What are intrusive thoughts?
Intrusive thoughts are unwanted and repetitive 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 can be random and not make much sense. They can be violent, sexual, blasphemous or focus on mistakes, disasters or diseases. Examples of intrusive thoughts include:
- Imagining your house burning down when you see a box of matches
- Worrying you will blurt out an obscenity when you are in public
- Visualizing crashing your car when driving
- Fearing you left an appliance on that could start a fire
- Obsessing over contaminating yourself or others with germs
- Dwelling on mistakes you made in the past
- Having urges to shout insults at loved ones against your will
- Sexual thoughts about strangers, family members or friends
- Violent or horrific images popping into your mind
Intrusive thoughts often generate feelings of fear, disgust, doubt, shock or a disconnect between one’s true desires and the nature of the thought. Most people are able to recognize intrusive thoughts as being irrational or originating internally, rather than being meaningful ideas. However, they can still cause a lot of anxiety.
What causes intrusive thoughts?
Experts are not entirely sure why some people experience intrusive thoughts more frequently than others do. However, these are some factors believed to play a role:
- Genetics – Intrusive thoughts seem to run in some families, indicating there may be a genetic component.
- Stress – High levels of physical or mental stress can make intrusive thoughts worse.
- Trauma – Post-traumatic stress and past abuse are linked to more severe intrusive thoughts.
- Medications – Some drugs may produce or exacerbate intrusive thoughts as a side effect.
- Substance abuse – Chronic use of alcohol or recreational drugs seems tied to intrusive thinking.
- Fatigue – Being overly tired reduces mental control and makes it harder to redirect intrusive thoughts.
- Brain structure and function – Differences in parts of the brain like the frontal lobes may contribute.
- Low serotonin – Some studies link low serotonin levels with greater frequency of intrusive thoughts.
In many cases, intrusive thoughts seem to arise from a combination of biological and environmental triggers. There are a few theories on how they start:
- Thought suppression – Intentionally trying not to think about something can make you focus on it more.
- Stress compounds – Intrusive thoughts get reinforced each time they reappear after stress.
- Cognitive bias – People with anxiety tend to focus more on potential threats.
- Attention breakdowns – Struggling to control attention makes it easier for unwanted thoughts to appear.
Regardless of the specific causes, intrusive thoughts are very common even in people without psychological disorders. But certain mental health conditions are linked to more severe and frequent intrusive thinking.
What mental health disorders involve intrusive thoughts?
While most people have some experience with intrusive thoughts, certain disorders are characterized by them to a debilitating extent:
Obsessive compulsive disorder (OCD)
Persistent, unwanted intrusive thoughts are a hallmark of OCD. People with OCD generally realize their obsessions aren’t rational but cannot stop dwelling on them. Common themes include:
- Contamination and cleanliness
- Doubting that doors are locked or appliances are turned off
- Fear of acting on unwanted urges to cause harm
- Need for order, symmetry or perfection
OCD compulsions are repetitive behaviors the person feels driven to perform in response to the obsessions. Examples are repetitive washing, counting, checking doors or “canceling out” thoughts.
Generalized anxiety disorder (GAD)
People with GAD suffer from excessive, difficult-to-control worry across many facets of life. Intrusive thoughts about possible catastrophes, future threats and sources of distress are a major fuel for the chronic anxiety.
Social anxiety disorder
Individuals with social anxiety obsess over fears of being negatively judged or embarrassed in social situations. Intrusive thoughts may fixate on saying something awkward or appearing unattractive.
Post-traumatic stress disorder (PTSD)
PTSD develops after trauma like combat, sexual assault or a natural disaster. People re-experience the trauma through intrusive memories, nightmares and flashbacks. Thoughts and feelings associated with the event are very distracting.
Body dysmorphic disorder (BDD)
BDD causes people to obsess over perceived flaws in their appearance that are not noticeable to others. Intrusive thoughts focus heavily on tiny or imagined physical defects.
Recurring negative thoughts are common in major depression. These can include intrusive thoughts about guilt, failure, death, suicide, low self-worth or health anxieties.
Anorexia nervosa and bulimia nervosa often involve intrusive thoughts about body image, food and weight control. These possessive thoughts interfere with daily activities.
Examples of specific intrusive thoughts
Here are some examples of common intrusive thoughts those with mental health conditions experience:
Contamination and cleaning
- “My hands are dirty and will contaminate everything I touch.”
- “I will get sick if I don’t wash my hands before eating.”
- “Cleaning products contain dangerous chemicals that will harm me.”
- “If I don’t scrub my skin thoroughly, I’ll get acne and become ugly.”
- “What if I suddenly grab a knife and stab my friend?”
- “I could easily swerve the car into oncoming traffic and die.”
- “My dog keeps staring at me. What if I kick him across the room?”
- “I’m having urges to push this child off his bike.”
Doubt about responsibility
- “Did I definitely unplug the curling iron, or do I need to drive home and check it again?”
- “What if I left the stove on and my house burns down?”
- “Even though I know I locked the door, maybe I should go back and test it again.”
- “Are all the windows in my car definitely rolled up?”
Need for order and symmetry
- “The picture frames on that wall are crooked. I need to fix them until they feel right.”
- “I must touch light switches an even number of times every time I enter a room.”
- “The items in the pantry aren’t organized correctly. I should rearrange them.”
- “My shoes aren’t perfectly aligned in my closet. I have to keep adjusting them.”
- “When I give this presentation, people are going to think I look awkward and weird.”
