Intrusive thoughts: when is it OCD?
A sudden image of pushing someone off a platform. A thought that you might have left the hob on and the house will burn down. A flash of something sexual or blasphemous that horrifies you. Thoughts like these can be deeply upsetting, and many people keep them secret out of shame.
Here’s something that surprises a lot of people: almost everyone has intrusive thoughts. Having them doesn’t mean you have OCD, and it certainly doesn’t mean you want to act on them.
What are intrusive thoughts?
Intrusive thoughts are unwanted thoughts, images or urges that pop into your mind without warning. They often go against what you value, which is exactly why they feel so disturbing. Common themes include harm, contamination, sexuality, religion, relationships and making mistakes.
When are intrusive thoughts a sign of OCD?
The difference usually isn’t the thought itself, but what happens next. With obsessive-compulsive disorder (OCD):
- the thoughts cause intense anxiety, disgust or doubt
- you feel driven to do something to neutralise them, such as checking, washing, counting, praying, seeking reassurance or mentally reviewing
- the relief from these compulsions is short-lived, so the cycle repeats
- it takes up a lot of time (often more than an hour a day) or gets in the way of work, sleep or relationships
Some people have mainly mental compulsions, sometimes called “Pure O”. The compulsions are still there; they just happen inside your head.
Why fighting the thoughts makes them stronger
It seems logical to push unwanted thoughts away, but trying hard not to think about something usually makes it come back more often. Compulsions work the same way: each one teaches your brain that the thought was dangerous and needed dealing with.
What does OCD treatment involve?
NICE recommends CBT with exposure and response prevention (ERP) as the main talking treatment for OCD. In practice, OCD treatment usually involves:
- understanding your own OCD cycle
- learning to notice intrusive thoughts without treating them as facts or threats
- gradually reducing compulsions and reassurance-seeking, at a pace you agree with your therapist
- easing the shame and self-criticism that often come with OCD
Working with an OCD therapist who understands these patterns can help you loosen OCD’s grip. If anxiety is also a big part of your life, you might find my post on online anxiety counselling helpful.
Ready to talk?
If any of this feels familiar, you don’t have to work through it alone. You’re welcome to book a free 30-minute chat on Zoom to see whether we’re a good fit, or read more about working with an OCD therapist online.
If you’re in crisis or at risk of harm, please call your local emergency number (999 in the UK, 112 in the EU). In the UK you can also call NHS 111 (option 2) or Samaritans free on 116 123.