Understand and Learn How to Stop Intrusive Thoughts

What are intrusive thoughts?

Intrusive thoughts are unwanted thoughts that can cause you distress, disturb or repulse you, they may even make you worried that you are a terrible person, capable of doing things that go against your character.

They can occur due to OCD, post-traumatic stress disorder or other mental health conditions.

With the current pandemic you may find that you have unwanted thoughts relating to Covid-19. It is crucial that you are aware of how to stay safe, but you also want to make sure that coronavirus is not dominating your thought processes. You might find it useful to read the following article on coronavirus and OCD.

Who gets intrusive thoughts?

All of us have experienced unwanted thoughts before, and not taken much notice of them. However, intrusive thoughts can impact a person’s life when they are part of mental health conditions. You can experience intrusive thoughts with the following mental health conditions.

Obsessive-Compulsive Disorder OCD
People with OCD experience intrusive thinking when they are thinking, for example, did I lock the door, have I done something terrible in the past?
Post-partum depression
You may experience postpartum OCD with anxiety-related thoughts that make you think that you could harm your baby, which cause intense distress.
Post-traumatic Stress Disorder PTSD
The mental flashbacks associated with post-traumatic stress, are one of the significant symptoms of PTSD

How are they diagnosed?

If you meet with a mental health professional, they will undertake a complete assessment of your presenting problem to provide you with a diagnosis. This diagnosis is to formulate a plan of treatment.

The psychologist or physiatrist will ask you a series of questions to determine, for example, if your unwanted thoughts are occurring due to a specific mental health condition, such as OCD.

There are two main manuals that a clinician may refer to for diagnostic criteria

• International Classification of Diseases; ICD¹
• Diagnostic and Statistical Manual of Mental Disorders; DSM²

In my own career, I would have referred to the DSM, and in according to DSM obsessions are

• Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance as intrusive and inappropriate, and that cause marked anxiety and distress.
• The person attempts to suppress or ignore such thoughts, impulses, or images or to neutralize them with some other thought or action.

If, for example, your diagnosis is that your intrusive thoughts are occurring due to having Obsessive-Compulsive Disorder, your clinician can then devise treatment based on the diagnosis of OCD.

Examples of Intrusive Thoughts

Disturbing sexual thoughts

These can include thoughts or mental images of violent sexual acts, sex with inappropriate people or things, questioning your own sexual identity or any idea of a sexual nature that cause you distress.

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These type of thoughts can be extremely distressing as arousal is usually involved. Even though you have not carried out the act, the idea of it may cause you to feel aroused.

Arousal does not mean that it is true; it is a normal physiological response.
However, most people with these types of thoughts, mistakenly believe that if they experience arousal that this must mean that the thoughts are real.

Unwanted Thoughts regarding children

These types of intrusive thoughts or mental images are incredibly distressing as you may be having unwanted thoughts that you could harm a child in some way. This can include unwanted thoughts that you could cause harm to your child.

These types of thoughts can occur in postpartum depression and are part of mental illness, as opposed to reflecting you as a person.

Read more on Postpartum OCD and also POCD

Aggressive thoughts that disturb

These may involve causing harm to yourself or others. Again, these thoughts are distressing as they may include the fear that you may hurt someone, even though you have probably never hurt someone in your life.

It can consist of an impulse to be aggressive to someone verbally or causing physical bodily harm. This does not mean you will carry this out, instead see it as one of the symptoms of OCD

https://moodsmith.com/wp-content/uploads/2020/03/CBT-for-intrusive-thoughts-knives-2.mp4

Religious thoughts that disturb

These include inappropriate sexual thoughts regarding religious people or figures. Swearing during prayer or worship. Strong urges to misbehave during services.
Most people that I work with find it difficult to see these as harmless thoughts. They are more than likely to see them as some sort of sign that something must be wrong with them to have such ideas.
Or even start to believe the thoughts – “Why would I be having them if I haven’t done ……..?” They are just thoughts.

