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Intrusive Thoughts: What are they and how do they relate to OCD?

You're going about your day and then bam, out of nowhere, a startling, scary, unwanted thought pops into your brain. "What if you're gay?" "What if you don't love your husband?" "What if you grabbed a knife and cut yourself?" "What if God is sending you to hell?"


You find yourself wondering where the intrusive thought came from, why it showed up, and what if it's true? But at the same time, you're incredibly confused because you don't have the desire for any of those things to happen or be true. And now you're anxious, distressed, and trying to answer all of those questions for yourself.


So what do intrusive thoughts mean? Well, in short, they mean you're human. But they might also indicate you're dealing with Obsessive-Compulsive Disorder (OCD).

Woman thinking

Disclaimer: This post is not intended as therapy, nor is it a replacement for mental health treatment. It should not be considered professional, medical advice for any one individual and is not intended to diagnose or treat any mental health condition, and does not create a clinician/client relationship. If in crisis, call 911 or go to local ER. See full disclosure statement here.


What Are Intrusive Thoughts?


Intrusive thoughts can come in the form of words, images, or urges that you experience as unwanted. These often start with, "What if," "Maybe," or sound like demands, "Check the door." Distressing images also fall under the intrusive thoughts category.


While most every human experiences intrusive thoughts, the vast majority of people barely even notice when they occur. And if they do notice their presence, they are able to easily and quickly move on. But for some people, intrusive thoughts feel loud and scary and become extremely repetitive. That's when we're probably looking at OCD (read more here).


Intrusive Thoughts and OCD


Intrusive thoughts make up half of the equation for an OCD diagnosis. When intrusive thoughts stick around and cause significant anxiety, that's when we start categorizing them as obsessions. These obsessions generally latch onto what you care about most. For example, someone who adores children (and has OCD) is more likely to have intrusive thoughts about harming a child. Someone who loves their partner beyond words is likely to have obsessions about what if they get divorced some day? A person who highly values their faith may fear God condemning them. I could go on and on with these.


Once we've noted significant presence of intrusive thoughts, we then look for what you're doing in response to those obsessional thoughts. Are you trying to make them go away by neutralizing them? Are you checking if they're true or could really happen? Maybe you find yourself asking other people (or Google) what they think the thoughts mean. It may come as a surprise, but all of the above behaviors are considered compulsions. Compulsions are not just visible actions like checking locks and washing your hands, but also mental acts.


Compulsions are done in effort to bring down the anxiety caused by the intrusive thought (obsessions). When obsessions and compulsions are causing significant distress and taking up a LOT of your time, an OCD diagnosis is very likely. We assess these symptoms using something called the YBOCS, which measures how significant your symptoms are. This is what would officially get you to an OCD diagnosis.


How do I Get Rid of Intrusive Thoughts?


The short answer to this question is that you don't get rid of them. I know it's not what anyone wants to hear, but in reality, the intrusive thoughts aren't the problem. It's the meaning you're giving them that is causing the distress.


When we give a thought importance (by doing a compulsion), we're telling our brain that the alarm it's sending out is accurate! But really, a thought is just a thought. If we can retrain your brain to not doubt whether or not an


intrusive thought is important, your distress levels will plummet. And you'll get back all the time you'd been losing to trying to figure out the thoughts.


This can be done through three therapy styles: Inference-based CBT, Acceptance-Commitment Therapy, and Exposure-Response Prevention.


What do I do Next?


If you're tired of intrusive thoughts ruining your day, I'd highly suggest you reach out to an OCD specialist offering one of the above treatments. And as always, feel free to reach out today to schedule a free consultation call with me.


Businesswoman smiling

All the best,

Lauren Spencer, MS, LMFT

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