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Understanding and Managing Common Obsessive Thoughts in OCD

When I say, "obsession," what comes to mind? Probably things you like!

"I'm obsessed with the show Only Murderers in the Building."

"Baking is my latest obsession."

"I'm obsessed with my partner."

But when we're talking about OCD, obsessions are actually a person's worst nightmare. Obsessions can come in the form of unwanted thoughts, images or urges that go against a person's values.

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.

Obsession or Intrusive Thought?

We often refer to obsessions as intrusive thoughts, but obsessions really are born from doubting whether or not an intrusive thought means something. Depending on the research, most stats indicate that just about every human has random intrusive thoughts. The difference is that those with OCD panic in fear that they mean something about their character or reflect reality.

The short answer: they don't mean anything.

Why do intrusive thoughts lead to compulsions?

The long answer is that sometimes brains send random thoughts to see if it's an actual threat. The way we respond to the thought is how our brain decides it was a good alarm to send. And in when someone has OCD, compulsions quickly follow the intrusive thought. This is due to that doubt of the thought being true. The unfortunate thing is that this confirms to your brain that the threat was a great alarm to send! If it wasn't a real threat, you wouldn't have responded to it.

This is why so much of OCD treatment is focused on changing how you respond to intrusive thoughts.

So what are some common obsessions?

While the content of obsessions aren't going to change the diagnosis, it can be helpful to have terminology for the themes of thoughts OCD sufferers have. This can start chipping away at shame, and will likely inform some of treatment.

Harm Themes:

These obsessions include fears of harming other people, either on purpose or accidentally. Think stabbing, pushing, strangling, etc.

Suicidal Themes:

These are different from actually being suicidal. Instead, suicidal obsessions are more of a fear of becoming suicidal or fear of hurting oneself.

Religious (Scrupulosity):

In this theme, there are thoughts that go against a person's faith and fear of offending their Higher Power. They often include fear of blaspheming, fear of going to hell, possession, and committing the unforgivable sin.


This theme surrounds the "rightness" of a relationship. Thoughts commonly sound like, "What if they're not the one for me?" "What if we divorce in the future?" "What if I don't love them enough (or vice versa)?"


This is one of the themes you've probably heard of. This theme includes fears of being contaminated by germs, illness, or even emotions.


These obsessions are often around the purpose of life and can also include questions around the afterlife. They can also include feeling disconnected from your body.

Sexual Themes:

In this theme, there is fear of acting inappropriately or being sexually deviant in some way.


These doubt a person's identity that they've known themselves to be. Thoughts often sound like, "What if I'm bi-sexual and don't know it?" "What if I'm not actually my trans identity?"

False Memory/Real Event Themes:

When a person has OCD, they'll often replay past events over and over. This is the real event theme. What this does is mess with the actual memory, and that's when false memory OCD is born. This is when the brain convinces itself that something actually happened, that didn't.

What do I do about my intrusive thoughts?

While intrusive thoughts can cause intense distress, there is effective treatment out there that can significantly reduce their anxiety as well as the compulsions. If these obsessions sound familiar, Inference-based Cognitive Behavioral Therapy, Acceptance-Commitment Therapy, and/or Exposure-Response Prevention will likely be a great help.

Reach out to a local therapist offering one or all of these, or click the button below to schedule a free consultation call if you are located in Washington State.

Moral of the story, intrusive thoughts are common and obsessions are scary, BUT there is effective treatment that can significantly help. Don't give up on that.

All the best,

Lauren Spencer, MS, LMFT

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