Intrusive Thoughts: What They Are and How to Deal With Them

We all have intrusive thoughts, ranging from the seemingly innocent (“What if I yelled right now in this quiet library?”) to the troubling (“What would happen if I drove my car off the road?”). But when intrusive thoughts happen often and disrupt our lives, they might be symptoms of a mood and anxiety disorder.

How do you know whether intrusive thoughts have crossed the line into obsessive-compulsive disorder (OCD) or another mental health condition? Aimee Keith, PsyD, clinical manager at Pathlight Mood & Anxiety Center, unpacks the difference.

What are intrusive thoughts?

Intrusive thoughts are unwanted and involuntary images, urges and words. They’re more common than you might imagine, affecting more than 6 million Americans.

“Intrusive thoughts themselves are a normal part of the human experience,” Dr. Keith explains. “In fact, studies have shown that a large percentage of New Yorkers have had an intrusive thought about pushing someone in front of the subway with no intent of actually doing so.”

Because intrusive thoughts are unsettling and often occur randomly, they can grow quite loud inside our minds. However, they do not lead to action. That’s one of the biggest differences between intrusive thoughts and impulsive thoughts.

“Impulsive thoughts often feel more sudden and are accompanied by strong urges to act,” Dr. Keith says. “Those actions may have consequences that a person might regret later, such as choosing to buy something unnecessary that they can’t afford.”

The link between intrusive thoughts and anxiety

Intrusive thoughts can occur with almost all types of anxiety disorders. For example, “research shows that a large majority of people who have a fear of vomiting (emetophobia) have intrusive images and thoughts about vomiting,” explains Dr. Keith.

A few other examples:

• Individuals with a panic disorder or a fear of crowds (agoraphobia) may think:      
  What if I have a panic attack? or What if I can’t get out?
• Individuals with fear of being rejected in social settings (social phobia) may think:      
  What if I get negative feedback? or What if people don’t like me?”

Additionally, intrusive thoughts sometimes occur in individuals diagnosed with depression.

“People with depression may have intrusive thoughts of suicide or self-harm,” Dr. Keith says. “They also might constantly ruminate about their perceived failures and engage in other negative self-talk.”

OCD and intrusive thoughts

Obsessions, such as those that occur with OCD, are persistent, unwanted intrusive thoughts that impair an individual’s ability to function throughout the day. It’s often difficult for a person with OCD to separate themselves from those thoughts.

“Someone without OCD who has an intrusive thought about pushing someone in front of a subway car may think to themselves, ‘That’s a weird thought. I’d never actually do that,’” Dr. Keith says. “But someone with OCD might respond as if these thoughts have a deeper meaning. They might think, “What if I secretly want to push someone in front of a subway car? I must be a terrible person.’”

In all types of OCD, obsessions and compulsions go hand in hand, with one fueling the other. In the example above, a person’s obsession over an intrusive thought (pushing someone in front of a subway train) could lead to a compulsion of comparing themselves to serial killers or pedophiles just to make sure they’re not a “bad person.”

Another common compulsion is avoidance, especially in people with harm-related OCD (which stems from the fear that they will hurt themselves or others).

“They might not allow themselves to be around children, animals, the elderly or other vulnerable individuals because they’re afraid they might act out their intrusive thoughts and hurt someone,” Dr. Keith says.

Intrusive thoughts and other health conditions

Recurrent intrusive thoughts also play a role in a variety of other physical and mental health conditions, such as post-traumatic stress disorder (PTSD) and attention deficit/hyperactivity disorder (ADHD).

PTSD and intrusive thoughts

“In PTSD, intrusive thoughts may be in the form of unwanted and persistent memories, flashbacks and negative beliefs about ourselves, others and the world,” Dr. Keith explains.

For example, an individual who has social phobia may also be living with PTSD if their intrusive thoughts are related to a past trauma, such as being publicly shamed, bullied or rejected by their peers.

ADHD and intrusive thoughts

The link between ADHD and intrusive thoughts is supported by research. One study ^[1] compared 37 college students diagnosed with ADHD and 23 students without ADHD. The results showed that individuals with ADHD experienced significantly higher levels of intrusive and worrisome thoughts.

