Obsessive compulsive disorder - OCD treatment and therapy from NOCD

I get disturbing images in my head. Is it OCD? 

By Erica Digap Burson

Nov 30, 20239 min read minute read

Reviewed byApril Kilduff, MA, LCPC

Intrusive and disturbing thoughts can strike just about everyone at some point or another, and they are never fun to experience firsthand. They’re especially distressing when they target the very last things you want to think about: 

  • A devoutly religious person who suddenly gets struck with disturbing and sacrilegious images of a naked priest 
  • A mother who pictures school shootings in sickening visual detail every time she drops her kids off at school
  • Someone who loves their family more than anything gets a sudden image of themselves hurting their child with a knife

These scary and unwanted thoughts can strike seemingly at random and make you imagine things that you would never purposefully want to see. If you experience particularly disturbing images, you might find yourself wondering: could they be a sign of OCD? 

Obsessive-compulsive disorder (OCD) is a condition that is largely defined by the presence of disturbing and unwanted thoughts, plus compulsive actions or thought patterns that are used to help quell the distress or anxiety that those thoughts can bring. It’s important to note that having disturbing images does not necessarily mean that you have OCD, and that all kinds of people can experience inappropriate or strange intrusive thoughts from time to time. However, unwanted images also play a big role in OCD—the difference lies in how you respond to them. 

We spoke with therapist April Kilduff, LCPC, LPCC, LMHC to unravel some of the reasons that you might experience disturbing images, as well as what you can do to learn to cope with these scary mental experiences. 

What makes OCD images different from other disturbing images? 

Intrusive thoughts can be defined as unwanted and often distressing thoughts, images, urges, feelings, sensations, or ideas. Depending on the kind of thought that you have, these unwanted thoughts can be extremely disturbing, especially when they go against your morals or values—which they tend to do when they’re related to OCD. 

Intrusive thoughts and uncomfortable images can happen to just about anyone, including people who do not have any history of diagnosed mental illness. However, intrusive thoughts and images are one of the cornerstones of OCD. Researchers have found that, when surveying groups of participants both with and without OCD, every participant reported experiencing at least one intrusive thought over the course of the study. Notably, the patients who had OCD did report significantly more of these unwanted thoughts than the others, but they were still present to some degree for everyone.  

So what makes those disturbing images different in OCD versus those experienced by people without OCD? As it turns out, the intrusive thoughts themselves aren’t significantly different; instead, it comes down to how people react to those unwanted thoughts. 

In 1978, researchers surveyed a group of people, some of whom had OCD, to try to understand whether there were differences in the kinds of intrusive thoughts that they experienced. Over the course of two weeks, the participants tracked the kinds of intrusive thoughts they experienced. At the end of the study, their tracked intrusive thoughts were given to professionals who were tasked with determining which thoughts were from people with OCD and those without to see whether they could make any distinctions. 

This study saw that the participants who had OCD tended to experience more long-lasting, intense, and frequent intrusive experiences than others. However, the researchers found that the actual thoughts experienced by people with OCD were not significantly different than those experienced by those without. In fact, the professionals involved in the study were not able to distinguish the intrusive thoughts of the OCD group from the others.

So the disturbing images someone with OCD might experience can actually be quite similar to the ones that people without OCD experience. The key difference, though, is how people with OCD respond to those disturbing thoughts. 

In general, people who do not have OCD can usually move on easily from those unwanted images. Even if those thoughts are extremely disturbing, they are often able to shrug off those images, not attribute any significant meaning to them, and ultimately dismiss them as random and harmless. 

However, for people with OCD, this is not the case. Their unwanted thoughts and images are instead a source of significant emotional distress.  

“I think people assume that thoughts are worse in people with OCD,” explains Kilduff. “To me, though, the difference is that, as a person without OCD, I can have a disturbing image or thought and just move on. Someone with OCD clings to that image. OCD tries to convince them that the thought means something, it’s bad, and it’s dangerous.” 

In addition to a higher frequency of those thoughts, people with OCD may also experience intrusive thoughts that center around certain themes, including “unacceptable ideas of harm” or “a dangerous self.” In fact, OCD is often broken down into specific subtypes that are based on the kinds of unwanted thoughts that people get. Some common subtypes of OCD include: 

  • Harm OCD: Unwanted and disturbing images of harming people or pets around you
  • Scrupulosity/Religious OCD: Intrusive thoughts or images about rights, wrongs, and morals 
  • Health/Contamination OCD: Intrusive thoughts and fears around becoming “contaminated” or developing a serious health condition
  • Relationship OCD: Intrusive thoughts and images about your relationship and/or your partner

Most significantly, though, the biggest difference between people with OCD versus those without is the presence of another major component that defines the condition: compulsions.  

