Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Intrusive Thoughts Vs OCD

By Cody Abramson

Mar 24, 20237 min read minute read

Reviewed byPatrick Carey

intrusive thoughts

We all experience intrusive thoughts. Whether it’s about driving off a bridge, physically harming someone, or yelling inappropriate words, everyone has unpleasant, unwanted thoughts, urges, and other experiences that pop into their mind from time to time. 

Though they are shared by everyone and harmless on their own, intrusive thoughts are also involved in serious mental health conditions such as obsessive-compulsive disorder (OCD), contributing to a great deal of personal suffering. So what exactly are intrusive thoughts, when are they a problem, and what can you do about them? We talked with Dr. Patrick McGrath, Chief Clinical Officer at NOCD, to answer these questions and more. 

What Are Intrusive Thoughts?

Intrusive thoughts, images, and urges have several features that collectively separate them from “regular,” non-intrusive experiences. 

  1. They are unpleasant and distressing: Intrusive thoughts feel bad. They are not pleasant experiences. If it makes you feel good, it’s not intrusive. 
  2. They are involuntary: Intrusive thoughts occur against one’s will. Often they happen despite—or even as a result of—one’s best efforts to make them stop.
  3. They are often “ego-dystonic”: Generally, intrusive thoughts are not in line with what one truly believes, desires, or values. 

Intrusive thoughts can be about a variety of topics and themes. Some examples include:

Do Intrusive Thoughts Mean That I Have a Mental Health Condition?

While intrusive thoughts are an important symptom of some mental health conditions, including OCD, having intrusive thoughts does not mean that you have a mental illness. In most cases, intrusive thoughts are not a symptom of any condition, and can be the product of a perfectly healthy mind.

Is It Normal to Have Intrusive Thoughts?

“Everybody in the world experiences intrusive thoughts,” shares Dr. McGrath, emphasizing the common nature of these uncomfortable psychological events. 

He elaborates with a story: in many of Dr. McGrath’s educational talks on OCD, he asks attendees to raise their hands if they have ever experienced an intrusive thought (e.g., an urge to drive their car off a bridge). At first, people are reluctant to admit it. Slowly though, people realize their intrusive thoughts are common. “Everyone starts looking around and gets this weird look on their face, and suddenly you start to see a bunch of hands going up,” he shares. “Then they realize they aren’t the only ones with these experiences.”

Researchers have found the same results. For example, one study found that 94 percent of participants admit to experiencing intrusive thoughts. Of course, because intrusive thoughts often involve topics such that some may not want to admit to having them, the real proportion is likely even higher. 

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What is OCD?

Though intrusive thoughts are typically not a sign of mental illness, they are one of the primary symptoms of OCD. People with this condition experience intrusive thoughts about a variety of topics, from contamination and morality to pedophilia and harm. These are known as obsessions, and they cause a great deal of distress or anxiety, causing people with OCD to feel a persistent, strong urge to engage in compulsions in an attempt to alleviate anxiety or prevent unwanted outcomes from occurring. 

How Can I Tell if My Intrusive Thoughts Are a Sign of OCD?

There are several important distinctions between intrusive thoughts when they occur in individuals with OCD and those without the condition. Here are three signs that the intrusive thoughts you’re experiencing are a symptom of OCD.

#1: You believe that having intrusive thoughts means something is wrong with you

“In OCD, the problem begins when you believe that you shouldn’t have intrusive thoughts, or that intrusive thoughts are a sign of something bad or wrong happening,” shares Dr. McGrath. 

People with OCD are more likely to attribute great significance to their intrusive thoughts, feeling they must mean something terrible about themselves. This is due to a phenomenon known as thought-action fusion (TAF), where one thinks having an intrusive thought is just as meaningful or morally bad as doing the thing they are thinking about.

While it’s normal to feel a little unsettled by intrusive thoughts, getting stuck on what they might mean or say about you can suggest that they’re a sign of something more. 

#2: You perform compulsions to feel better

Intrusive thoughts don’t typically result in any kind of behavior done to reduce the anxiety they cause or prevent some bad event associated with them from occurring. People with OCD, however, are likely to respond to obsessions by performing compulsions. 

This is likely the result of the personal significance that those with OCD attribute to intrusive thoughts, at least to some degree. Because they see them as potentially immoral or wrong, someone with OCD will be very motivated to get rid of all their obsessions. As Dr. McGrath shares, they may think something like, “I’m having this bad thought. Therefore I must neutralize it because if I don’t,  it means that I’ve accepted the thought, and if I accept a bad thought then I am a bad person.” 

#3: They interfere with your ability to function

As with many mental health conditions, part of what determines whether there is a problem is if you’re having trouble living your life the way you want to, whether at work, at home, or with friends. If your intrusive thoughts negatively impact your ability to function in the areas of life you care about, they are likely a symptom of another condition like OCD. 

Is it Possible to Stop Having Intrusive Thoughts?

Unfortunately, it is not possible to stop having intrusive thoughts altogether. Whether you have OCD or not, you’ll continue to experience them from time to time. However, there are several things you can do to decrease the degree to which they interfere with your life and make them less distressing when they do occur. 

What is the Best Way to Respond to Intrusive Thoughts in OCD?

Here are four methods you can use to ensure that intrusive thoughts don’t spiral out of control and interfere with your ability to live a happy life. 

#1 Don’t try to uncover what they mean

“Don’t try to figure out where they came from, why you had them, or what they mean,” says Dr. McGrath. ”Your efforts to come up with a satisfying understanding or explanation are almost sure to end in doubt and disappointment. This will only strengthen your obsessions and ensure they reoccur with greater force.”

#2 Don’t try to neutralize them

Whether by trying to learn what they mean, “replacing” them with positive thoughts, or engaging in a compulsion, trying to neutralize an obsession will only make things worse. Let them be as they are. 

#3: Don’t try to avoid thinking about them

If I tell you not to think about pink elephants, what is the first thing you think about? Pink elephants, of course. This general psychological tendency, often called the pink elephant effect, applies to intrusive thoughts just as much as any others. So if you experience an intrusive thought, don’t try to push it away, as that will only worsen it.  Instead, try to make the thoughts occur. 

As Dr. McGrath infers, if trying not to think about something makes you more likely to think about it, test out the exact opposite: “If I actually tell myself to think an intrusive thought, guess what happens? My brain tends to find something else to think about.”

#4: Don’t let intrusive thoughts get in your way

Intrusive thoughts can make it very tempting to avoid the situations that might trigger them. Doing so, however, will only make things worse, reinforcing the belief that these thoughts are dangerous and should be avoided. Instead, it’s best to continue with your life as you would like. For example, suppose that on your way to see a friend, you have an intrusive thought about hurting them when you see them. You might be tempted to cancel your plans, but you should do the opposite. “Don’t turn around and go back home and seek safety and come up with an excuse,” shares Dr. McGrath. “Go to your friend’s house and your brain will learn that having that thought, image, or urge floating around in your head will not cause you to hurt your friend.” 

It’s worth noting that these tips reflect the fundamental aspects of exposure and response prevention (ERP) therapy—the most effective line of treatment for OCD—in which individuals work with a trained professional to confront obsessions or intrusive thoughts without engaging in their typical compulsive behaviors. Through ERP, individuals with intrusive thoughts learn to sit with uncertainty, tolerate the distress and anxiety caused by their obsessions, and reduce the impact of their unpleasant, unwanted thoughts. So by making yourself confront or sit with your intrusive thoughts without trying to neutralize them or run away, you are practicing aspects of a tried and true therapeutic strategy.

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