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Can intrusive thoughts turn into psychosis?

Intrusive thoughts are unwanted and disturbing thoughts, images, or urges that suddenly pop into a person’s mind and cause distress or anxiety. They are common in people with and without mental health conditions. Intrusive thoughts alone don’t signify a mental illness. However, intrusive thoughts can sometimes be a symptom of mental health conditions like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), anxiety, or psychosis.

What are intrusive thoughts?

Intrusive thoughts are involuntary thoughts, images, or unpleasant ideas that may pop into a person’s head and cause anxiety. They seem to come “out of the blue” and are usually shocking or upsetting to the person. Everyone has some intrusive thoughts from time to time. But when they persist and cause significant distress or impairment, it may signal an underlying mental health condition.

Common intrusive thoughts include:

  • Fear of inadvertently harming others
  • Unpleasant sexual thoughts or images
  • Violent or horrific images
  • Thoughts about contaminating others or oneself
  • Thoughts about behaving inappropriately or saying something embarrassing
  • Doubting personal relationships or distrusting friends and family
  • Thoughts about safety/danger to self or others
  • Forbidden or taboo thoughts about religion or sex

People are often troubled or ashamed of these intrusive thoughts. But having bizarre, violent, or disturbing thoughts does not mean the person is actually violent, dangerous or psychotic. The content of the thoughts is less important than how the person reacts to them.

What causes intrusive thoughts?

Researchers aren’t entirely sure what causes intrusive thoughts. Possible factors include:

  • Brain chemistry – Intrusive thoughts may be related to changes in brain chemicals like serotonin.
  • Stress – High stress levels may make someone more prone to upsetting thoughts.
  • Trauma – Past trauma or negative experiences can trigger unwanted thoughts.
  • Genetics – OCD and intrusive thoughts seem to run in families.
  • Faulty thought suppression – Trying to suppress thoughts may backfire, causing more unwanted thoughts.

Intrusive thoughts are a nearly universal human experience. Even people without mental health disorders can experience bizarre or disturbing thoughts from time to time. These thoughts don’t come from thin air – they often relate to underlying fears, doubts, or anxieties. But they aren’t an accurate reflection of the person’s character or true desires.

Are intrusive thoughts a sign of psychosis?

Intrusive thoughts alone are not typically a sign of psychosis. However, in some cases they may be linked to mental health conditions like:

  • Obsessive-compulsive disorder (OCD) – Repeated intrusive thoughts are a core symptom of OCD. The person may experience obsessions about contamination, safety, taboo thoughts about sex/religion, or fears of harming others.
  • Schizophrenia – Auditory and visual hallucinations are common in schizophrenia. Someone may hear voices or see images that aren’t really there.
  • Psychotic depression – Depressive episodes can include psychotic symptoms like hallucinations and delusions.
  • Bipolar disorder – During a severe manic episode, someone may experience psychosis with hallucinations or delusions.
  • Post-traumatic stress disorder (PTSD) – People with PTSD often experience intrusive memories or flashbacks of their traumatic event.

Intrusive thoughts on their own don’t signify psychosis. Psychosis refers to a detachment from reality, usually with delusions and hallucinations. Delusions are fixed false beliefs that don’t respond to evidence, while hallucinations involve seeing/hearing things that aren’t there.

While intrusive thoughts can be disturbing, the person is aware that they are irrational and not reality. With true psychosis, the person believes their hallucinations and delusions are real.

When do intrusive thoughts require treatment?

Occasional intrusive thoughts are normal and don’t require treatment. But if they become very frequent, persistent, or distressing, it may indicate a mental health disorder requiring psychiatric help. Signs that intrusive thoughts need treatment include:

  • Thoughts that are frequent, unwanted, and difficult to manage
  • Thoughts disrupt daily activities or cause significant distress
  • Engaging in compulsive behaviors to cope with the thoughts
  • Withdrawing from others because of shame over the thoughts
  • Inability to disregard the irrational thoughts

A mental health professional can help determine if obsessive, violent, or bizarre thoughts are a symptom of an underlying illness requiring treatment. Even without a diagnosable disorder, therapy can help manage troublesome intrusive thoughts.

Can intrusive thoughts turn into psychosis if left untreated?

There is no evidence that intrusive thoughts will turn into psychosis if left untreated. Intrusive thoughts alone are not a sign of emerging psychosis. However, untreated mental illnesses like OCD, schizophrenia, or bipolar disorder may worsen over time without proper treatment and care.

Getting appropriate professional help prevents worsening of symptoms. But psychosis does not always emerge even in serious untreated mental illness. And intrusive thoughts getting worse does not mean someone will inevitably develop psychosis.

Tips for coping with intrusive thoughts

Intrusive thoughts, while disturbing, are manageable. Coping strategies and self-care can reduce their frequency and intensity. Useful techniques include:

  • Acknowledge the thought but don’t dwell on it
  • Distract yourself with another activity
  • Talk to a friend or loved one
  • Write thoughts down and throw away the paper
  • Let the thought pass without reacting to it
  • Challenge catastrophic thinking about the thought
  • Practice relaxation methods like deep breathing
  • Get regular exercise and quality sleep

Avoid thought suppression and compulsions as they tend to worsen intrusive thinking. If self-help strategies aren’t reducing intrusive thoughts within a few weeks, consider seeking professional mental health support.

Professional treatment of intrusive thoughts

If intrusive thoughts are linked to an underlying mental health condition, treating that disorder can help manage them. Treatment options may include:

  • Medication – Antidepressants and anti-anxiety medication can reduce obsessive thoughts.
  • Psychotherapy – Cognitive-behavioral therapy helps patients cope with irrational thoughts.
  • Exposure therapy – Controlled exposure to a fear source reduces its power over time.
  • Mindfulness – Mindfulness meditation helps patients relate to thoughts differently.

A psychiatrist can prescribe appropriate medications if needed. Psychologists and licensed therapists provide different types of counseling and therapy.

When to see a doctor

Make an appointment with a doctor or mental health professional if:

  • Intrusive thoughts are causing significant distress
  • Thoughts interfere with work, school, or relationships
  • You have self-harm/suicidal thoughts
  • Thoughts involve harming others
  • You engage in compulsive rituals to cope
  • Symptoms persist after trying self-help for a few weeks

A doctor can check for underlying physical causes contributing to intrusive thoughts, like a medical condition, head injury, or medication side effects. A mental health evaluation is important determine if symptoms are part of a mental health disorder requiring treatment.


Intrusive thoughts are common and not necessarily a sign of mental illness. But when they are frequent and cause significant distress, anxiety, or impairment, professional help may be needed. With appropriate treatment and self-care, intrusive thoughts can be overcome. Support from loved ones also aids recovery. While intrusive thoughts can worsen without treatment, there is no evidence they will inevitably turn into psychosis.