desires. In fact, the reason these urges tend to be so distressing is that they’re often completely opposed to people’s values. This is also referred to as being ego-dystonic, a quality seen in intrusive thoughts of all kinds, regardless of whether they’re experienced as a thought, image, urge, or physical sensation.

People experiencing intrusive urges may understand that their thoughts are illogical or improbable, but because OCD doesn’t respond to logic, that understanding won’t do anything to change the distress they feel. This distress will often drive them to engage in compulsions, which they may also understand to be illogical, but still feel compelled to do, both to prevent the imagined harm from happening and to manage the intense anxiety that they are experiencing. This can and often does lead to interference in their daily lives and functioning.

What do intrusive urges look like in OCD?

The ways that intrusive urges manifest for people with OCD will be unique to each individual and the particular obsessions they experience. The following examples are a few ways they may present:

Urges as physical compulsions: Leah feels like she can hardly go anywhere. Whenever she walks through a doorway, she feels the impulse to touch it three times on each side. There isn’t a particular reason for this; she just has this sense that it must be done. This behavior has gone on for years. It waxes and wanes, but she notices that it seems to increase when she’s under more stress or going through any life changes, regardless of whether those changes are positive or negative. She’s tried to shake the behavior but found it hard to stop. When she feels like something bad may happen or that she will have a bad day, she finds herself thinking that everything will be okay if she does this behavior because it will even out the doorway. Even though she knows that following these urges only brings a little relief, and she’ll feel the need to do it again at the next doorway she encounters, she finds the feeling hard to overcome.

Urges as verbal compulsions: Whenever Garret hears certain words, whether they’re said in a television show or by the people around him, he feels the urge to say good things in his head to balance them out. He has difficulty explaining this to others, as it can be caused by anything. It’s just a need to cancel out the bad or scary things he hears. Garret takes long pauses during conversations to finish his replacement thoughts in a way that’s “just right,” and if he’s interrupted in any way, he feels the need to repeat himself. This often ends up being embarrassing and time-consuming. He knows the behavior doesn’t make much sense, but at the same time, it makes him feel better for a while. But it always seems to come back. Because he can’t control what other people say or watch on television, this feeling gets triggered a lot. 

Harm-related urges: Aurora used to love traveling. She enjoyed going on long drives to new places and exploring—until recently. She was driving around town running errands, on what seemed like an average day, when suddenly this feeling came out of nowhere. Aurora felt an urge to swerve her car into oncoming traffic. The feeling was a mixture of fear that she could do it and anxiety about why she was having that thought. Instantly, she was overcome with intense distress. Now, whenever she goes anywhere, she has urges to swerve her car off the road into people, traffic, trees, or anything that is nearby. She doesn’t want to hurt herself and the idea of hurting someone else horrifies her. The presence of these urges troubles Aurora, and she’s found herself avoiding driving more and more frequently since they started happening.

Urges related to physical sensations: Liv has always seemed to pay more attention to her body sensations and feelings than most people. When she was little, she would ask all kinds of questions about the human body and suffered from fears of swallowing. She also became fixated on her eyes and blinking. More recently, she’s noticed that she feels the need to urinate all the time. Every time she feels any inkling of discomfort, she feels as though she needs to go to the restroom. The urge that she needs to relieve the urine in order to move forward with her day has happened so frequently that it’s impacted her work. She’s brought her concerns to her doctor and they’ve discussed possible reasons for it but haven’t found an answer. The urge wakes her up at night and feels like it’s consuming her life.

The impact of intrusive urges

OCD can be very nuanced, focusing on the strangest of themes, and these examples are just a few of the many ways that intrusive urges may appear. Because OCD is often thought of in terms of verbal or visual intrusive thoughts, people may not recognize that urges are also a result of the condition.

Urges, like any OCD symptom, can have a debilitating impact, affecting not only a person’s day-to-day functioning but also their relationships with others. People experiencing them may feel out of control. It’s important to recognize intrusive urges so that they can be properly treated. 

Reducing the distress of intrusive urges

If you’re struggling with intrusive urges, highly effective treatment is available: exposure and response prevention (ERP) therapy. ERP can teach you how to stop engaging with urges. You’ll learn how to sit with uncomfortable feelings without doing compulsions and over time, this process will lessen the distress that these urges cause. Through ERP, you’ll learn that uncomfortable feelings will pass, and that you don’t have to do anything for that to happen.

ERP is most effective under the guidance of a therapist who specializes in it. At NOCD, all of our therapists specialize in OCD and receive ERP-specific training from some of the top OCD experts and researchers in the world. When you work with a NOCD Therapist, they’ll provide you with a personalized treatment plan designed to meet your unique needs, teach you the skills to begin your OCD recovery journey, and support you every step of the way.

To prevent cost from being a barrier to accessing treatment, we offer affordable options and partner with many insurance plans. You can learn more about starting OCD treatment with a NOCD therapist by scheduling a free call with our team.

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