Understanding and recovery from Intrusive Thoughts

Written by Dr Elaine Ryan Founder of MoodSmith Psychologist

Table of Contents

What are intrusive thoughts?

Intrusive Thoughts is another phrase for the obsessions that exist within Obsessive-Compulsive Disorder. The obsessive thoughts may be of a sexual nature, aggressive, religious, or anything that disturbs you. The thoughts stick around, not only because they alarm you, but because they attack your sense of self, your identity, and your core values. This article will explain, give examples of intrusive thoughts and show you how to stop them.

Start with self-help

Self-help is where you work alone without meeting with a therapist. .

Therapy

If self-help did not work the next step is sessions with a psychologist.

Medication

You might need medication which can be prescribed by a psychiatrist.

The Latin root of the word ‘obsessed’ means to besiege. If you are suffering from Intrusive Thoughts, you are surrounded by distressing thoughts, which you eventually obsess about. They effectively become intruders in your everyday life.


The following image might illustrate this better. The thoughts initially do not belong to you but are catapulted into your thought stream. What you do with them next depends on whether they become unwelcome intruders in your life.

 

If you can bat them away or ignore them, they will never take hold of your mind. If you worry about the thoughts or believe in them, if they threaten your identity, these thoughts may intrude on your daily life. 

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?

Postpartum depression

You may experience postpartum OCD with anxiety-related thoughts that make you think you could harm your baby, which causes intense distress.

Post-traumatic Stress Disorder PTSD

The mental flashbacks associated with post-traumatic stress are one of the significant symptoms of PTSD.

How do I know if I have intrusive thoughts?

It is advisable to meet with your doctor or a licensed mental health professional to get a correct diagnosis. Getting a diagnosis and understanding why the thoughts occur can be the basis of a treatment plan. 

Suppose you meet with a mental health professional. In that case, 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 because of 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; ICD1.1
  • Diagnostic and Statistical Manual of Mental Disorders; DSM2.
  •  

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

  • Recurrent and persistent thoughts urges, or images experienced 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 neutralise them with some other thought or action.
 

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

 

Will the thoughts stick around?

it depends on how you react to them

What causes intrusive thoughts

Most people I work with wish to know why they have intrusive thoughts. I want to begin by stating that they do not reflect on you as a person.

 

Random thoughts bombard everyone’s mind all the time. We all get them; I get them. 

 

I watched TV last night and had a random thought that my living room would be better without curtains. Then I saw a large tree on the television and thought, ‘that would be a good place for a hanging.’ Both are random thoughts that I had no control over while watching TV, but one might become intrusive.

 

The thought itself is not the problem; how you react to it is a problem.

In the paragraph above, what thought grabbed your attention most?

 

  • Random thought one living room better without curtains
  • Random thought two large trees would be suitable for a hanging

 

I’m guessing you thought number 2 (large tree would be a good place for hanging) as this would disturb you more than whether my living room had curtains! 

 

You could quickly think, the second thought could lead to harm, or it suggests something about you as a person. This judgment makes random thoughts more likely to stick in your mind and become intrusive or obsessive.

 

A random thought that becomes intrusive is one that was so disturbing; you could not ignore it. Like an unexpected visitor who calls to your home and becomes an unwelcome guest. 

 

 

If someone calls to your home and you choose not to answer, they don’t get in. If, however, you open the door and they overstay their welcome and take over your home. It’s hard to not only get them out of your mind but also out of your home.

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 sexual idea that cause you distress.

These types of thoughts can be distressing, as arousal is 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.

 

Would you like my help

Stop intrusive thoughts

If you would like my help, I have a discreet online course that is available to start right away, Dr Elaine Ryan

Unwanted Thoughts regarding children

These intrusive thoughts or mental images are distressing, as you may have unwanted thoughts that could harm a child somehow. 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 instead of reflecting on 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 comprise an impulse to be aggressive to someone or causing physical harm. This does not mean you will carry this out, instead see it as one symptom of OCD.