Intrusive Thoughts regarding your sexuality identity

Many people have unwanted intrusive thoughts that make them question their sexual orientation. This is not the same as someone who knows that they are attracted to the same sex. If you have intrusive thoughts regarding your sexual orientation, you still are heterosexual, but due to the beliefs, you may begin to suffer from doubts. It is known as Homosexual OCD, and I have a detailed post on HOCD here.

Intrusive Thoughts regarding your relationship

You might find that you obsess about your relationship. If you experience this type of intrusive thought, it has nothing to do with the quality of your relationship or how suitable your partner is for you.

Instead, the thoughts you have about your relationship are to do with the obsessions and compulsion that occur within Relationship OCD.

Involuntary regarding family members

These can include thoughts relating to;

• kissing members of your own family.
• Sexualised thoughts regarding family members.
• Intrusive images of family members, for example, naked.
• “What if I am attracted to my sister, my brother?” etc.

Intrusive Thoughts about death

This can include being constantly worried about death, that your heart could give up at any given time. It can also include distressing images of death, either you own or someone you care about.

Needing certainty around safety issues

It is normal to worry about your kids and family when they are not with you. Still, you might find that you worry excessively and experience intrusive thoughts and images concerning their safety. These can include
Thinking that they have had an accident when you have no real reason to believe this.
Thinking that they could come to harm or hurt themselves.
These type of thoughts may make you seek reassurance regarding their safety. You might tell people you care about to send a message or call you when they reach their destination or to message when they are leaving to come home.

Are Intrusive Thoughts Normal?

In a word, yes! Everyone gets intrusive thoughts; I get them. The problem is not in the thought itself, but instead what you do with it.

For example, if I get a random thought that I could do something that I consider wrong; if I just carry on with what I am doing and pay no attention, I won’t be bothered by the thought.

https://moodsmith.com/wp-content/uploads/2020/03/Intrusive-thoughts-and-your-brain.mp4

Whereas, if I start to wonder why I got the thought, what does it say about me, what if I carry it out? Then I am adding ‘meat’ to the idea. I am starting to create a narrative in my brain.

You will not have intrusive positive thoughts that stick; what will make you anxious are the negative thoughts.

Bad thoughts

Why are my Intrusive Thoughts about ‘bad things’?

I think the best way for me to answer this is to do it in two parts;

• what things are important to you, and
• how much attention you pay to the thought.

Intrusive thoughts latch on to the things that are important to you. For example, I adore animals, if the idea popped into my head that I could harm an animal, this would certainly grab my attention, as it would shake my values to their core and cause me untold amounts of anxiety.

I could have several unwanted involuntary thoughts in my head, but most will go unnoticed. The ones that go against my core values will stick out from the rest. If you get an unwanted thought that goes against your core values, you will probably feel something, such as fear, disgust, anxiety or alarm. These strong negative emotions makes the idea appear stronger than it is.

So to answer the first part of why the thoughts are about bad things, it is essential to note that it is different from person to person. It is what you consider bad; what would attack your core values.

Someone else could have the thought about harming animals, and it might slip under the radar for them, as they might be into hunting. As such, an animal being hurt may not give the same fear response that I would get. So this thought may never become intrusive for them.

The only difference between an intrusive thought that pops into your head and then leaves, and an intrusive thought that is distressing, is how you respond to it.

To finish answering why the thoughts are about bad things, you also need to attend to them. When I say ‘attend to them’ it is sort of like planting a flower, if you leave it alone, it will die and wither, but if you tend to it, water it and feed it, it will survive and flourish.

dr Elaine Ryan

Once a thought strikes your core values, if you leave it alone, it will wither and die, but if you pay attention to it; think about it, analyse, give it special attention amongst all the other thoughts, it will become stronger.

Hence when I am working with people with Intrusive Thoughts, I aim to get them to disregard the thought and not add fuel to the fire, or maybe I should say fertiliser to the soil to continue with the flower example.

The vital point to note is that it is not the thought that is the problem, rather the problem arises with what you do with the thought, how much you feed it.

