Intrusive Thoughts and OCD

Most of us have heard about symptoms of Obsessive Compulsive Disorder relating to contamination and symmetry. A lesser known aspect of OCD (and anxiety) that I often see in my practice, is intrusive thoughts. Thought patterns that I am referring to are cognitions that are distressing and unwanted. Intrusive thoughts can manifest as images, urges, or impulses that seem to arise out of nowhere (Butterfield, 2019). Experiencing such thoughts are troublesome and tend to keep a cycle of anxiety at play, unless we gain more understanding, and know how to effectively manage them. This blog post will explain the most common types of intrusive thoughts and include some coping strategies to reduce the overwhelming feelings that accompany them. The most common intrusive thoughts relate to violence, sexuality, religion, self-doubt/ fear of making mistakes, and health related fears. Anyone can experience a random thought about these themes, but those with OCD (anxiety driven) intrusive thoughts struggle to dismiss such thoughts and often find themselves feeling guilty, ashamed, embarrassed, and fearful (Butterfield, 2019).

•Violent intrusive thoughts are those that are aggressive toward another person. There may also be a preoccupation that one will inadvertently cause harm to another individual. For instance, if a person is holding a knife, they may have the thought, “What if I stab this person in front of me?” (McAdam, 2022). Another example of someone experiencing violent intrusive thoughts might look like fearing they accidentally hit someone with their car. Clients often share that they did something in order to lessen the distress from these thoughts. Some examples include: hiding sharp objects and getting them out of sight so not to be tempted to use them, retracing the path they drove looking for signs that someone was hit or harmed by a car, or reviewing their actions in an effort to uncover any harm they may have inflicted on another person (Rosen, n.d.).

•Sexual thoughts that illicit fear and anxiety related to OCD are ones that contradict ones own values and morals. These thoughts, images, or fears are usually ones that are highly distressing in nature. This theme is often hard to discuss due to the sensitive topic and for fear of judgement. The images are often considered socially inappropriate and can involve deviant type behavior. It is important to note that people with intrusive OCD thoughts are actually less likely to act on their thoughts. The reason for this is because they do not take pleasure in the thoughts, but instead are repulsed by them.

•Religious thoughts also known as “scrupulosity” are intrusive thoughts that are distressing about religion or morality. There is great concern that one has committed the unpardonable sin, fear of blasphemy, fear of being possessed, fear of death, constantly trying to gain certainty about their beliefs, or striving for purity (Siev, 2022).These are some of the indications of scrupulosity but others can be included in this category if one repetitively ruminates on needing reassurance in this area. Scrupulosity often compels people to seek reassurance from religious leaders and others close to them, and can be triggered by faith-related content especially through media.

•Self-doubt/fear of making mistakes also known as “responsibility” OCD manifests with obsessions about making mistakes, negligence, or any decision that could cause an adverse outcome. Examples of this type of OCD include fears about saying something wrong, offending another person, or making a legal mistake. People with responsibility OCD may put off making decisions for fear of making a mistake. (Quick, 2022). Common triggers for “responsibility” OCD often manifest by observing or hearing about another person’s mistake or feeling one is being analyzed by others (Quick, 2022).

•Health fears related to intrusive thoughts include fear of having a serious or life-threatening medical condition. Thoughts associated with this type of OCD go beyond normal thinking, and include rumination about their health with no evidence to support the fear. This type of intrusive thought pattern often compels individuals to seek repetitive evaluations from medical professionals. The goal is to receive reassurance. This pattern may persist even after assessments have shown no cause for concern. Individuals with health related OCD often spend time online researching symptoms.

Tips For Managing Intrusive Thoughts:

1. Recognize the thought for what it is. When we realize that we are ruminating over a specific thought and we identify that it is theme related, we then can label it as an intrusive or OCD thought.

2. Allow the thought to exist and acknowledge it for what it is without judging yourself.

3. Continue doing whatever you were doing before the intrusive thought popped up. Allow the discomfort to be present but resist the urge to give the thought more attention.

4. Normalize that intrusive thoughts will come again, and remind yourself they are not based in reality.

5. If the first 4 tips do not provide the relief you are looking for, consider making an appointment with a therapist.

As distressing as intrusive thoughts are, they can be managed and you can feel empowered. These thoughts are not a predictor of your future behavior and they aren’t based in reality (Butterfield, 2019). These thought patterns represent some thoughts along with many other cognitions you experience.

Until Next Time,

Amy Shorter LPC MHSP

amyshorter.com

Butterfield, A. (2019, September 16). Intrusive thoughts. Retrieved from https://theocdandanxietycenter.com/intrusive-thoughts/

McAdam, E (2022, August 10). The six most common types of intrusive thoughts. Retrieved from https://therapyinanutshell.com/the-6-most-common-types-of-intrusive-thoughts/

Quick, S. (2022, December 29). Fear of making mistakes. Retrieved from https://www.treatmyocd.com/what-is-ocd/common-fears/fear-of-making-mistakes-ocd#

Rosen, A. What is harm OCD?. Retrieved from https://www.centerforanxietydisorders.com/what-is-harm-ocd/

Siev, J. (2022). What is OCD and scrupulosity? Retrieved from https://iocdf.org/faith-ocd/what-is-ocd-scrupulosity/