Is making up scenarios in your head a mental illness? An expert weighs in

Do you find yourself constantly making up scenarios in your head that may or may not be likely to happen? Are you the parent or caregiver of a child with an “overactive imagination”? If so, you might be wondering: is this a problem? 

“Creating scenarios in your head, and imagining different things occurring is a very natural human experience. It’s part of the way your brain tries to make sense of the world. Your brain is very creative,” says Taylor Newendorp, M.A., LCPC, a Network Clinical Training Director at NOCD.

There is a point, however, when these thoughts move beyond a natural human experience and become something you may want to seek mental health support for. So what is that point? Here’s Newendorp’s take, and how to find effective treatment.

Why do you make up scenarios in your head?

Imagining things that haven’t happened can prepare you for an important event, or get you excited about something you want to happen. “But if you’re actively trying to imagine things in order to get immediate relief from an obsessive fear or doubt, it could be a sign of a more serious issue,” says Newendorp. “Maybe you frequently feel anxious about a hypothetical situation, and envision how you’d handle it. And you have a sense of urgency to figure it out, because you worry that something horrible could happen if you don’t.”

Another sign is impairment in functioning. “Are you so caught up in these scenarios that they interrupt your daily life?” says Newendorp. “For example, do you have a hard time concentrating on things you need to get done? Or have you noticed that you’ve been withdrawing or isolating yourself? If so, you may be experiencing obsessive-compulsive disorder (OCD) and/or anxiety.” 

What is obsessive-compulsive disorder? 

OCD is a debilitating disorder that causes excessive doubt about a particular theme. It’s a cycle that consists of repetitive, unwanted intrusive thoughts, images, urges, sensations, or feelings (obsessions) that create extreme distress. As a result, you perform mental or physical actions (compulsions) to try to alleviate the stress. 

Intrusive thoughts often come in the form of “what if?” questions, and may be about things that you find disturbing, taboo, or uncomfortable. Or you might have a bodily sensation that you interpret as “meaning something.”

It’s important to know that someone with OCD doesn’t like or want their intrusive thoughts. Those with OCD are no more likely than the general population to act on their feelings—and may be even less likely to follow through with them, since they’re so afraid of them. 

The most well-known type of OCD is contamination OCD, which is when you worry that you’re contaminated or dirty, and engage in excessive cleaning behaviors. But OCD can focus on anything that you value. Here are some other common themes of the condition:

• Relationship OCD is where you experience doubts about your relationships—typically a romantic one. You might have repetitive thoughts like, What if we’re not in love enough? What if I’m not really attracted to them? What if we’re destined to break up?

• Harm OCD. With this theme of OCD, you worry about accidentally or purposefully hurting someone. You might be concerned that you’re secretly a violent person and will one day snap. This theme can also manifest as worry over being the victim of harm. Intrusive thoughts could be things like, What if I pushed that person off the train platform? What if I accidentally hit someone with my car? What if I get jumped while walking down the street? 

• Sexual orientation OCD is when you fear that you don’t know your “one true” sexual orientation. You might be afraid that you’re secretly in denial, and are lying to yourself and your partner. 

• Pedophilia OCD. This looks like severe worry that you’re attracted to children. You might wonder, What if I’m secretly a pedophile? I’m at the park near a playground and feel a stirring in my groin area—does that mean I’m attracted to the children playing? 

• Illness/health OCD is a fear that you might have a terminal or serious illness and don’t know it. You might be hyper aware of every sensation or microshift in your body. 

Intrusive thoughts are what’s called ego-dystonic, which means that they don’t align with your values, beliefs, or morals. While everyone experiences intrusive thoughts sometimes, if you have OCD you can’t dismiss the thoughts and move on as well as someone without OCD. Instead, you may become anxious, fearful, panicked, ashamed, or embarrassed, and worried that the thoughts must mean something. 

“Compulsions are an attempt to solve intrusive thoughts, and ultimately relieve distress. In the case of making up scenarios in your head, you might imagine all the ways you’d prevent yourself from doing something bad, or play out really detailed scenes in which you might ‘lose control,’”says Newendorp.

Here are a few examples of compulsive scenario-making: 

• Julia is concerned that she’s in denial of her sexuality. She’s been with her wife for five years and can’t imagine life without her, yet she keeps having thoughts of, what if I’m really not gay, and I blow up our entire lives? To try to figure it out, she imagines having romantic experiences with men. All the while, she assesses herself for positive feelings and/or physical arousal. She feels this will give her a “final answer.” 
• Ben is a 10-year-old who worries that he’s going to harm one of his classmates. He’s scared that he’s secretly a monster. Whenever he holds a pencil, he tries to imagine stabbing his friend with it. Even though the thought disturbs him, he wants to make sure that he “dislikes” this scenario. 
• Cameron is afraid that they aren’t attracted enough to their partner, despite being deeply in love. To try to solve the problem, Cameron imagines situations in which they flirt with or go on dates with someone else, to test whether this makes them feel more aroused or attracted to their partner.

