Intrusive thoughts: the uninvited visitors

There are two key facets of Obsessive Compulsive Disorder: obsessions and compulsions. Obsessions are thoughts, images or urges that repeatedly and uncontrollably intrude, unwelcome, into a person’s mind. They are a source of distress, often because the content is unpleasant, theatening or believed to be socially unacceptable. A passion for cars, or cooking, would not be classed as an obsession – even if you talk about it so much it annoys your friends: Obsessions are the last thing you would want to be thinking about; interests are the first things you want to think about.

Compulsions are repetitive thoughts or behaviours that are performed for the purpose of trying to reduce or eliminate distress triggered by obsessions. A compulsion may be an attempt to prevent obsessions from coming to mind, or to prevent some feared outcome associated with the obsession.

Intrusive thoughts are like the embryos of obsessions: they are intrusive, unprompted and distressing thoughts that differ from obsessions by frequency: they may be only occasional and fleeting, instead of constantly occupying thoughts.

Intrusive thoughts happen to us all. Research has showed the content of an intrusive thought for an average person is identical to an obsession in someone with OCD – the difference is these thoughts are extremely troubling to the person with OCD, but tend to be quickly shrugged off by others. In the post, “Are You Sure?” I explain how being unable to shrug off an intrusive thought can lead to a cycle of increasingly frequent and distressing obsessions.

There are some common themes of intrusive thoughts – such as contamination, violence and sex. Specific, common intrusive thoughts include:

• having an urge, while driving, to swerve into a pedestrian or oncoming traffic;
• images of having sex with a person you would never want to have sex with;
• an urge, when standing in a high place, to push a loved one over the edge;
• an urge to shout profanity in a church;
• thoughts of publicly exposing your genitals;
• thoughts that you could have AIDS and be unknowingly infecting others;
• images, when around sharp knives, of stabbing people;
• thoughts that you might be a murderer or paedophile.

It is easy to see that these thoughts can be very distressing. When experiencing an intrusive thought it is common to at least briefly worry about the origins of the thought: “Why would I think such a thing?” We usually assume that our own thoughts are always a perfect reflection of our intent. The reality is they are not. Sometimes our brain hiccups and the result is a thought dramatically inconsistent with who we are. Such thoughts will be only occasional – except that if we become consumed with anxiety about them, then the fear of the thought can paradoxically trigger the thought.

The best strategy for managing intrusive thoughts is to remember they happen to almost everyone and are in no way indicative of your true character – there is nothing else to be done but allow them to pass harmlessly. No need to call the police for these unwelcome visitors – as unpleasant as they are, they depart on their own without doing any harm.