Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Intrusive thoughts when you’re around knives? You’re not alone

By Grant Stoddard

Sep 28, 20237 minute read

Reviewed byApril Kilduff, MA, LCPC

You are not your thoughts. 

This simple sentence is easy to understand, but it can be difficult to fully internalize. It conveys the idea that our identity is not defined by the continuous stream of thoughts going through our minds, and implies that thoughts are transient, subject to change, and influenced by many external and internal factors. 

Moreover, it highlights that thoughts that pop into our heads often contradict our true beliefs and values. That last part is particularly important to understand if you’re inundated with intrusive thoughts, urges, feelings, sensations, or images about harming yourself or someone else, particularly when knives or other dangerous objects are within reach. 

In this article, we’ll try to shed some light on this surprisingly common experience, explain what might be causing it, and offer some ideas about how you may be able to regain control of your life and feel more at ease when you’re around dangerous everyday objects

Where do intrusive thoughts come from? 

When talking about intrusive thoughts, we refer to bizarre, unwanted, and often taboo content that inexplicably shows up in our minds. It can feel a bit like an unknown and uninvited entity has grabbed the remote control of our brains. But what’s truly fascinating about this phenomenon is how commonly reported intrusive thoughts are, with one study demonstrating that 94% of people experience them. 

These mental glitches are a byproduct of the brain’s intricate, incredibly complex cognitive processes. One key contributor is the brain’s default mode network (DMN), which is responsible for introspection and self-referential thinking. With minor malfunctions or hyperactivity in the network, it can lead to a heightened focus on negative or distressing thoughts, giving rise to intrusive experiences. Furthermore, the amygdala, a region linked to emotions and threat perception, also plays a pivotal role. It can overreact to stimuli, exaggerating their emotional significance and contributing to the persistence of intrusive thoughts. 

However, though intrusive thoughts are a nearly universal and perfectly natural experience, they don’t actually have any particular meaning, nor do they pose an actual threat or indicate the presence of any real danger. They’re simply a byproduct of the enormously complex data and stimuli that are running through your mind at any given moment.

Could my anxiety about harming myself or someone else be a mental disorder? 

Regardless of how frequent or intensely intrusive thoughts show up, the great majority of people can shrug them off and get on with their day fairly easily, because they’re not among the roughly 2.5% of people who struggle with Obsessive-Compulsive Disorder (OCD). People with OCD tend to fixate on these unwanted, intrusive experiences, unable to dismiss these random thoughts and causing them to become obsessions—the “O” in OCD.  

All OCD-related obsessions provoke distress, but when those obsessions are focused on the fear of grabbing a knife and stabbing yourself or someone else, the fear is often all-consuming and overwhelming. To reduce the distress their obsessions cause, people with OCD perform compulsions—mental rituals or repetitive behaviors intended to feel better or prevent their fears from coming true. These compulsions often do reduce anxiety, but only temporarily, and at the cost of strengthening the sequence of obsessions, anxiety, compulsions, and short-lived relief, known as the OCD cycle. 

Let’s take a minute to see what this cycle can look like when you’re inundated with intrusive thoughts triggered by being around knives. 

Scenario: Sarah

Sarah, a 39-year-old marketing executive, knew that something was wrong. What she didn’t know was that she had OCD. She’d always thought that OCD was confined to worries about germs that led to relentless hand-washing, a world away from her harrowing experiences. 

Whenever Sarah was around knives, she had distressing thoughts about hurting her husband, Jules, even though it was the last thing she’d ever do. This made cooking together, something they both enjoyed, incredibly hard.

Scary thoughts would pop into Sarah’s head as they chopped vegetables or carved meat. It was as if a scene from a scary movie was playing on repeat, and it made her feel increasingly anxious and guilty. Before long, the first thought that popped into Sarah’s head when she got out of bed in the morning was “What if I lose control today? How can I stay away from the kitchen?”

To ease her rapidly mounting anxiety, Sarah developed compulsions—some obvious, and others less so. 

