In conversation, print, and social media, people have been using the terms “intrusive thoughts” and “unwanted intrusive thoughts” to refer to a wide range of thoughts, feelings, and images that enter our heads. It’s important to make the distinction between the various types of intrusive thoughts. Depending on the emotional and pathological context, they can represent vastly different phenomena.
Many intrusive thoughts are benign, and some are pleasant and desired—for instance, falling in love, or a burst of creativity while composing a song.
Intrusive thoughts can include everything from funny, bizarre passing thoughts that make great stand-up comedy to a range of unwanted intrusive thoughts. These include command hallucinations that can occur in psychotic states, depressive ruminations, and any unwanted “self-talk” (including rumination). People may also use the term to refer to the content of trauma flashbacks that intrude into ongoing experience.
These intrusive thoughts, whether unwanted or not, are very different from the unwanted intrusive thoughts that characterize some types of OCD. We have noted press reports suggesting that Lindsay Clancy, currently on trial for murder of her children, must have OCD because her actions were driven by what she referred to as intrusive thoughts. But there is no report of Clancy ever having been diagnosed with OCD. She may have had terrible intrusive thoughts, but she was likely in a postpartum psychotic state, which was seemingly not adequately diagnosed or treated.
This case and others involving intrusive, disturbing, or unwelcome thoughts must be evaluated in the context in which they occur.
Who Commits Violent Acts?
Violence is characteristic of people with poor impulse control, people in the midst of psychosis, and people with actual malevolent intent such as psychopaths or antisocial criminals.
Diagnoses consistent with loss of impulse control may include intense psychotic states, bipolar mania, flagrant paranoia, or dissociated states secondary to extreme trauma. Still, violent acts driven by mental illness are rare, even in psychosis, and most violent acts, whether impulsive or intentional, are not caused by mentally ill people.
OCD is a disorder of overcontrol. It does not involve impulsive explosions of violence or harm.
Passing Intrusive Thoughts and Unwanted Intrusive Thoughts in OCD
Everyone has the former. “Normal” (passing) intrusive thoughts may not even be remembered. However, the unwanted intrusive thoughts of OCD can be torturous, persistent, and shameful, and can escalate in frequency and intensity. They are maintained by the paradoxical effort of trying to banish them from your mind, a phenomenon sometimes called the ironic effect.1
Some facts about unwanted intrusive thoughts in OCD:
- They do not cause people to commit acts of violence. Passing intrusive thoughts are meaningless—often just associations, seemingly random, and frequently experienced as “out of the blue.” True unwanted intrusive thoughts in the context of OCD are the opposite of intent and contrary to one’s values and nature. This is why they are resisted. Unwanted intrusive thoughts are accompanied by images, feelings, sensations, and emotions. Just as in a nightmare, imagination can create an experience that is intensely vivid but still not reality.
- Stuck unwanted repeating intrusive thoughts in OCD are not random: They mean the opposite of what they seem to mean. They get stuck because of one’s entanglement with them. This entanglement happens because they are so personally offensive, disgusting, or shocking, and the urge to resist them, argue with them, or struggle against them is so powerful. In fact, they do not need to be resisted, despite how they feel. They are just thoughts, feelings, images, or sensations. Nothing more.
- Unwanted intrusive thoughts are the building blocks of obsessions. They are identified not by their content, but by how they feel and how they act. They repeat, they spread, and they intensify. They provoke imagined narratives of catastrophe or misery. They “feel” relevant, true, and important even though they are not. They may feel like urges, but they are not.
- They do not indicate poor impulse control. It is overcontrol rather than undercontrol that feeds obsessions. Trying to control thoughts is a hopeless project that leads to a rabbit hole of increasing thoughts and anxiety. Elevated levels of anxiety come with emotional and perceptual distortions that give the thought the illusion of an urge or an intent that must be resisted.
- They do not represent impulses, “repressed” desires, or unconscious wishes. Once again, they are the paradoxical result of trying to control thoughts that feel unacceptable.
OCD is a disorder of doubting. Frequently, one may “know” that the content of the intrusion is nonsense but may also experience obsessional doubt and feel the need to seek reassurance or checking (i.e., “Am I ‘sure’ that this is OCD and not psychosis?”). So even the most remote possibility is haunting.
Casual use of the term “intrusive thoughts” by people who are referring to hallucinations, depressive ruminations, intentional violent fantasy, or other completely different phenomena can cause so much unnecessary pain and suffering. It reignites doubts in people with genuinely harmless OCD thoughts.