How do they start?

Take a moment and think about the different kinds of thoughts that can wander through your mind. If you find yourself in work, at a meeting and your mind wanders onto “Did I turn the dishwasher on…. What will I have for dinner…?” you will not pay too much attention to this.

However, if you are going about your daily business and a thought of a sexual nature that you consider disgusting or obscene pops into your head, you will pay this serious attention as it will not be just neutral.

By not neutral, I mean, it will probably make you feel something in your body.
You might feel anxious, embarrassed, feel your face go red, screw your face up as if somehow you can shake the thought. You get a small stress response the first time it happens. So what does this do? This feeling of anxiety in combination with the thought, might be enough for your brain to mark this as a threat.
Read more on how thoughts become intrusive

OCD and Intrusive Thoughts

Intrusive Thoughts are part of OCD and have both obsessions and compulsions. The obsessions are the unwanted thoughts and images in your head, relating to the particular type of intrusive thoughts that you get and the compulsions are the things you do to try to cope with the thought.

I will give some examples; I have not included HOCD in this list as I have detailed the obsessions and compulsions in relation to HOCD here

Obsessions

In relation to harm

• What if I hurt someone?
• What if I stab someone?

In relation to children?

• What if I hurt my child?
• What if I look at them wrong?
• Am I a paedohpile?

In relation to God?

• What if I say something inappropriate?
• Thoughts that you consider offensive and disturbing

Compulsions

The compulsions fall into two categories
Overt
Those that I could see if I were with you, such as removing knives, or avoiding a kid’s birthday party, asking for reassurance, and
Covert
The things you do that I would not be able to see, such as analysing everything inside your head.

In relation to harm

• Moving knives etc. out of your reach
• Analysing your thoughts in your head
• Avoiding people in case you are capable of something bad

In relation to children

• Not changing or undressing your child
• Avoiding being around children

In relation to God

• Avoiding church services
• Penance for your thoughts

Urges and unwanted thoughts

The urges are the same as the thoughts; they are both a symptom, in that they fall under the umbrella of obsessions. An urge is an obsession.

Typical urges experienced in OCD and Intrusive Thoughts

• Touch someone inappropriately
• Want to kiss someone, this can include kissing someone that would seem inappropriate, such as members of your own family, members of the same sex (if you are heterosexual)
• to hurt someone that you care about
• To confess to something that you haven’t done

The urges that you get depend on what you hold dear; what you value most. Intrusive Thoughts, including the urges that you get, tend to go after your value base – the things that you would never do.

Urges can also include the urge to carry out a compulsion, e.g. If you get the thought that you could hurt someone else, you might have the urge to remove all implements that could cause harm.

Or if you falsely believe that you are a bad person and have done something bad, you might have the urge to confess.

Are the urges different than the thoughts?
No, both the urges and the thoughts are, in fact obsessions.

Examples of how obsessions and compulsions work together in unwanted thoughts

An important point to note before you read the following examples if you recognise yourself in any of the scenarios, that does not mean that you are a bad person; you are having intrusive thoughts. The following article might be useful to read when you finish this page; Am I a bad person for having intrusive thoughts?

Obsessions and compulsions in relation to harm

Harm towards others
Example: Sitting in a room and notice the “tie-back” on the curtains and suddenly think “I could strangle someone with that.” Thoughts and images relating to this are the obsessions. They usually come in relation to people that you care about and would never want to harm in any way.

To make sure that you never hurt the people that you love, you might remove the ‘tie-back’ from the curtains and store it away. You could also remove anything that is ‘rope-like’ that could be used to cause harm to others – just in case.

You could also try to reassure yourself, by going over all instances in your head, looking for evidence that either you would never hurt the people you care about or are indeed capable of causing harm.

Removing the tie backs and the analysis inside your head are the compulsions. They serve to sort of ‘neutralise” the stressful thoughts you are having, and you carry them out to protect the people that you love, and to make sure you never carry out your thoughts.

