What if my intrusive thoughts are real?

It’s tempting to think you have full control over your thoughts. But in reality, thoughts come in and out of our brains all day long. According to a fascinating study, we have about 6,000 thoughts a day, and we don’t necessarily have a say in the matter. 

“We can’t control all of our thoughts, and sometimes our brains just put things out there that aren’t necessarily what we want but are just ideas,” says April Kilduff, MA, LCPC, LMHC, therapist and clinical trainer at NOCD.

Intrusive thoughts are a universal phenomenon—everyone has them. A 2014 research study interviewed university students across 15 sites in 13 countries spanning 6 continents, and found that nearly 94% of participants experienced at least one intrusive thought during the last three months. And plenty of other studies back up the findings that intrusive thoughts are ubiquitous.

So even if intrusive thoughts make you feel like you’re “weird” or abnormal, they’re actually something you have in common with everyone else around you, as odd as the thoughts can seem. But that doesn’t mean that the way they make you feel isn’t real—in fact, the way you respond to intrusive thoughts can mean a lot about your mental health. Keep reading to learn more about intrusive thoughts, the condition that can cause you to feel highly distressed over them, and how you can get help.

What are intrusive thoughts?

So, what exactly are these intrusions that nearly all of us experience? 

An intrusive thought is unwanted mental content that one usually finds uncomfortable, inappropriate, and/or disturbing. By definition, they are ego-dystonic. This means that they are out of alignment with your values, intentions, or beliefs.

For an estimated 2.3% of U.S. adults at some point in their lifetime, intrusive thoughts become highly distressing. For these individuals, intrusive thoughts are not just random, unimportant mental glitches. Instead, they can feel like serious threats to your values, safety, and identity, almost impossible to ignore. This distress is a major component of obsessive-compulsive disorder (OCD), a serious and highly misunderstood mental health condition.

What is OCD, and what does it have to do with intrusive thoughts?

OCD is a debilitating disorder. So much so that in some cases, it qualifies as a disability. It’s dubbed by some as the “doubting disorder,” as it can cause you to doubt even the things you were once most sure about. 

OCD is characterized by three primary components: 1) repetitive intrusive thoughts, images, urges, or sensations (known as obsessions), 2) extreme distress over those intrusions (panic, fear, anxiety, guilt, shame, embarrassment), and 3) mental or physical actions taken with the intent to relieve that distress (called compulsions). 

“OCD loves to come in and say, ‘Wait a minute, why did you have that thought? That must mean something,’” says Kilduff.

Despite popular belief, OCD can latch onto anything—not just a fear of germs, though that is one possible manifestation, called contamination OCD. The focus of one’s intrusions can also be about sex, sexuality, relationships, harming oneself or others, the meaning of life, and anything else that aims to contradict the sufferer’s values.

Obsession can take nearly any form. Here are some examples:

• Endless “what if?” questions, such as, what if I secretly want to stab my children? or what if I’m in denial about my true sexuality? or what if I don’t love my partner ‘enough’? 
• Uncomfortable/disturbing images, for example: kissing someone that would be considered taboo, such as a family member
• A physical sensation that is connected to your fears, such as a groinal response or a “lump in the throat” feeling
• A sudden urge to, for example, swerve your car off a bridge, break up with your partner, or cause harm to someone
• A feeling that you interpret as proving your fears are true. For example, disgust toward your partner (in the case of relationship OCD) or excitement when seeing children (someone with pedophilia OCD may interpret this as proof that they’re a pedophile)

It must be noted that people with OCD are no more likely than others to commit violence or other inappropriate acts they’re worried about. One might even argue that they’re less likely to commit these acts because they’re so terrified of them. Remember: people with OCD do not enjoy or want their intrusive thoughts—that’s what makes them intrusive.

But what if my intrusive thoughts are actually my real thoughts?

“It’s not uncommon for people with OCD to experience doubt over whether or not they even have OCD,” says Kilduff. “Instead, they’re worried that their intrusive thoughts truly mean something about who they are or what they want to do.”

Maybe you’re worried that your intrusive thoughts are ones you really want “deep down” or that they’re a “warning” of something bad to come. You’re worried that you’re the exception. Of course, with just about anything, there is always the possibility of your brain asking, What if?

In other words, we cannot be 100% certain of most things. However, you know now that by definition, intrusive thoughts are unwanted. Moreover, if you liked them, they probably wouldn’t be bringing you so much distress. Kilduff explains: “There’s a major difference between intrusive thoughts and thoughts that align with your actual values or intentions—and if you’re so worried about these thoughts, that’s a good sign that they are, indeed, intrusive.”

“Sometimes people can get caught up in whether the thought is coming from OCD or from their own mind, so sometimes I’ll have people change the language,” Kilduff says. “Instead of thinking But my mind keeps telling me I’m going to hurt someone, you can reframe it as I can acknowledge any thought I have and then move on with my life.”

How can I feel less fear about my intrusive thoughts?

The evidence-based, go-to treatment for OCD is a form of behavioral therapy called exposure and response prevention (ERP). Unlike traditional talk therapy, which can actually make OCD worse, ERP—which was developed specifically to treat OCD—is clinically proven to be highly effective in the majority of people.

ERP works by teaching your brain, through active therapy exercises, that your intrusive thoughts don’t have to wield any power over you, even when they’re uncomfortable or scary. You’ll also gain a greater tolerance for uncertainty throughout your life—even about your intrusive thoughts themselves. 

For example, if the thought that your intrusive thoughts could be real is causing you intense worry or anxiety, you’d work with a therapist to accept this uncertainty, rather than needing to know for sure that your intrusive thoughts are real or not. “In order to push past OCD, you have to accept uncertainty in life—which is what everybody else without OCD also accepts,” Kilduff explains. “It’s just that OCD makes it seem like it’s really, really important to get absolute certainty about your thoughts.”

Most of the time something amazing happens as a result of this therapy: you won’t be as disturbed by intrusive thoughts, images, or urges. Your need for absolute certainty goes away. And your values, identity, and sense of control won’t feel like they’re at risk of slipping away.