Obsessive intrusive thoughts are unwanted, repetitive thoughts, images, urges, or mental “what if” scenarios that enter a person’s mind and feel difficult to dismiss. They are often distressing, disturbing, or inconsistent with the person’s values and intentions.
Examples may include:
- Fear of harming someone accidentally or intentionally
- Repeated doubts (“Did I lock the door?”)
- Intrusive sexual or violent images
- Fear of contamination or illness
- Religious or moral fears (“What if I’m a bad person?”)
- Constant worry about making mistakes or causing harm
A key feature is that the thoughts are ego-dystonic, meaning the person usually does not want them and is disturbed by having them.
Obsessive intrusive thoughts may commonly be associated with Obsessive-Compulsive Disorder, but they might also occur with:
- Anxiety disorders
- Trauma-related conditions
- Depression
- High stress or sleep deprivation
- Postpartum mental health conditions
- Sometimes even in people without a mental health disorder
In OCD, intrusive thoughts could be followed by compulsions, behaviors or mental rituals meant to reduce anxiety, such as:
- Reassurance seeking
- Excessive checking
- Counting
- Praying repeatedly
- Mental reviewing
- Avoidance behaviors
Psychologically, the problem may not be the thought itself, but the meaning attached to it and the attempts to suppress or neutralize it. Research shows that many people experience strange or disturbing thoughts occasionally; OCD tends to involve:
- Overestimating the importance of the thought
- Feeling overly responsible for preventing harm
- Intolerance of uncertainty
- Trying to gain absolute certainty
Common evidence-based treatments may include:
- Cognitive Behavioral Therapy (CBT)
- Exposure and Response Prevention (ERP), a specialized form of CBT
- Mindfulness-based approaches
- Sometimes medications such as SSRIs
One important clinical point: having intrusive thoughts may not mean a person secretly wants to act on them. In fact, the distress may usually reflects the opposite?, the thoughts might conflict with the person’s values.
Shervan K Shahhian
LIBERTY PSYCHOLOGICAL ASSOCIATION 