Compulsions are mental or physical behaviors that people with OCD engage in as a way to reduce the intense discomfort that their disturbing thoughts and images can bring. While someone without OCD can more easily move on from a disturbing intrusive thought, the intense fear that someone with OCD experiences after these thoughts compels them to do (or avoid) something in an attempt to feel better or keep something from happening that they’re afraid of. 

For example, say that a person experiences unwanted and disturbing images of themselves hurting their loved ones. If that person does not have OCD, they would generally have a much easier time acknowledging that the thought was random and does not in any way mean that they want to actually hurt that person. They would be able to move forward with their day.

However, someone with OCD who has similar mental images might attribute a much more significant meaning to that thought, and feel intense fear over whether or not they are capable of doing harm because they had the thought. They would then engage in compulsive behaviors to ease that intense anxiety, which might include rituals and actions like: 

  • Locking all their knives in drawers and avoiding cooking with them
  • Compulsive self-reassurance (ie: repetitively telling themselves over and over that they would never hurt their family) 
  • Mental compulsions like trying to “cancel out” images of harming their family with images of good memories 
  • Avoiding their loved ones altogether 
  • Repeatedly praying for reassurance that they won’t harm their loved ones

Can you stop disturbing images from popping into your mind? 

No matter where those unwanted images come from, they can understandably be distressing to experience. Even if you don’t have OCD, having disturbing images pop up in your mind is unpleasant. But can we stop those images from happening? 

Unfortunately, no, we aren’t able to stop them altogether—just as we’re unable to perfectly control any other kinds of thoughts. “I feel like we have 50-50 control over our thoughts,” says Kilduff. “There are some things we can think on purpose, but a bunch of stuff our brain just throws out at us. I don’t think we can get rid of disturbing images.” 

“But oddly enough, acceptance is kind of the answer,” she goes on. “Being able to accept that I have a brain with an imagination and sometimes it goes to weird dark places I don’t want it to go, but that it’s also not dangerous if it does. The more you accept them, the more they tend to become less frequent and less disturbing.” 

Learning to accept that your brain can sometimes come up with scary thoughts and images—and, importantly, learning that they don’t actually mean anything about yourself or your character—is key. Seeking help from a certified therapist can help you gain the tools you need to accept potentially disturbing thoughts and images so they don’t have to rule the way you feel and act.

“Images aren’t any different than thoughts. They’re just mental events,” assures Kilduff. “They’re not going to make things happen. They don’t have to say anything about you other than that you have a brain and an imagination.” 

This goes for anyone who has disturbing thoughts, but especially people with OCD. With OCD, you can’t just “get rid” of intrusive thoughts. In fact, the more you try not to think about them, the more they seem to pop up. Unfortunately, it is much more difficult for someone with OCD to simply “move on” from these images. 

However, that doesn’t mean that you can’t get help. OCD is a highly treatable condition, and there is hope for breaking out of the constant cycle of distress and compulsions that those thoughts can trigger. 

The best way to cope with disturbing OCD images

People who struggle with OCD can’t control the images that pop into their heads any more than they can control their thoughts. However, this doesn’t mean that they have to resign themselves to struggling with a constant cycle of discomfort and anxiety. 

Exposure and response prevention (ERP) therapy is the gold standard treatment for OCD. Unlike traditional talk therapy, which can actually backfire and make OCD symptoms worse, ERP has been clinically proven to be highly effective in treating patients with OCD. 

OCD is not a disorder that can be ignored or run away from. Trying not to think those disturbing thoughts can actually make things worse. Instead, ERP therapy helps you confront the things that bring you the most anxiety and helps you realize that there is nothing to fear from your thoughts alone. 

In other words, ERP doesn’t completely get rid of intrusive images—rather, it takes their power away. 

To understand how ERP therapy works, let’s look at an example of how it might be carried out on someone who has Harm OCD. People with Harm OCD may have intrusive thoughts and images about hurting someone they love, like a family member. Killduff explains that she might work with this patient to write out a worst-case scenario about them hurting their family, or look up news stories or TV shows in which someone hurt their family. She would also try to find out what kinds of compulsions they do for a sense of relief or assurance, then practice allowing those disturbing images to exist without doing those compulsions. As they go through their ERP, they would eventually learn to make a conscious choice to sit with the fear. Over time, their brains get used to the threat—and may even get bored by it. 

The best part? Research shows that virtual ERP therapy is just as effective as in-person therapy. It’s also found that ERP delivered in live teletherapy sessions brought results in under half the time, on average, of traditional outpatient ERP therapy. The key is to work with a therapist who has received specialized training in ERP. 

If you are interested in learning more about how NOCD can help you deal with disturbing images tied to OCD, I encourage you to learn more about NOCD’s accessible, specialized approach to ERP therapy for OCD

NOCD therapists specialize in OCD and receive ERP-specific training. Our virtual ERP sessions can help you take the power away from those disturbing images and help you realize there is nothing to fear from your thoughts alone. 

We specialize in treating OCD

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