“Unwanted.” “Bizarre.” “Disturbing.”
These are just some of the words people commonly use to describe mental images, ideas, or urges that pop up out of nowhere, commonly known as intrusive thoughts. Researchers who have studied the phenomenon will likely use another word: “Common.” One such study found that 94% of people report experiencing them.
Many who’ve experienced intrusive thoughts might call them “meaningless” or “random,” as most people can easily shrug them off as nothing more than a weird mental glitch. But the 1-2% of people who have Obsessive-Compulsive Disorder (OCD) tend to use other words to convey their experience—”horrifying,” “scary,” “overwhelming,” and “distressing.” That’s because an inability to dismiss intrusive thoughts is one of OCD’s defining characteristics. It’s how they become obsessions—the “O” in OCD.
Aside from their persistence, one of the things that makes these intrusive thoughts so frightening is the fact that they’re what psychologists call “ego-dystonic,” meaning that they are in conflict with what we believe about ourselves and the world in general (e.g., a religiously devout person experiencing an upsetting sacrilegious image).
In this article, we’ll look at a very common concern among people with OCD: the fear that they’ll say their ego-dystonic, intrusive thoughts out loud.
Before we get into the likelihood of saying your intrusive thoughts out loud, let’s step back to gain a clearer understanding of OCD.
In the media, OCD is usually portrayed as a benign quirk, but in reality, there’s no limit to the ways OCD might present, with obsessions commonly centering around relationships, violence, existential doubts, and sexual themes.
People with OCD find it difficult to dismiss intrusive thoughts, finding them highly distressing and impossible to ignore. As a result, they engage in repetitive behaviors or mental acts—called compulsions—to temporarily relieve the anxiety that comes from their obsessions. Together, these obsessions and compulsions are distressing, take up time, and interfere with people’s day-to-day lives.
Being caught in the vicious cycle of OCD can often be debilitating and, when left untreated, can put sufferers at a greater risk of developing other mental disorders and even suicide. Sadly, OCD goes untreated far too often and for far too long. One recent study found that, on average, people suffer from OCD symptoms for nearly 13 years before they’re correctly diagnosed.
Now that we have a better understanding of the condition, let’s turn to the business at hand—assessing the likelihood of whether you’ll say your intrusive thoughts aloud.
Why do I worry about blurting out intrusive thoughts?
You might not worry too much about things like car accidents, plane crashes, getting cancer, or burning your house down. So why do you feel so anxious that you could say an intrusive thought out loud? After all, there are a lot of things you have less control over than the words you say.
In part, it comes down to the phrase we introduced earlier: ego-dystonic. Since intrusive thoughts often oppose your values, intentions, and identity, the slightest possibility that you could say them out loud feels dangerous.
In addition, many people believe that simply having intrusive thoughts must mean something about them. Why else would they occur? The fact is that your intrusive thoughts don’t mean anything at all about who you are or what you are likely to do or say. If anything, they’re evidence of the exact opposite, corresponding with the very things you would never intend to say out loud.
Will I say my intrusive thoughts out loud?
“Intrusive thoughts are just one of the many unpleasant parts of the human condition,” says NOCD Clinical Director Dr. Nicholas Farrell. “They’re particularly unpleasant for people with OCD because they’re worried about what these thoughts say about them and what they’ll be thought of should they ever escape their lips. However, the prospect of saying your intrusive thoughts out loud is highly unlikely. People in our field have found that having something extremely obscene or offensive on your mind—seemingly on the tip of your tongue—confers no risk of blurting it out.”
This is not to say, however, that it’s impossible for a person to say their intrusive thoughts out loud. Saying anything is possible—technically speaking—but that doesn’t mean that it’s likely. In fact, research has shown that people with OCD are no more likely to act impulsively than anyone else—they just feel outsized worry and anxiety about any slight possibility that something bad could happen. This is also supported by studies, which have shown that despite controlling their impulses as well as everyone else, people with OCD tend to believe that they’re more impulsive than others, even though that isn’t the case.
What this all means is that a fear of vocalizing one’s intrusive thoughts (often the very last things anyone would ever want to say) is a very common concern for people with OCD—a population that commonly underestimates their own capacity for impulse control in general. In reality, there’s no actual cause for worry. Rather, these fears can be addressed by learning to accept them and loosening their grip over time.
Dr. Farrell adds that a specific form of therapy known as exposure and response prevention (ERP) can be highly beneficial for people who fear blurting out intrusive, ego-dystonic thoughts. He explains that, through exposure exercises, people can gradually confront situations where they find themselves afraid of verbalizing unwanted thoughts and learn that they can trust themselves with their own behavior and intentions, even if they feel anxious sometimes. Let’s take a deeper dive into what people undergoing ERP can expect.
How specialized treatment may help
ERP is a widely used and highly effective therapy for people with OCD. Considered the “gold-standard” therapy for OCD, ERP is designed to help people confront their obsessions or distressing thoughts while refraining from performing compulsive behaviors. ERP works through exposure exercises, in which a person intentionally confronts situations or triggers that typically provoke anxiety, and then deliberately resist the urge to engage in compulsive behaviors that temporarily alleviate that anxiety but only make obsessions worse over time.
ERP has proven to be highly effective in helping people learn to manage OCD symptoms long-term. Numerous studies have shown that it can significantly reduce the severity of obsessions and compulsions, leading to improved daily functioning and a better quality of life in around two-thirds of people, often in a few months of regular sessions and homework.
ERP typically involves several steps:
- Assessment: You’ll begin by working with a therapist who specializes in OCD treatment. They’ll assess your obsessions and compulsions and how they impact your life. Understanding your unique triggers is crucial for creating a personalized ERP plan. Your therapist will work with you to create an exposure hierarchy —also known as a “fear hierarchy” or “fear ladder.” This is a list of scenarios you’ll rate from least distressing to most distressing.
- Goal-setting: You and your therapist will then set clear, achievable goals for treatment. These objectives will guide your progress and give you a sense of direction throughout the therapy process.
- Exposures: The core component of ERP involves exposure to situations, thoughts, or objects that trigger your OCD-related anxiety. This can be challenging at first, but a crucial step as your brain learns that these triggers are not as threatening as they seem.
- Response prevention: During exposure, you’ll also practice response prevention—as you may have guessed from the approach’s name. This means refraining from engaging in your usual compulsive behaviors or rituals. Doing this will break the cycle of anxiety and compulsions, allowing your brain to rewire its response patterns.
- Monitoring progress: You and your therapist will regularly review your progress toward the goals you initially set. This evaluation helps make adjustments to the treatment plan if needed. If you’re among the majority of people who benefit from ERP, it’ll also show you how far you’ve come.
- Support and guidance: Throughout the process, your therapist will provide support, guidance, and feedback. They’ll help you navigate difficult emotions and challenges that often arise during treatment.
ERP is a bold step towards regaining control over your life and finding relief from OCD symptoms. Your therapist will support you until you’ve conquered your OCD fears—including the worries you have about blurting out your intrusive thoughts.