Do I Have OCD Intrusive Thoughts? How Can I Stop Them?

Researchers estimate that humans have over 6,000 thoughts over the course of a day. These tend to be fleeting thoughts that can range from mundane thoughts, like wondering what to wear, to more complicated tasks, such as like handling grief or running a household.

However, for people experiencing obsessive-compulsive disorder (OCD), some thoughts may become intrusive and affect their well-being on an everyday basis. Individuals living with OCD may experience difficulty controlling complex, intrusive thoughts, which can lead to compulsive behaviors intended to reduce anxiety. 

Below, we’ll explore what obsessive-compulsive disorder is, the role that intrusive thoughts can play in the disorder, the types of thoughts people with OCD may experience, and the role of therapy in management.

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a serious mental health condition that can affect an individual’s emotional, cognitive, and physical well-being. According to the Mayo Clinic, obsessive-compulsive disorder generally "features a pattern of unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.”

Although the causes of obsessive-compulsive disorder are not fully understood, it is believed that biology, genetics, and the environment may play roles in its development.

Types of OCD-related intrusive thoughts

Recurring, unwanted thoughts or impulses—called obsessions—are a primary feature of obsessive-compulsive disorder (OCD). Although intrusive thoughts could be about anything based on an individual’s experiences or fears, they typically fall into six categories:

1. Relationships

It can be common to worry about relationships from time to time. However, OCD intrusive thoughts about relationships (e.g., obsessions about one's sexuality or the suitability and fidelity of one's partner) can dominate a person's mind. These thoughts can put a significant strain on relationships, and the person experiencing them may feel overwhelmed trying to manage and diminish their fears. Examples of intrusive thoughts in this category can include:

• Overanalyzing every aspect of a relationship

• Needing constant validation or reassurance from a partner

• Constantly worrying about a partner's faithfulness

• Questioning one's sexual orientation to an excessive degree, or the orientation of others

• Experiencing fear of unintentionally cheating on a partner, or being cheated on

2. Body-focused obsessions (Sensorimotor OCD)

A person with OCD can have a hyperawareness of certain bodily sensations and may obsess over whether these feelings are normal or abnormal. Some typical bodily obsessions involve:

• Breathing

• Blinking

• Swallowing/salivating

• Digesting food

• Having an obsessive awareness of certain body parts

3. Sexual intrusive thoughts

These obsessions can include unintentionally causing sexual harm to loved ones or others or experiencing sexual harm themselves. A person may question their sexuality and desires, perhaps perceiving them as wrong or deviant. People with these thoughts may fear showing affection to younger people or a family member.

Examples of sexually intrusive thoughts may include:

• Fear of being sexually attracted to children or family or fear of other socially inappropriate relationship types

• Thoughts about touching people inappropriately

• Fears and doubts about being attracted to someone of the same gender (or someone of another gender, if a person identifies as gay)

• Intrusive sexual thoughts about authority figures or a deity

4. “Magical thinking” OCD intrusive thoughts

Many people may cling to a few superstitions, like having a favorite color or outfit. However, a person with magical thinking OCD may believe that their superstitions and thoughts can control events or others' lives.

They may feel that they must complete rituals or processes—some of which may be elaborate and time-consuming—to dispel their intrusive thoughts. Examples of magical thinking or superstition-related intrusive thoughts may include:

• One's thoughts could make disasters occur.

• Certain numbers or colors represent good or bad luck.

• Thoughts about harming someone could cause the person actual injury.

• Imagining a disaster or accident will make it more likely to happen.

5. Religious intrusive thoughts

Having religious or spiritual beliefs can be a source of inspiration and motivation for many people. However, when religious thoughts become a fixation, they may cause a significant strain on one's beliefs. These intrusive thoughts may cause someone to stray from their religion or live in constant fear of angering a deity. Examples of intrusive religious thoughts can include:

• Fearing their sins or actions will never be forgiven

• Obsessively repeating prayers to be “good enough” for acceptance

• Constantly feeling sinful and unworthy

• Repeating blasphemous thoughts

• Constantly fearing unintentionally breaking religious laws and rules

• Having intrusive "impure" thoughts during prayer or religious services

6. Violent obsessions

These types of intrusive thoughts are often disturbing for those who experience them. A person fixated on these thoughts might feel like they are a horrible person. Like intrusive sexual thoughts, violent obsessions may cause the person experiencing them to withdraw socially and avoid public places. Common violent obsessions may include:

• Thinking about killing or otherwise harming innocent people

• Thinking about poisoning the food of loved ones

• Considering jumping in front of vehicles like trains or cars

• Believing one will uncontrollably act on violent impulses

• Considering using objects to inflict harm on others (and subsequently avoiding these objects)

Why are intrusive thoughts so persistent?