Most of these were avoidance compulsions. At first, she avoided participating in any meal prep that involved handling a blade. She began buying microwavable, ready-to-eat meals when she realized this was virtually impossible. Jules didn’t like them—neither did Sarah—yet this compulsion was somewhat successful in reducing her anxiety. Until that is, Jules insisted on making dinner from scratch. Sarah caught sight of a knife Jules had left on the countertop, and the OCD cycle began again and even stronger than before.     

Jules noticed something was wrong. He could see the worry on Sarah’s face, but he didn’t fully understand what she was going through. Sarah wanted to tell him but was scared he might not understand.

Eventually, Sarah made excuses not to make dinner together, previously a highlight of the couple’s domestic life. She began feeling distant from Jules and desperately wanted to escape her torturous thoughts.

“Intrusive thoughts and obsessions triggered by being around knives indicate an OCD subtype called harm OCD,” says Dr. Patrick McGrath, Chief Clinical Officer at NOCD. “Do these obsessions mean the person having them will likely act on them? No. In fact, intrusive thoughts are ego-dystonic, meaning they completely contradict what a person would want to happen. 

“For that reason, I’d say that someone who has obsessions about stabbing someone is actually less likely to act upon them than someone who doesn’t. I’m so confident that I’ve stood on a train platform with a patient who had obsessions about pushing someone onto the train tracks, knowing that I was as safe as ever. OCD focuses on the last thing you’d ever want to happen, so I felt very confident that I’d be unharmed—and well, I’m still here!” 

Why was Dr. McGrath teetering on the edge of a train platform with a person who spends hours of their day worrying about the possibility that they could push someone into the path of an oncoming train? He was doing an exposure—a core component of an OCD treatment considered the “gold standard” by psychologists and other experts in the mental health field. The other core component is response prevention, which is why this approach is known as exposure and response prevention therapy (ERP).

Exposure and response prevention (ERP) explained

ERP is a highly effective therapy for treating OCD. It operates on the principle that facing feared situations or objects without reinforcing obsessions through compulsive behavior gradually reduces anxiety and diminishes the urge to engage in compulsions in the future.

In ERP, you’ll intentionally and gradually confront situations that trigger your obsessions. You’ll then deliberately refrain from engaging in your usual compulsions, whatever they may be. This process helps break the cycle of anxiety and compulsive behavior by teaching the brain that your feared outcomes are unlikely and do not need to be responded to as real threats.

In your first session, you develop a fear hierarchy with your ERP-trained therapist. Next, you’ll start with exercises that trigger a relatively small degree of distress. For someone like Sarah, who experiences obsessions triggered by knives, an initial exposure might involve just imagining having a knife in easy reach. A later exposure might involve looking at pictures of knives—maybe starting with cartoon drawings of a knife, then a butter knife, as they work up to bigger, scarier-looking knives—and an even later exposure could see her handling a knife for a short period, working up to chopping vegetables with one. More and more, she would become prepared to confidently engage in her usual meal prep with others in the kitchen, living life on her own terms once more.

With each exposure, she will be encouraged to avoid engaging in her usual compulsions—these could include avoidance, distraction, repeating “safe” words, checking and rechecking the locations of knives, among many other possibilities. Through repeated, progressively more intense exposures, Sarah will learn that her feared outcome—harming her husband—is highly unlikely to happen, and that she can feel confident and confident, even in the face of uncertainty and intrusive triggers. By continually practicing her exposures and committing to the cooking activities she wants to engage in, her anxiety will gradually decrease. 

Studies have shown ERP to be remarkably effective in the long-term management of OCD. Around two thirds of people experience significant reductions in symptoms and improved quality of life. Furthermore, ERP equips people with lifelong skills to manage OCD. You’ll learn to approach anxiety-provoking situations with resilience and confidence, ultimately gaining greater control over your life—often in just a few months. 

It’s also important to know that ERP is more accessible than ever before. More and more insurers are covering it, and it can be delivered remotely. In fact, some studies have shown that it can be even more effective when delivered remotely than in person. 

Get your life back from OCD

All of our therapists specialize in OCD and receive ERP-specific training. If you think you might have OCD and want to learn how it’s treated with exposure-based therapy, schedule a free 15-minute call with the NOCD Care team to learn more about how we can help you get your life back on track. 

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