Somehow, the term “intrusive thoughts” have become mainstream. I can’t go a day on social media without hearing about people letting the intrusive thoughts win, or joking about intrusive thoughts they have when they’re all alone.
It’s easy to see why the word has become so misunderstood and co-opted by the public at large. A simple google search yields an array of definitions.
But, intrusive thoughts are no joke to people with Obsessive-Compulsive Disorder.
So, let’s clear the air, shall we?
When it comes to OCD, intrusive thoughts go beyond the odd thoughts that seem to come out of nowhere. They are more than just the random inappropriate thoughts that many people have. For people with OCD, these intrusive thoughts are both unexpected and unwanted. They are disturbing in nature, because they often feel connected to a very scary consequence.
Let me illustrate the difference.
Someone without OCD might have the intrusive thought of, “I’m chopping vegetables. What if I just decided to chop my finger off?” They might think, “Gross! … anyway!” and then they’d move on. The thoughts just bounce off their brains like Teflon, and slide away into irrelevance.
Someone with OCD might have that same intrusive thought: “What if I just decided to chop my finger off? Oh god. Why did I have that thought? Do I want to do that? Am I deranged? What’s wrong with me?”
So you can see that the thought isn’t in and of itself the issue– it’s everything that comes afterwards.
For individuals with OCD, the intrusions have meaning. They could feel like warnings: “That surface is disgusting. You’re gonna bring that into your house, and it’ll get everywhere.” They could feel like demands: “You need to do that again, or else you’re bringing bad luck to your family.” They could be images: images of yourself acting inappropriately towards your child. They could be feelings of guilt: “You’re a bad person for not confessing your thoughts.” They could even just be physical sensations: “I feel off. I gotta fix it.” An infamous example of a intrusive sensation is the groinal sensation. This is when people with sexual-themed OCD experience arousal nonconcordance, which is just a fancy word to describe the physical sensations associated with arousal in situations where you are not actually aroused.
When someone with OCD has intrusive thoughts, these thoughts are terrifying because they feel illogical. They seem to go against their values, morals, and common sense. These thoughts seem to justify a growing sense of doubt about your perceptions, your character, and your reality. This obsessional doubt is the nature of OCD and what sets it apart from other anxiety disorders.
Because of the disturbing and unwanted nature of these thoughts, individuals with OCD try to get rid of them or prevent them from happening in the first place. This is where compulsions come in to play. And unfortunately, because the brain likes to create shortcuts for us, it starts to link compulsions with these thoughts, and these thoughts with the feeling of danger.
So, it’s easy to see how OCD intrusive thoughts are qualitatively different from the types of intrusive thoughts that could be present in other mental health conditions, like depression or PTSD. As a clinician, it’s crucial to really go beyond just the surface diagnostic criteria. OCD is more than just not being able to stop thinking about something. It is more than just struggling to stop doing behaviors. Those with OCD experience a process where these intrusive thoughts turn into unwanted, disturbing, and consequential warnings.
If you’re suffering with OCD, there is hope. OCD is treatable. Many people with OCD are able to live lives where it is a nonfactor. If you’d like to work with a therapist, please check out the International OCD Foundation directory. You can also work with me 1:1 if you live in PA, CT, CA, or MO in the United States, or in the UK and parts of Europe.
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