What are intrusive thoughts, and are they normal?

The human brain is weird.

What if I just took this knife and instead of chopping up these carrots, I stab myself with it? 

What if my husband leaves for work and gets into a 4-car pile-up?

What if I push this stranger onto the train tracks?

What if someone I walked past on the street has the measles and now I’m going to get it and give it to my kids?

Yikes, why the heck did I think about that? It feels like it came out of nowhere! Where did that thought come from, anyway?

These examples are just a few intrusive thoughts—which can be defined as thoughts, images, sensations, feelings and/or urges that are unwanted and distressing. The very nature of the fact that they’re intrusive means that they’re not something you want gaining access to your headspace. But intrusions do anyway—and they can be particularly loud and powerful. 

In this article, we’ll dive more into intrusive thoughts, including why these anxiety-provoking thoughts pop up, if they actually mean anything, and if you need treatment to control them.

Why do I have intrusive thoughts, and are they normal?

First, it’s important to understand that intrusive thoughts are incredibly normal. “We have so many thoughts daily. Some are good, some are bad, and some make us uncomfortable,” says Monique Williamson, LMFT, a licensed therapist with NOCD. Because everyone will sometimes talk to themselves in their head, it’s inevitable that the content of some of those thoughts is going to be weird, awkward, or make you feel uneasy. In fact, research suggests that people who have these rich inner lives tend to have more of these intrusions. 

When working with kids, Williamson might dub intrusions as “yuck thoughts,” a description that people of any age can probably relate to. After all, an intrusive thought can make you scared, ashamed, and you may even question who you are and if you’re actually a good person. Because no one else could possibly have the fleeting thought of pushing someone onto the train tracks, right? (In reality, because of how common intrusive thoughts are, so many people can relate.) 

For many, intrusive thoughts come and go. One might pop into a person’s head, they think, Wow, why’d I just think of that! But then they release that thought and move on with their day. For others, though, these intrusions are like brain barnacles. 

Folks who struggle with certain mental health issues, however, may find that it’s incredibly difficult to let one of these intrusive thoughts go. If this is an issue for you, you may feel that you need to know why you thought about it, prove that what you’re thinking isn’t reflective of who you are, and then stop the thoughts from happening again. In this case, there may be deeper mental health issues going on. It’s worth it to explore what’s underlying your distress. 

What mental health conditions are related to intrusive thoughts?

Even though the existence of intrusive thoughts doesn’t necessarily mean that you have a mental health condition, research shows that there are some illnesses linked to frequent, disturbing thought patterns. Such as:

Depression

Depression is a mood disorder that affects how you feel and think, according to the National Institute of Mental Health (NIMH). In order to be diagnosed with major depression, your symptoms—feeling hopeless, having brain fog, having sadness that doesn’t go away—must have persisted for at least two weeks and affect your ability to perform daily functions, like sleep, work, or eat. Intrusive thoughts in depression may include self-harm or negative statements about yourself or life. 

PTSD

Post-traumatic stress disorder can occur after going through something that’s shocking, scary, or dangerous, such as war, an assault or abuse, or natural disaster—or being a witness to one of these events—says the NIMH. With PTSD, intrusive thoughts can come in the form of flashbacks where you relive your trauma or as an intrusive dream. 

Anxiety

While there are many different types of anxiety disorders, generalized anxiety disorder, or GAD, is one in which you have intense worry or anxiety that you just can’t shake. There’s endless fodder to be anxious about, and these feelings can pop up in the form of intrusive thoughts: What’s going to happen in the future? What if I lose my job? What if that bump under my skin is cancer? What if something happens to my kids, are they in danger? Some amount of anxiety is normal. It allows you to think two steps ahead and keep you and your loved ones safe. But GAD is life-sucking, making it difficult to focus, increasing irritability, and causing you to lose sleep. 

OCD

Obsessive-compulsive disorder (OCD) is a cycle of obsessions (intrusive thoughts, images, sensations, feelings and/or urges that cause distress) and compulsions (mental or physical behaviors done to neutralize the distress or prevent something bad from happening). Once you perform a compulsion, your distress lifts and you temporarily feel better. However, compulsions always come back if not treated, and so if you have OCD, you can get stuck in the vicious obsession-compulsion cycle.