Regardless of the compulsions you perform, they all serve the same purpose: They provide short-term relief from your obsessions. But, in the long term, they only exacerbate OCD by reinforcing the notion that intrusive thoughts deserve attention and action. 

Anxiety vs. OCD

Another related—but distinct—condition to know about if you chronically make up scenarios in your head is anxiety.

Anxiety on its own is a feeling. It tends to be paired with stress, worry, fear, panic, and anticipation. Anxiety is a common human emotion like sadness, anger, or joy, and can be useful at times. It may prepare you for an important event or performance, or warn you of danger. 

The feeling of anxiety morphs into an anxiety disorder when the distress becomes unmanageable and impairs your life in some way. Anxiety disorder is an umbrella term that includes generalized anxiety disorder, social anxiety disorder, panic disorder, specific phobias, and selective mutism. 

Anxiety disorders and OCD share certain qualities, like the presence of excessive worry, fear, and anxiety. However, if you have an anxiety disorder and not OCD, you don’t experience distinct obsessions and compulsions. 

Specific symptoms of an anxiety disorder can include:

• Feelings of excessive and distressing worry, anticipation, and/or fear

• Asking yourself “what if?” questions that often don’t match up to the reality of the situation 
• Ruminating on those “what if?” questions or other worries, ideas, or thoughts
• Having physical symptoms of anxiety, such as a racing heart, sweatiness, dizziness, shakiness, headaches, or gastrointestinal issues

If you have an anxiety disorder, you might make up scenarios in order to feel more prepared for situations you’re worried about. Here are some examples::

• Amy has social anxiety disorder, and is terrified that people will think she’s weird or boring. Whenever she knows she’ll have to meet new people, she spends several weeks beforehand trying to imagine the situation. She pictures the best and worst-case scenarios, in an attempt to prepare herself for every outcome. 
• Liam has anxiety about opening presents from his family members on Christmas. He feels a lot of pressure to look and act a certain way, and worries that if he doesn’t act happy enough, he’ll hurt someone’s feelings. In the weeks leading up to Christmas, he imagines the day, what facial expressions he’ll make, and what everyone else will say. 
• Margaret has panic disorder and is always afraid of having a panic attack in public. She constantly imagines scenarios in which she has a panic attack and no one can help her, or people make fun of her. She tries to imagine how she could get out of the situation.

Though anxiety disorders don’t entail specific compulsions in response to intrusive thoughts, they do often come with “safety behaviors.” The most typical safety behavior is avoidance—which is when you steer clear of anything that triggers your anxiety. 

Whether it’s OCD or anxiety—or even both—the good news is that both conditions have an effective, evidence-based treatment. 

How can you get help?

Because of the shared qualities, the go-to treatment for OCD and anxiety is a form of behavioral therapy called exposure and response prevention (ERP). Unlike traditional talk therapy, which can backfire and make these disorders worse if it involves the judicious use of safety behaviors, ERP is clinically proven to be highly effective in the majority of people.

Here’s how it works: A trained therapist who specializes in OCD/Anxiety will take the time to understand your symptoms and create a custom ERP therapy plan specifically for you. Then, you’ll work together to rank your fears or triggers based on how stressful they seem. To begin with, your therapist will typically prompt you to face a fear that brings on only a mild amount of distress. The fear thoughts will likely come up, but you’ll learn to tolerate the discomfort. By making this conscious choice and seeing that nothing bad occurs, or realizing that you handled the discomfort better than you thought you could, your brain gets the message that there was nothing to fear in the first place.

As your therapy progresses, you’ll tackle triggers that elicit a bit more distress and conquer bigger fears. With an ERP therapist guiding you, you’ll practice confronting your fears in your everyday life instead of just the controlled setting of therapy. 

Most of the time something amazing happens as a result of this therapy: You won’t be riddled with distress from intrusive thoughts, images, or urges. Your need to engage in compulsions goes away. And the things that matter the most to you won’t feel like they’re at risk of slipping away.  

Working with a specialist to address the thoughts and situations that cause you distress is more accessible than ever thanks to virtual ERP therapy. In fact, peer reviewed research shows live teletherapy sessions of ERP can be more effective, delivering results in less time than traditional outpatient ERP therapy, often in as little as 12 weeks. 

Want to begin your ERP therapist search? We encourage you to browse the NOCD Therapist Directory. Every NOCD therapist is not only specialized in ERP but trained to deliver treatment online. Choose your therapist and we do the rest, including helping with scheduling and payment. Of course, if NOCD Therapists aren’t the right fit, you can also explore the International OCD Foundation Therapist Directory.