Harm towards yourself
Having intrusive thoughts about causing harm to yourself is different from suicidal thoughts. Suicidal thoughts are when the person wishes to end their life. If this is you, this page is not suitable for you, and there are a list of contact numbers here.

If you are having intrusive thoughts about harm relating to yourself, you could well have a good life and are happy enough and have no intention of wanting it to end, but still, the thoughts persist.

Example: Standing waiting on a train and think “I could jump off just as the train approaches.” This is an unwanted intrusive thought about harming yourself. You might start to worry, is there something wrong with me, what type of person am I, that I could do that to my family? These are the obsessions.

If you keep having these thoughts, you might stop using the train and find another mode of transport, or stand well back from the train tracks. These are the compulsions you carry out to keep yourself safe, just in case you cannot resist the urge to jump.

Obsessions and compulsions in relation to religion.
Example: Unwanted random thoughts such as those mocking God, mocking your religious beliefs, involving the devil, or any form of worship that goes against you and your beliefs. These obsessional thoughts can shake you to your core, and of course, you will do something to try to restore your faith, or to protect others in your congregation (if you believe the thoughts.)

Treatment for Intrusive Thoughts

If you have read about me, you shall know that I am a Dr of psychology who specialises in anxiety disorders. I work a lot with people who have disturbing thoughts and recommend the following type of treatment program.

Whether you choose to start my online program or work with another therapist, if you want to overcome intrusive thoughts you need to do the following;

https://moodsmith.com/wp-content/uploads/2020/03/intrusive-thoughts-how-to-get-the-best-from-your-c-1.mp4

• Learn to accept your thoughts
• Take the thoughts less personally
• Take the fear out of your thoughts, and
• Stop changing your behaviours

Learning to accept your thoughts

How to learn to accept your thoughts

I use mindfulness and acceptance and commitment therapy strategies to help you to accept your thought process. You have probably come across this phrase before ‘accept your thoughts’ so I shall take a second and explain why this is helpful.

Why is this important?

At the moment if you are suffering, you are not able to accept the thoughts as ‘just a thought.’ You are reacting to them as if they are real, or worried that you might act on the thoughts and cause some harm either morally, to yourself or someone else. You probably have developed several ways to cope with your thoughts, which may include avoiding things or avoiding your thoughts.

Learning to accept your thoughts helps to stop thought action fusion

This is where you believe that thinking about something makes it more likely to happen

Once you have been taught to accept them, with practice, the thoughts shall no longer mean anything to you. The reason why they keep popping into your mind at the moment is that you shine a spotlight on them, trying to figure out what they mean, trying to avoid them and adopting various tactics to make sure you do no harm. Your brain has decided ‘this is something we need to pay serious attention to.’

Further Reading

• CBT for Intrusive Thoughts
• ERP for Intrusive Thoughts

Take the thoughts less personally

You need to be taught that the thoughts do not mean anything about you as you a person

Take the fear out of your thoughts

Having an emotional reaction to the content of your thoughts keeps the unwanted thought alive in your mind. When you can let the thought come into your mind, and your feelings are not affected, the thoughts start to lose their power.

Stop changing your behaviours

You might have changed the way you exist in the world, to prevent you from causing some sort of harm (concerning your thoughts.) for example

If you have intrusive thoughts regarding knives, you might have moved the knives in your kitchen, or

If you experience intrusive thoughts regarding children, you might avoid children parties, or are extra careful with how you look at a child or are uncomfortable bathing and dressing children. or

If you have unwanted thoughts regarding your sexuality, you may avoid people, places or things that trigger your thoughts.

You need to learn to stop doing this, as even though the strategies that you have developed help you in the short term, they are not effective long term, as they only serve to keep this cycle going.

Cognitive Behavioural Therapy, in addition to mindfulness-based approaches, combined with relaxation training, will help you to achieve this and all are included in my course.

Further reading

• ADAA
• MIND

Diagnostic Manuals

• International Statistical Classification of Diseases and Related Health Problems (11th ed,; ICD-11; World Health Organization, 2019).
• Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013).