The criteria for being diagnosed with OCD is that you spend at least an hour a day experiencing these symptoms. That can be easy to do if you have OCD, because you’ll continually loop back to your intrusive thoughts, says Williamson. “You might engage with those intrusive thoughts by asking yourself questions about them or trying to reason with yourself,” she says. 

So, if you find yourself ruminating about why you had that thought, keep trying to logic your way out of the thought that popped into your head, and are just generally having an internal battle with yourself about an intrusive thought—that may be one indication that it could be OCD. Plus, this type of rumination has been shown to make intrusive thoughts worse and more persistent—like a mosquito bite that you can’t calm by scratching.

Finding treatment for intrusive thoughts

First, it’s important to keep this powerful message in mind as intrusive thoughts shove their way into your precious mental space: “You’re under no obligation to take your intrusive thoughts seriously,” says Williamson. “These thoughts do not need to be evaluated or dug into deeper. They don’t deserve time, effort, or attention,” she says. It’s okay to acknowledge their presence, skip self-judgment, and then let them go. 

The problem is not that you have an intrusive thought—it’s your relationship with that thought. In other words, if you interpret them as being threatening to your sense of self, read into their supposed meaning, or try to block them and push them away, you may actually feel a greater sense of distress, fear, or guilt. Research in the Journal of Obsessive-Compulsive and Related Disorders backs this up. 

What that means is that the more you deny them, or don’t want these thoughts around, the stronger they become. It’s like that “don’t think of a pink elephant” example. (You just thought of a pink elephant.)

Sometimes there may be more going on that triggers these intrusions, such as depression, anxiety, PTSD, or OCD. And “letting them go” will seem impossible. So, the first critical step is to receive the correct diagnosis, because that will inform the right treatment for you. In the case of depression, for example, talk therapy may be recommended. 

But if you have OCD, traditional talk therapy can backfire and make OCD worse. Sometimes, even though your therapist is well-meaning, some of their suggestions for coping mechanisms on how to handle intrusive thoughts may actually create new compulsions. Or they may inadvertently give you reassurance, which just feeds the OCD.

So, think about your symptoms and seek out a diagnosis that feels right for you. “Many therapists aren’t qualified to diagnose OCD, and it’s important that you see a trained professional specializing in OCD treatment who can evaluate you,” says Willamson. Diagnosis is done via a semi-structured interview in order to investigate if OCD is present. 

They will often use the Yale-Brown Obsessive Compulsive Scale (Y-BCOS) or the Dimensional Obsessive-Compulsive Scale (DOCS) to make their assessment. Receiving treatment from a mental health clinician who specializes in your specific mental health disorder is incredibly important so you can get the correct care. 

If you do have OCD, the most successful treatment is a form of behavioral therapy called exposure and response prevention (ERP), which was developed specifically to treat OCD and is clinically proven to be highly effective in the majority of people. If you have PTSD and OCD—two disorders that may occur together—or an anxiety disorder, ERP therapy can also be valuable. 

For example, maybe a common intrusive thought is that by going to a grocery store, you’ll catch an illness. Williamson helps clients process these intrusive thoughts in a couple of ways. One is with uncertainty. Where OCD is looking for an absolute answer—100% assurance that you won’t catch a virus when shopping the aisles—you’re going to give it a question mark, she says. You’ll tell yourself something like, Maybe or maybe not will I get sick from running this errand. Another is acceptance. Yes, you might get sick, but you can go to the doctor if needed. Life is full of uncertainty, and you can learn to accept or even embrace it!

Most of the time something amazing happens as a result of this therapy: You won’t be riddled with distress from intrusive thoughts, images, sensations, feelings and/or urges. Your need to engage in compulsions goes away. And the things that matter the most to you won’t feel like they’re at risk of slipping away. You’ll be able to enjoy the fact that your parents can drive to your home to spend time with you, rather than avoid get-togethers entirely out of fear of an accident. 

Remember that intrusive thoughts are normal and they happen at some point to the majority of people. The best thing you can do is let them float on by—but sometimes that’s not possible. With mental health treatment, you can develop a better relationship with these thoughts so that you see them as being just there—not an intrusion in your life.