The link between hormones and intrusive thoughts

Hormone shifts might trigger brief periods of intrusive thoughts. This is most common in females and may be linked to events like pregnancy/postpartum, childbirth, menstrual cycles, menopause and conditions like premenstrual dysphoric disorder.

“Hormones affect serotonin, dopamine and norepinephrine, neurotransmitters that send signals to an individual’s central nervous system,” Dr. Keith says. “As a result, hormone shifts may lead to the development of intrusive thoughts over a short period of time.”

Some of these thoughts can be viewed as a typical reaction to major life events like childbirth. New moms, for example, might have recurring intrusive images of accidentally dropping their baby or finding their baby not breathing.

“Those thoughts are pretty normal, because new parents love their babies and are driven to protect them,” Dr. Keith says.

In moms with OCD, however, these thoughts could become compulsions. For example, new moms might check on their baby several times a night to make themselves feel better.

“This type of compulsive behavior often increases the intrusive thoughts because it gives weight to them, leading an individual with OCD to think that something will go wrong if they don’t check on their baby,” Dr. Keith explains.

How to get rid of intrusive thoughts

When people experience intrusive thoughts, they may try common coping skills without success. For example, they might try to push the thoughts out of their mind, a process called “thought stopping.” Or they might try to distract themselves from the unwanted thoughts in some way. Or they might try to neutralize their intrusive thoughts or use a compulsive behavior to deal with them.

“But all of these things only fuel the intrusive thoughts further—especially for people with OCD or PTSD,” Dr. Keith says.

However, a skill called cognitive defusion has proved helpful with intrusive thoughts. With cognitive defusion, one simply observes the thought instead of trying to reason with it, figure out what it means or replace it with a “nice” thought.

“OCD wants you to get in the ring and wrestle with your intrusive thoughts, PTSD wants you to avoid them, but cognitive defusion does neither,” Dr. Keith says. “Defusion is just observation. It teaches your mind to see these thoughts as mental events instead of mandates or prophecies. As a result, over time, intrusive thoughts usually become less frequent, less intrusive and less distressing.”

How do I know if a loved one is struggling with intrusive thoughts?

Unfortunately, intrusive thoughts are often hidden deep inside, so they’re not easily noticed or identified by others.

“People who have intrusive thoughts that are socially unacceptable usually do not share them, even with their therapists,” Dr. Keith says. 

This is especially true for people with OCD.

“These are people who are usually very kind-hearted. So the idea of being someone who could have these thoughts is very distressing to them,” Dr. Keith says.

You may be able to tell if someone is having intrusive thoughts if they:

• Display signs of feeling anxious. These can include pacing, hyperventilating, shaking their leg, talking faster than normal or becoming irritable.
• Engage in compulsions such as excessive cleaning, checking/rechecking or avoidance.
• Appear distracted, disengaged or disassociated, which is common after having intrusive thoughts, memories or images.

How can I help someone who is struggling with intrusive thoughts?

If you notice any of the behaviors listed above, the best thing to do is to ask your loved one, “Are you having intrusive thoughts right now?”

“If the person says yes, don’t try to ‘fix it’ or prove the thought wrong,” Dr. Keith says. “Instead, help them practice cognitive defusion and remind them that their thoughts are simply thoughts.”

In addition, validate that the person’s experience is unpleasant and remind them that you’re there for them and that you love them.

How to get help for intrusive thoughts

When your thoughts are so frequent, intense or distressing that they’re getting in the way of your daily life, it’s time to seek professional help.

Today individuals with intrusive thoughts, OCD, PTSD or other mental health conditions can access the comprehensive care they need through Pathlight Mood & Anxiety Center. Pathlight offers multiple levels of care — including residential, partial hospitalization and intensive outpatient — so individuals can get matched with the exact level of support they need.

At Pathlight, treatment for intrusive thoughts incorporates cognitive defusion techniques, which are integrated into evidence-based therapies such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Intrusive thoughts can be distressing, but they can be overcome. If you or a loved one is ready to take the brave first step and stop the cycle of unwanted thoughts, schedule a free assessment today.

Related Reading

The 7 Signs of High-Functioning Anxiety & How to Get Help 
The Link Between ADHD, Anxiety and Depression 
Exposure Therapy for OCD: How Does Exposure & Response Prevention Work?