When Are Intrusive Thoughts a Sign of OCD?

Intrusive thoughts are one of the primary features of obsessive-compulsive disorder (OCD). However, having intrusive thoughts doesn’t automatically mean you have OCD, and the experience of intrusive thoughts is nearly universal. 

So when are intrusive thoughts a sign of OCD, and when are they just an ordinary experience signifying nothing else? We spoke with Dr. Nicholas Farrell, a Regional Clinical Director here at NOCD, to find out the answers to these questions and more. Here’s what we learned.

What are intrusive thoughts?

Intrusive thoughts share several traits which distinguish them from “regular” thoughts. Specifically, intrusive thoughts are:

Involuntary: 

Intrusive thoughts typically occur against one’s will. In fact, the harder you try not to have them, the more likely they are to pop up in your mind.

Unpleasant:

Intrusive thoughts make you feel bad. If the experience is pleasant, it’s not intrusive.

Ego-dystonic: 

Intrusive thoughts typically go against your genuine values, intentions, and beliefs. This is why they are experienced as unpleasant and intrusive.

Often highly unusual:

“Typically, the content of thoughts that are intrusive is out in the extremes,” shares Dr. Farrell. “They’re generally more than just your garden-variety, day-to-day worries.” For example, they may be about incest, harming a loved one, or potentially false memories, rather than taking out the trash. 

What is OCD?

OCD is a mental health condition characterized by two primary symptoms: obsessions and compulsions. The condition affects around 1 in 40 people globally, or over 197 million individuals worldwide. 

Obsessions

Obsessions are distressing, persistent, and often time-consuming intrusive thoughts, images, or urges. They can focus on a wide variety of themes. Some common topics include:

Contamination: 

Involves fears related to germs and illnesses

Harm:

Causes fear about potentially harming oneself or others

Religiosity: 

Characterized by concerns about violating religious rules or beliefs

Sensorimotor sensations: 

Occurs when individuals with intrusive thoughts focus on bodily sensations

Existentialism: 

Involves fears related to philosophical topics, such as the meaning of life, skepticism, or the existence or free will

Compulsions

Compulsions are mental or physical actions performed in response to obsessions in an attempt to alleviate distress or anxiety or to prevent some unwanted outcome from occurring. Some common examples of compulsions include:

• Excessive handing-washing
• Seeking reassurance about fears
• Arranging items in a particular way
• Repetitive counting
• Repeating words or phrases

When do intrusive thoughts become obsessions?

Both intrusive thoughts and obsessions involve unwanted thoughts, images, and urges. They can even be about the same topics and themes. So what’s the difference, and how might a mundane intrusive thought become an obsession?

#1 You find a negative or fearful meaning in them

“Two people could be experiencing the exact same intrusive thought and assign different meanings to them.” shares Dr. Farrell. For example, in response to an intrusive image of smothering one’s child, one person may think, “Well, that was unpleasant, but I would never do that and life goes on,” while another thinks, “I must want to harm my child. Why else would I have that thought?” 

#2: They cause a significant amount of stress or anxiety

Finding a scary or disturbing significance in an intrusive thought naturally gives rise to unpleasant emotions. As. Dr. Farrell shares, “if the thought is appraised as a threat, this is what makes it very anxiety-laden,” meaning it will cause fear or some other feeling of distress.

#3: They are difficult to move past

For people with OCD, intrusive thoughts are “sticky.” Rather than popping in and out of their minds, they grab and maintain attention. This happens because of both the negative meaning that people with OCD assign to their intrusive thoughts and the unpleasant emotions they feel as a result.

#4: You try to rid yourself of them

“As the thought becomes increasingly difficult to discard, people that experience these fear-based appraisals of intrusive thoughts try to rid themselves of them,” shares Dr. Farrell. For example, they might try to suppress it, distract themselves, think about something else, or neutralize it with a compulsion. This contrasts with the typical response to intrusive thoughts, which is to let them pass freely through one’s mind. 

#5: They are experienced frequently

“While people without OCD may experience intrusive thoughts here and there, they take up a disproportionate amount of time and mental space in those with the condition,” says Dr. Farrell. “This is, in part, a direct result of attempts to suppress them. All of those cognitive efforts backfire. Trying not to think about something paradoxically makes it more likely that one will think of something. The end result is this thought is now being experienced much more frequently, and the distress associated with it is becoming more and more intense.” This leads to more attempts to get rid of the thought, which causes it to become more frequent, and so on. 

When are intrusive thoughts not a sign of OCD?

In most cases, intrusive thoughts are not a sign of OCD. So when is one’s response to intrusive thoughts harmless or even healthy? As Dr. Farrell puts it, “the short answer would be if the person views them as just meaningless, random mental noise that has no bearing on the type of person they are or what they’re going to do.”

Ultimately, how we handle intrusive thoughts dictates whether they indicate OCD. Are you able to let the thought go? If the answer is yes, you’re probably just experiencing an intrusive thought and nothing more. Can you still be bothered by intrusive thoughts? Absolutely. They are called intrusive thoughts because they are unwanted and unpleasant. It’s natural to dislike thinking about jumping off a building or hurting a newborn, but many can let these thoughts come and go in and out of their consciousness with minimal disruption. As long as you’re able to do this and avoid reading into what they mean or spending hours trying to move on, your response to intrusive thoughts is likely not indicative of OCD. 

Are intrusive thoughts always a sign of a mental health condition?

No, intrusive thoughts are not always a sign of a mental health condition. “One of the things that we know about intrusive thoughts is that they are, for all intents and purposes, universal.” shares Dr. Farrell. “It’s as common to experience them as having the hiccups, a bout of sneezing, or any other unpleasant, involuntary event.” 

One study found that 94 percent of participants admitted to experiencing intrusive thoughts, but when you account for the fact that not everyone is likely to admit they have them, the actual number is likely higher. So, in a great majority of cases, people have intrusive thoughts without experiencing a mental illness. 

Research has shown that this is true across cultures. For example, one study involving 777 students in 13 countries across six continents found that 93.6 percent reported having at least one intrusive thought in the previous six months. They also found no correlation between the type of intrusive thought and where the participants were from, meaning that whether it’s about sex, violence, religion, or anything else, intrusive thoughts of all kinds appear to be prevalent and equally common in all people.