You're doing something perfectly ordinary -holding your baby, cutting bread with a knife, waiting for the train- and out of nowhere a horrible, violent or absurd image drops into your head, one that has nothing to do with what you want. You freeze, heart pounding, thinking: 'how can I think this? what is wrong with me?'.
If that sounds familiar, take a deep breath: it has a name and it's far more common than you think. They're called intrusive thoughts, and the vast majority of people have had one. In this article I'll explain what intrusive thoughts are, why they appear, how they relate to OCD and anxiety, when they're a problem and how you can manage them without letting them take over.
Intrusive thoughts: what they are exactly
Intrusive thoughts are ideas, images or urges that appear in your head suddenly, involuntarily and unwanted. They come on their own, without being called, and they usually clash head-on with your values and with the person you are; that's why they're so distressing. The American Psychological Association describes them as unwanted thoughts that break into awareness. They can be a one-off or come back repeatedly, and they almost always leave a mix of strangeness, shame and fear.
Does everyone have intrusive thoughts?
Pretty much, yes. Studies find that around 90% of people have had an intrusive thought at some point. The difference isn't who has them and who doesn't, but how each person reacts. Most people let it pass -'what a silly thought'- and don't give it another moment. The problem starts when a thought sticks and we chew it over, because then it seems to mean something about us. And it doesn't.
Why we have intrusive thoughts
The brain churns out thoughts non-stop, and not all of them make sense or were asked for. There's a part of the brain devoted to spotting danger: it imagines bad scenarios to warn us and keep us on guard. Sometimes that alarm goes off over things that aren't a real threat at all. The fact that your head produces a terrible image doesn't mean you want it; often it's the opposite: it shows up precisely because it's what you reject most. The thought makes noise because it touches something you care about.
Intrusive thoughts: common examples
Intrusive thoughts can be about anything, but they tend to cluster around the topics we find most taboo or most frightening.
The most frequent themes
- Of harm: a fear of accidentally hurting someone you love, or yourself.
- Of a sexual or taboo nature that disgusts you.
- Blasphemous or religious, often in people of faith.
- Of contamination, germs or illness.
- Of doubt: 'did I turn off the gas?', 'what if I ran someone over without noticing?'.
- Of having done, or being about to do, something unforgivable.
Having one of these thoughts says absolutely nothing about you as a person. In fact, someone who has intrusive thoughts of harm is usually the person most afraid of doing it, not the one anywhere near it.
The key isn't the thought, but the reaction
This is the crux of it. An intrusive thought isn't dangerous in itself: it's just mental noise. What turns it into a problem is the importance we give it and what we do next. If you treat it as a real threat -'if I think it, I must want it' or 'thinking it is as bad as doing it'- anxiety spikes, you pay it attention and, without meaning to, you reinforce it. The harder you fight not to think about it, the more it comes back. It's the white bear effect: try not to think of a white bear and see what pops straight into your head.
Intrusive thoughts and OCD
When this cycle gets stuck, obsessive-compulsive disorder (OCD) can appear. In OCD, intrusive thoughts turn into obsessions: ideas that come back again and again and cause a lot of distress. To calm it, the person performs compulsions -checking, washing, repeating, asking for reassurance, praying. That brings relief for a moment, but it teaches the brain that the thought really was dangerous, and the cycle grows stronger. The UK's National Health Service (NHS) notes that these obsessions don't reflect who the person is. Not everyone with intrusive thoughts has OCD, but OCD almost always starts here.
Intrusive thoughts and anxiety
Intrusive thoughts and anxiety feed each other. When you're going through a spell of stress, exhaustion or a lot of anxiety, the brain is more on edge and produces more of them. They also mix with other mental habits: rumination (going round and round), catastrophic thinking or, when they're about health, health anxiety. In intense cases, a very distressing thought can end up triggering a panic attack.
Intrusive thoughts after childbirth
There's one time of life when intrusive thoughts are especially frequent and especially hard to bear: right after having a baby. Many mothers -and fathers too- have intrusive images of accidentally harming the baby or of something terrible happening to them. They're as common as they are terrifying, and they almost always reflect the exact opposite of what the person wants: a protective instinct that has switched on with too much force. Having them doesn't mean you'll harm your child or that you're a bad parent. That said, if they come with deep sadness, disconnection from the baby or a lot of distress, it's worth ruling out postpartum depression and asking for help as soon as possible.
When intrusive thoughts are a problem
Having them now and then is normal and calls for nothing. It's worth seeking help when intrusive thoughts:
- Take up a lot of your day and make it hard to concentrate on anything else.
- Cause a lot of distress, shame or guilt over a sustained period.
- Force you to perform rituals or checks to feel calm.
- Make you avoid places, people or situations (for example, not wanting to be alone with the baby).
One important point: an intrusive thought is not an intention. That said, if at any moment you feel a real urge to harm yourself or someone else, or you're not sure you can keep it in check, seek immediate help: you can call 024 (Spain's suicide helpline) or 112 (emergencies).
How to manage intrusive thoughts
The good news is that you can learn to live alongside them until they lose their grip. The underlying idea isn't to 'get rid of them' -the more you chase them, the more they come- but to change the relationship you have with them.
Strategies that help
- Name them: 'this is an intrusive thought', not an order or a truth about you.
- Don't argue with them or analyse them: let them pass like a car driving by, without getting in.
- Don't do the ritual: don't check, don't seek reassurance. The relief it gives feeds the cycle.
- Practise mindfulness: mindfulness teaches you to observe thoughts without latching on to them.
- Treat yourself kindly: self-compassion lowers the shame, which is the fuel of the problem.
- Look after the basics: sleeping well, moving your body and lowering stress mean fewer of them appear.
What doesn't help (even if it seems to)
There are very human reactions that, without our realising, fatten up intrusive thoughts: trying to block them by force, seeking reassurance over and over that 'nothing's wrong', googling it at 3 a.m., or avoiding everything that sets them off. All of them give short-lived relief, but they confirm to the brain that the thought was important and that something had to be done about it. Learning not to respond to these 'traps' is a big part of the work.
How therapy helps
If intrusive thoughts are stealing your peace, therapy works, and works well. It uses tools with proven effectiveness: cognitive behavioural therapy, exposure and response prevention -learning to stay with the thought without doing the ritual- and acceptance. Little by little, the thought stops being frightening and goes back to being what it always was: background noise. The US National Institute of Mental Health (NIMH) notes that these are the first-line approaches. If what you're going through fits OCD, OCD therapy can help; if it's more about anxiety, anxiety therapy. I do this through online therapy, in Spanish or Catalan.
You don't have to live with this distress on your own. Get in touch for a first assessment with no obligation and let's start taking away their power, step by step. Your mind isn't your enemy; it just needs you to teach it to let the unimportant stuff go by.