Can a hormone imbalance cause intrusive thoughts?

To date, researchers have identified over 50 different hormones in the human body, each of them playing a vital role in our health and well-being. These chemical messengers control metabolism, influencing how the body uses and stores energy. Hormones like insulin manage blood sugar levels, while thyroid hormones regulate metabolism and body temperature. Reproductive hormones like estrogen and testosterone control sexual development and fertility. Adrenaline—another hormone with a household name—triggers the “fight or flight” response during stress, while growth hormones promote tissue and bone growth.

In addition to everything else they do, hormones play a significant role in regulating our mood, emotions, and behavior, keeping our overall mental well-being in check. That means that when our hormones are out of whack, our state of mind can suffer. 

Intrusive thoughts—random, unwanted, often distressing urges or images—are, in and of themselves, not indicators of a mental disorder. In fact, almost everybody experiences them. We can think of intrusive thoughts as a benign bug in the software our brains run on. However, people with Obsessive-Compulsive Disorder (OCD) find intrusive thoughts incredibly challenging to dismiss, giving rise to the distressing obsessions and time-consuming compulsions that characterize the condition. 

This article aims to investigate whether hormone imbalances are able to cause or exacerbate intrusive thoughts and highlight the efficacy of the gold-standard treatment in reducing the intensity and impact of such intrusive thoughts, whether they’re related to hormone imbalances or not.

Intrusive thoughts: a near-universal human experience

Though it’s tricky to calculate precisely, researchers postulate that the human brain operates at 1 exaFLOP, which is equivalent to a billion billion calculations per second. Given this mind-numbing number of computations, is it any wonder that it randomly serves up something odd, unwanted, or upsetting from time to time?  

You don’t have to have OCD to be caught off guard by a thought about stabbing your partner, yelling an obscenity in church, or having sexual thoughts about a minor. They’re enough to make the most stoic amongst us wince. For around the 1 or 2% of us with OCD, however, these intrusive thoughts have a sticky quality about them. Rather than shrugging them off as the other 98% of people do, we tend to fixate on them for what they might mean. 

Could I really be capable of something so horrible? 

What does this awful thought say about me? 

“No” and “nothing” are the real answers to these two questions, but unfortunately, OCD just doesn’t accept them. In short order, people with OCD are obsessing over these ego-dystonic thoughts—those that run counter to a person’s true values and beliefs.

For people with OCD, these obsessive thoughts produce intense distress and anxiety, leading them to engage in repetitive and ritualistic actions or thoughts in an effort to tamp down the distress they feel. While these compulsions temporarily relieve the anxiety and distress caused by obsessions, they do so at the cost of strengthening and perpetuating the sequence of obsessions, anxiety, compulsions, and temporary relief known as the” OCD cycle.” 

Hormone-related health conditions and intrusive thoughts

A large body of research points to hormonal fluctuations’ ability to cause or exacerbate a range of mental health phenomena, including intrusive thoughts—in people with or without OCD. 

Premenstrual dysphoric disorder (PMDD) and intrusive thoughts

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that affects many people during their menstrual cycles. It is characterized by a range of emotional and physical symptoms, including mood swings, irritability, fatigue, and changes in eating habits. One of the significant mental health aspects of PMDD is the presence of intrusive thoughts.

For people suffering from PMDD, these thoughts can be particularly intense and distressing during the premenstrual phase. They might experience recurring thoughts of self-doubt, guilt, or fear, leading to heightened anxiety and emotional turmoil. The hormonal fluctuations that occur during the menstrual cycle are believed to play a role in triggering these intrusive thoughts.

Research suggests that the interaction between hormonal changes, such as fluctuations in estrogen and progesterone levels, and brain chemistry may contribute to the emergence of intrusive thoughts in PMDD. 

“We know that many people around the time of ovulation will report that OCD gets worse,” says Dr. Patrick McGrath, NOCD’s Chief Clinical Officer. “We also know that a similar thing can happen in the perinatal experience.”

Postpartum OCD and intrusive thoughts

Postpartum OCD is a form of Obsessive-Compulsive Disorder that occurs after childbirth, affecting approximately 1 in 18 new mothers. While it is normal for new mothers to experience some degree of mood fluctuations and stress after giving birth, PPOCD is much more severe and can significantly impact one’s ability to care for themself and their baby. Other postpartum mental health conditions like postpartum depression (PPD) are fairly well-known phenomena for new parents, but many people have no idea that Postpartum OCD also exists—and can impact a large portion of new mothers. 

Intrusive thoughts are a common feature of postpartum OCD, and they can be distressing and unsettling for new mothers. These thoughts may involve fears of accidentally harming the baby, doubts about their abilities as a mother, or feelings of overwhelming guilt and sadness. The hormonal changes that take place during pregnancy and after childbirth are believed to be major contributors to the development of PPOCD—and Perinatal OCD— and its associated intrusive thoughts.

Thyroid disorders and their impact on mental health

The thyroid gland plays a crucial role in regulating various bodily functions, including metabolism and energy levels. When the thyroid gland produces inadequate thyroid hormones (hypothyroidism) or excessive amounts (hyperthyroidism), it can significantly affect mental health.

In the case of hypothyroidism, where there is an underproduction of thyroid hormones, individuals may experience symptoms such as fatigue, lethargy, and difficulty concentrating. On the other hand, hyperthyroidism, characterized by an overproduction of thyroid hormones, can lead to symptoms such as anxiety, restlessness, and irritability, contributing to anxiety disorders or worsening pre-existing mental health conditions. For instance, a person with a history of anxiety, depression, or OCD may experience worse symptoms during hormone fluctuations. 

How are distressing intrusive thoughts treated? 

You should speak with your doctor if a hormone imbalance coincides with more frequent or distressing intrusive thoughts. They’ll work with you to discern whether a medical intervention might help you rebalance your hormone levels and reduce the impact of these thoughts. 

If intrusive thoughts are especially distressing or interfering with your life in a significant way, this may often be a sign of OCD, and proper treatment can help you manage your symptoms, even if they are influenced by hormone fluctuation. In that case, you should also speak to a qualified clinician about exposure and response prevention therapy (ERP), a first-line treatment for OCD. 

During ERP, you’ll be gradually exposed to situations, objects, or thoughts that trigger your distressing intrusive thoughts or fears. You’ll then learn to resist the urge to engage in your typical compulsive behaviors—such as reassurance-seeking or rumination—that would usually alleviate your discomfort. Instead, you practice tolerating your discomfort and anxiety, habituating to these feelings over time so that they make less of an impact in your life.

The duration of ERP treatment can vary depending on the individual and the severity of their condition. Generally, it involves several weekly sessions over a few months. The focus is on gradually building tolerance to anxiety and gaining better control over obsessive thoughts and compulsive behaviors, ultimately improving mental well-being.

Getting the help you need

If you think you might have OCD and want to learn how it’s treated with ERP, I encourage you to learn more about accessing evidence-based treatment with NOCD. 

All of our therapists specialize in OCD and receive ERP-specific training. You can also get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.