Those with obsessive-compulsive disorder (OCD) and intrusive thoughts can live with the condition without acknowledging or being aware of it. They may be unaware this is a mental illness. Researchers believe the brains of those living with OCD may operate somewhat differently than the brains of those who don’t have OCD.

According to the Anxiety and Depression Association of America, OCD involves the brain’s "fear network," which alerts individuals that something is potentially wrong and needs to be addressed immediately. The obsessions and compulsions may commonly revolve around people or things someone deeply cares about. For instance, a loving mother may become obsessed with her children being harmed. She may then repeatedly check the stove to make sure it’s turned off. 

Individuals trying to control or repress intrusive thoughts on their own may feel like they “fail” to do so. Focusing on not having intrusive thoughts can make them more frequent. 

Proper diagnosis of OCD

There are currently no known laboratory tests to identify OCD. The disorder can be diagnosed when a trained mental health professional interviews a client and uses an assessment tool to determine if they meet the criteria for OCD. Additionally, a mental health professional may help you to determine if any other mental health conditions are co-occurring with a potential OCD diagnosis. Some typically co-occurring mental disorders could include:

• Mood and anxiety disorders

• Eating disorders

• Attention-deficit/hyperactivity disorder (ADHD)

How to stop intrusive thoughts

If you’re experiencing symptoms of OCD, know that you’re not alone. There are treatments available to help you learn how to how to stop intrusive thoughts. According to the Mayo Clinic, treatment often involves talk therapy and/or medication.

Medications

If you are diagnosed with OCD, a doctor or psychiatrist may prescribe medication to help you manage your symptoms. Although these drugs might not eliminate intrusive thoughts completely, some patients may experience significant symptom reductions. Medications commonly prescribed typically include antidepressants, such as the following medications that are approved for OCD by the U.S. Food and Drug Administration (FDA):

• Paroxetine (for adults only)

• Clomipramine

• Fluoxetine

• Sertraline

• Fluoxetine

It’s recommended that you consult a physician before starting or stopping a medication. Some of the above medications have minimum age restrictions as well as potential side effects. Also, all antidepressants are required by the FDA to include a black box warning about risk of suicidal thoughts, which may occur in some individuals after they start taking an antidepressant.

If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.

Therapy

Cognitive-behavioral therapy (CBT) is a common type of therapy used to help those with OCD stop or reduce intrusive thoughts, as well as the resulting compulsions. 

For a person living with OCD, their automatic thoughts and subsequent reactions to personal fears can feel all-consuming at times. To treat OCD, a therapist may use a type of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP), which typically involves gradually exposing a person to the thing they fear and teaching them to avoid performing their rituals in response to their fear. In time, the intrusive thoughts may reduce in frequency and become more manageable.

How can online therapy help those living with OCD?

Individuals living with OCD can sometimes have trouble leaving home. This may be due to underlying nervousness or discomfort that may be accompanied by certain compulsions or intrusive thoughts. Online therapy provides the option to seek support within one’s home or in any safe space. 

With online therapy, you can choose the most comfortable way to communicate with your therapist, whether by phone, live chat, or videoconferencing. Also, BetterHelp allows you to contact your therapist at any time through in-app messaging, and they’ll respond as soon as they can. This may be useful if you experience obsessions and compulsions in between sessions and want to document them for your therapist. 

Is online therapy effective for those experiencing OCD?

Recent research shows that internet-based cognitive behavioral therapy (ICBT) can be an effective way of helping people with intrusive thoughts related to OCD. In a study published by Cambridge’s Psychological Medicine, 60% of participants experiencing OCD symptoms reported clinically significant improvement after receiving internet-based treatment. Participants completed online exercises and interacted with therapists—primarily by email—three or four times per week. 

The study found that participants generally experienced a noticeable decrease in symptoms and an increase in general functioning as a result of treatment.