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 sign that something must be wrong with them to have such ideas.

Or even believe the thoughts–“Why would I be having them if I haven’t done……..?” They are just thoughts.

Read more on Religious OCD

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. Suppose you have intrusive thoughts regarding your sexual orientation. In that case, you still are heterosexual, but you may suffer from doubts because of the beliefs. 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. Suppose you experience this type of intrusive thought. In that case, it has nothing to do with your relationship’s quality 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 worried about death, which your heart could give up. 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 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 types of thoughts may make you seek reassurance regarding their safety. You might tell people you care about sending a message or calling you when they reach their destination or to message when they are leaving to come home.

 

 

Will they ever go away?

 

Thoughts that become obsessive or intrusive that cause you distress can go away with the proper treatment.

Learning not to react to the thought as if it is true deprives it of attention, and it loses its power. You are less likely to think it, or if you do, it does not disturb or frighten you anymore.

What treatments are available for intrusive thoughts?

If you are ready to start treatment, the most successful treatments include Cognitive Behavioural Therapy; CBT and Exposure Response Prevention; ERP.

You can start with self help, or meet with a licensed mental health professional for face to face therapy.

Options available to you to help you stop intrusive thoughts.

 

I would recommend a stepped care approach to treatment, where you start with the least intervention, as outlined below.

 

Start with self-help

Self-help is where you work alone without meeting with a therapist. .

Therapy

If self-help did not work the next step is sessions with a psychologist.

Medication

You might need medication which can be prescribed by a psychiatrist.

Start with Self Help
I have an online course that is based on my private practice to help stop intrusive thoughts

Regardless of whether you want to start with my course, self-help may be enough for many people and a more cost-effective option than individual therapy. 

If you cannot work on your own or self-help did not work for you, face-to-face therapy is your next option.

I would recommend working with a psychologist rather than having general counselling, as their training may be more suitable for your needs.

Important. If you have intrusive thoughts, there will be things you do that are best addressed by specific therapy models, which I shall explain to you now.

 

 

 

stop intrusive thoughts image showing moodsmith instructions on label and move on

The most critical steps to stop intrusive thoughts

Step 1. Dedicating time to the thought

If you analyse your thoughts, wondering why you have them, what it says about you as a person, there are models of therapy that will help you stop doing this.

Why do you need to stop doing this?

Thoughts need the energy to survive. Acceptance and Commitment Therapy works well for this as it teaches you to label the thought and move on.

You can do this right now, although it takes practice. Next time you have an intrusive thought, rather than dedicating time to it, label it as just as thought and move your attention away from it. Try it now.

 

Decide on your label. You can use a label such as.

  • there’s an intrusive thought
  • its just a thought

Don’t push the thought away; this does not work. The more you tell yourself to stop thinking about something, the more likely you will think about it. Try this for yourself. Don’t think about your favourite food for one minute. This might be desserts, pie, steak, whatever it is, do not think about it.

Did you notice an increase in saliva? If you did, not only did you think about the thought, but you changed your physiology, as your body is now preparing for food!

Keep labelling; there’s a thought, and move on.

Step 2. How to learn to accept your thoughts

I use mindfulness and acceptance, and commitment therapy strategies to help you accept your thought process. You have 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 cannot accept intrusive thoughts as ‘just a thought.’ You react to them as real or worried that you might act on the thoughts and cause some harm either to yourself or someone else. You have developed several ways to cope with your thoughts, including avoiding things or avoiding your thoughts.

Learning to accept your thoughts helps to stop the 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, the thoughts shall no longer mean anything to you with practice. The reason 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 not harm. Your brain has decided, ‘this is something we need to pay serious attention to.’ Learning to label them and move on helps to stop this.

Step 3 Stop doing things differently.

To cope, you now do things differently. You might avoid things you believe trigger your thoughts, or you might find that you engage in things to make you feel better. These are known as compulsions.