- “Everyone at this party can tell I’m anxious. They probably think I’m a loser.”
- “I know I’m blushing. My face looks blotchy and disgusting right now.”
- “My voice sounds shaky when I talk. People will think I’m stupid if I open my mouth.”
Body dysmorphic disorder
- “My nose looks hideous from this angle. How has nobody ever told me it’s crooked?”
- “I look so old and haggard. My skin is saggy and covered with wrinkles.”
- “My thighs are gigantic. I shouldn’t wear shorts or swimsuits.”
- “I need to examine my face from every possible angle to analyze my flaws.”
- “My life is hopeless. Things are never going to get better.”
- “Everyone would be happier if I just disappeared.”
- “I’m useless – I can’t do anything right.”
- “What’s wrong with me? Why do I feel like this?”
- “I’m disgustingly fat. I shouldn’t have eaten anything today.”
- “If I don’t run 5 more miles, I’ll gain weight immediately.”
- “Throwing up after a meal is the only way I can stay thin.”
- “I need to know the exact calorie count of everything I put in my mouth.”
How are intrusive thoughts treated?
Treatment of intrusive thoughts depends on any underlying cause, but cognitive behavioral therapy (CBT) is generally the first-line approach:
CBT helps people identify and change thought patterns like catastrophic thinking, overgeneralization, labeling and mental filtering that make intrusions worse. Other cognitive strategies include:
- Challenging the irrational parts of obsessive thoughts
- Letting intrusions flow without reacting to them
- Naming and accepting the thought before letting it go
- Postponing or setting aside repetitive thoughts for certain times
- Reframing negative intrusions into neutral observations
Avoiding triggers reinforces intrusive thinking, so CBT also uses exposure therapy. This involves gradually facing feared thoughts, objects and situations in a controlled way to decrease their power. Other tactics include:
- Letting thoughts pass without performing compulsions
- Resisting reassurance-seeking about intrusive worries
- Sitting with uncertainty and anxiety without reacting
- Practicing mindfulness, relaxation and distress tolerance skills
- Engaging in healthy, competing activities
Medications like antidepressants and anti-anxiety drugs are sometimes used alongside CBT for intrusive thoughts related to depression, anxiety, OCD or PTSD. Other additional treatments can include hypnosis, exercise, support groups and limiting alcohol. Dealing with sources of stress and fatigue is also helpful.
When to seek emergency help
Most intrusive thoughts are not dangerous. But if they become extremely vivid, frequent or distressing, seek help right away, especially if:
- You fear you may act on thoughts of harming yourself or others
- Intrusive thoughts disrupt your ability to function every day
- You use compulsions excessively in reaction to the thoughts
- You suffer from depression, social isolation or difficulty caring for yourself
Severe intrusive thoughts can be a psychiatric emergency. Warning signs justifying emergency care include:
Constant vivid thoughts of killing or harming yourself require emergency intervention. Extreme hopelessness or preoccupation with death are red flags.
Intense repeated urges to seriously injure or kill another person, especially with a specific plan, need crisis care.
Auditory hallucinations or inability to distinguish real from unreal experiences indicates a psychotic break. Get immediate help.
Racing unrelated thoughts, reckless impulses and elevated mood signal a manic episode that needs prompt treatment.
Don’t wait to see if disturbing intrusive thoughts simply fade – get an urgent evaluation, even if it means calling 911 or visiting an emergency room. Ongoing lack of treatment can allow symptoms to worsen over time.
Self-care and support for intrusive thoughts
Living with repetitive unwanted thoughts can be exhausting without adequate self-care. Be patient and treat yourself kindly. Some self-help strategies that can help are:
- Postponing obsessional thoughts to worry about later at a set time
- Exercising to improve mood and distract yourself
- Calling a support friend or family member when urges feel overwhelming
- Avoiding triggering media that exacerbates intrusive thoughts
- Letting the thoughts pass by focusing on your senses in the present moment
- Practicing relaxation techniques like deep breathing, visualization or progressive muscle relaxation
- Joining a local OCD, anxiety or ADHD support group to decrease isolation
- Keeping a thought log to identify patterns causing issues
- Setting small, achievable goals each day to give a sense of control
You may feel ashamed of repugnant or nonsensical intrusive thoughts. But having them does not mean you are abnormal or dangerous. Millions of people secretely struggle with them. Getting professional and social support can help you reclaim your mental freedom.
When intrusive thoughts are an emergency
Most intrusive thoughts, while disruptive, are not dangerous or requires crisis care. However, a psychiatric emergency exists if they:
- Include vivid suicidal or homicidal intent with a plan
- Are inseparable from reality in a way that seems psychotic
- Fuel manic, risk-taking behavior with elevated mood
- Paralyze ability to function or care for yourself
Don’t wait to see if severe symptoms improve on their own. Get immediate help by calling 911, visiting an emergency room or contacting a crisis line. With treatment, even severe intrusive thoughts can eventually be overcome.
Intrusive thoughts are involuntary, distressing mental images or urges that disrupt everyday thinking. They are a common experience for people with conditions like OCD, PTSD and anxiety disorders. Examples include obsessions about germs, forbidden thoughts of violence, or repetitively doubting that the stove is off.
Though not necessarily dangerous, intrusive thoughts can severely impair functioning. Their exact cause is unknown, but they can be improved with CBT, medication, lifestyle changes, relaxation skills and support groups. Don’t hesitate to call emergency services if thoughts include plans to commit suicide or harm others. But for most people, intrusive thinking is manageable with proper professional care and self-compassion.