Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Intrusive thoughts vs. Impulsive thoughts: What’s the difference?

By Grant Stoddard

Nov 30, 20236 min read minute read

Reviewed byApril Kilduff, MA, LCPC

Understanding the nuances of our inner thought processes is a crucial aspect of mental health awareness. If we don’t understand what we think and what it means (or doesn’t mean) about us, how can we learn to adjust our thought and behavior patterns and live better lives?

Intrusive thoughts and impulsive thoughts are two mental phenomena that people often conflate—but in reality, they could hardly be more different. And because both impulsivity and distressing intrusive thoughts can both have a major impact on people’s mental health—or be signs of treatable mental health conditions—distinguishing the two can be crucial. 

In this article, we’ll delve into the definitions, offer examples of each, and identify some mental disorders that are associated with these types of thoughts.  

What are impulsive thoughts? 

Impulsive thoughts are sudden, intense urges or desires to act on a whim, often without considering the potential consequences. They arise spontaneously and can lead to impulsive behavior if acted upon. These thoughts can be powerful and compelling, prompting people to make decisions in the heat of the moment without adequate planning or reflection.

Here are some examples of impulsive thoughts: 

  • Feeling a strong urge to quit a job without considering financial implications or alternative employment options.
  • Making spontaneous and potentially regrettable purchases due to a desire for immediate gratification overriding rational decision-making.
  • Exhibiting abrupt verbal outbursts in social situations, expressing feelings without considering appropriateness or potential harm.

It’s important to note that while impulsive thoughts can be a normal part of human experience, they can become problematic when they lead to impulsive actions that negatively impact one’s life or well-being. 

Impulsive thoughts can also be associated with certain mental disorders. Attention-deficit/hyperactivity disorder (ADHD) is characterized by impulsive behaviors and difficulties in maintaining focus. Borderline personality disorder (BPD) often involves impulsive actions that are driven by especially intense emotions. And a much less common condition known as antisocial personality disorder (ASPD) can lead to recklessness and impulsivity, often accompanied by a lack of regard for others’ well-being.

If you believe that your impulsive thoughts are a symptom of any of these disorders, it’s important to seek the right form of professional help. ADHD and BPD are quite common conditions, and both are particularly treatable with evidence-based approaches.

Treatment approaches for disorders often associated with impulsive thoughts.

The primary treatments for ADHD often begin with stimulant medications like methylphenidate or amphetamines. These increase dopamine and norepinephrine levels in the brain, improving focus and impulse control. Behavioral therapies and lifestyle adjustments, such as structured routines and exercise, complement medication.

BPD is typically addressed with a combination of psychotherapy approaches. Dialectical behavior therapy (DBT) is particularly effective, focusing on emotion regulation, interpersonal skills, distress tolerance, and mindfulness techniques. Medications, such as mood stabilizers or antidepressants, may also be used to alleviate specific symptoms.

ASPD presents significant challenges in treatment. Psychotherapy, especially cognitive-behavioral interventions, addresses distorted thinking patterns and behavior modification. However, therapy’s effectiveness can be limited due to the nature of the disorder and the reluctance to seek treatment that many people with the condition have in the first place. 

What are intrusive thoughts? 

Intrusive thoughts are unwelcome, involuntary thoughts, images, ideas, memories, or sensations that enter our consciousness, often causing significant distress or discomfort. They’re a natural part of human cognition and are experienced by virtually everyone at some point in their lives. These thoughts can be disturbing, vivid, and emerge suddenly, catching us off guard.

Here are just a few examples of the sorts of intrusive thoughts that people commonly experience: 

  • Thoughts of causing harm to loved ones despite no intention or desire to act on them.
  • Visualizing violent or aggressive acts despite abhorring violence.
  • Repetitive and distressing thoughts about religious or blasphemous themes.
  • Persistent doubts about one’s sexual orientation despite a firm sense of identity.
  • Intrusive thoughts about inappropriate or taboo sexual acts or experiences.
  • Worries about making mistakes or causing harm.
  • Disturbing images or thoughts of self-harm or suicide, even when there’s no intention to act on them.

It’s important to emphasize that experiencing intrusive thoughts does not indicate a desire to act on them. They are a product of the complex workings of the human mind and are not indicative of one’s true intentions or character. And while these thoughts can be distressing, they are a common phenomenon and do not necessarily signify the presence of a mental disorder. 

However, in some cases, these thoughts can become persistent and distressing, leading to the development of maladaptive coping mechanisms. These intrusive, often disturbing thoughts are a hallmark symptom of obsessive-compulsive disorder (OCD). 

People with OCD experience distressing intrusive thoughts, images, urges, sensations, or feelings known as obsessions, followed by compulsive behaviors or mental rituals called compulsions done to alleviate their discomfort or keep something unwanted from happening. For instance, someone with contamination-related OCD—one of the more widely known OCD subtypes—might have intrusive thoughts about germs, leading them to compulsively wash their hands, even to the point of causing lasting skin irritation and damage.

Others with OCD may have intrusive thoughts about causing themselves or others harm, engaging in taboo sexual behavior, or doubting their attraction to their partner. Whatever these thoughts are about, they can be profoundly distressing and significantly impact daily life. Fortunately, there’s an evidence-based treatment that reduces the impact of troubling intrusive thoughts, called exposure and response prevention therapy (ERP).  

How are OCD intrusive thoughts treated?

ERP is a widely used and effective therapy for people with OCD, designed to help people deal with distressing intrusive thoughts without relying on compulsions for short-term relief, since compulsions actually make OCD symptoms worse over time.

To continue the example of contamination OCD, consider a person whose fear of germs has kept them from having others in their home for years—they are overwhelmed with intrusive thoughts about getting sick or infecting others with deadly illnesses. At the beginning of treatment, they may feel that having others over will be simply too distressing, so their therapist would come up with an easier way to face their anxieties first. Instead, they start by bringing an object from another location—like a pencil from a friend’s home—into their living room, without sanitizing it first.

Then, their therapist will guide them as they learn to deal with the emotions that come up during the process of having a potentially “contaminated” object with them. Sitting with these intrusive thoughts and feelings, they find that they can get through the experience, that their extreme fears haven’t overtaken them, and they become more comfortable with the uncertainty and anxiety that comes from gradually expanding their world.

ERP has proven to be highly effective in helping people manage OCD symptoms in the long term. Numerous studies have shown that it can significantly reduce the severity of obsessions and compulsions, allowing people to live with a newfound sense of confidence, accept uncertainty, and live life on their own terms, rather than being ruled by intrusive thoughts and other obsessions.

ERP is a brave step towards regaining control over your life and finding relief from OCD symptoms. Your therapist will support you until you’ve mastered your toolkit and resumed living on your terms. 

You can overcome distressing intrusive thoughts

If you think you might have OCD and are interested in learning how it’s treated with ERP, I encourage you to learn more about NOCD’s accessible approach to treating all themes of OCD.

All of our therapists specialize in OCD and receive ERP-specific training—by working with trained specialists who have experience helping people like you, you can soon find that your intrusive thoughts don’t bother you as much, and don’t guide how you live your life.

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