Behavioural therapy will help you with this, for example, CBT and ERP.

Why do I need to do this?

It’s unnecessary. The only purpose it serves is to make you feel better temporarily. If this strategy worked, you would not be reading this page, as the thoughts would be gone.

Stop changing your behaviours.

You might have changed the way you exist in the world to prevent you from causing some 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.

It would be best if you learned to stop doing this, as even though the strategies you have developed help you in the short term, they are not effective long term, as they only keep this cycle going.

Cognitive Behavioural Therapy, in addition to mindfulness-based approaches, combined with relaxation training, will help you achieve this.

Step 4 Take the thoughts less personally.

It would be best if you were taught that thoughts do not mean anything about you as a person.

Step 5 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 lose their power.

 

 

Are intrusive thoughts normal?

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

For example, if I get a random thought I could do something that I consider bad, if I just carry on with what I am doing and pay no attention, the thought won’t bother me.

Whereas, if I 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 thought. I am creating a narrative in my brain.

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.

Why are the 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 latches on to the things that are important to you. For example, I adore animals, if the thought 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.

I could have several uninvited thoughts in my head, but most will go unnoticed. The ones that go against my core values, will stick out from the rest. I mentioned at the start of this article that we all have these types of thoughts, but some we pay more attention to than others and what values you hold, can play a role in this.

If you get an unwanted thought that goes against your core values, you will probably feel something, such as fear, disgust or alarm. These strong negative emotions makes the thought appear stronger than it really is.

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

Another person could have the thought about harming animals, and it might slip under the radar for them, as they might be into hunting, and therefore not get the same fear response that I would get in relation to an animal being hurt so this thought may never become intrusive for them.

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.

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, my aim is 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 important 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.

Urges

The urges are exactly 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.

How to manage urges that come from having Intrusive Thoughts.

There are different treatment models, but I find that using Acceptance and Commitment Therapy (ACT) works well for managing urges. ACT is included in my online course.

The problem arises when you pay too much attention to the urge. For example, lets say you are very religious and had the urge to shout out something obscene during your religious service.

The more you focus on this urge the stronger it becomes. This is because you are paying attention to it, giving it some importance.

A contact with a trigger can create an urge, for example, if you already have experienced intrusive sexualised thoughts with someone that you consider inappropriate, you might be in their company and experience an urge to touch them or kiss them.

This does not mean that you are being immoral in any way, it just means that something has triggered your intrusive thoughts. Remember your intrusive thoughts will go after those things that you hold dear and value most.
 

Recap

Any random thought can become intrusive, if it disturbs you or you change how you react based on the content of the thought. Having a good understanding of what is happening puts you in control and ready to take steps to overcome the intrusive thought. 

Should you wish to continue reading my articles, you can find more on the subject here.

Further reading

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).

Sources

Rebetez, M. M. L., Rochat, L., Barsics, C., & Van der Linden, M. (2018). Procrastination as a Self-Regulation Failure: The Role of Impulsivity and Intrusive Thoughts. Psychological Reports121(1), 26–41. https://doi.org/10.1177/0033294117720695

Simone Kühn, Florian Schmiedek, Annette Brose, Björn H. Schott, Ulman Lindenberger, Martin Lövden, The neural representation of intrusive thoughts, Social Cognitive and Affective Neuroscience, Volume 8, Issue 6, August 2013, Pages 688–693, https://doi.org/10.1093/scan/nss047

Collardeau, F., Corbyn, B., Abramowitz, J. et al. Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: study protocol. BMC Psychiatry 19, 94 (2019). https://doi.org/10.1186/s12888-019-2067-x

Arnáez, S., García-Soriano, G., López-Santiago, J., & Belloch, A. (2021). Illness-related intrusive thoughts and illness anxiety disorder. Psychology and Psychotherapy: Theory, Research and Practice94(1), 63–80. https://doi.org/10.1111/papt.12267