What are OCD Intrusive Thoughts And How Are They Created?

Intrusive Thought OCD is when you have habitual, automatic, repetitive, unwanted thoughts that are the OPPOSITE of your moral or social values.

Intrusive thoughts represent your innermost, core taboos, the things you absolutely could not cope with if you did them, became them, said them or if those things happened.

People who have Intrusive Thought OCD are NOT violent. They are NOT evil. In fact, they tend to be caring, decent people with above-average moral values.

If someone suffers horrifying, vile thoughts of hurting animals, that person will not work in an abattoir. They will not go to watch blood sports or hunt or hurt animals. They are more likely to be the vegans and vegetarians of this world.

The same applies to what are – arguably – more emotive forms of this horrible illness. People with Intrusive Thought OCD who are traumatised (and I mean TRAUMATISED!!) with thoughts of hurting or abusing children are NOT the paedophiles of this world; they are the ones whose inner moral values are “hurting children is wrong”.

Note: in the few OCD groups I have joined, I have met many, decent, law-abiding, caring people who have been so traumatised by violent or sexual thoughts that they have attempted suicide, have given up their jobs, have spent prolonged periods in hospital, have delayed or even forgone the desire to have children of their own, have become house-bound and/or have subjected themselves to prolonged counselling and medicinal drugs. I would feel perfectly safe alone with any one of those people. Their psychiatrists and psychotherapists are happy for them to continue being parents / grandparents / teachers / doctors / care-assistants. I leave each OCD meeting without the slightest fear that they will hurt anyone. I also now have the confidence to know that I myself will not hurt an innocent person.

A few Examples of Intrusive Thought OCD

If you are a very religious person and your core belief is that you must worship God, Intrusive Thought OCD could create horrible, vile blasphemous thoughts.

If you are a loving parent, postnatal or postpartum OCD could create terrifying thoughts of hurting, killing or abusing your precious young children. Both men and women can suffer this. (See my struggles with postnatal OCD.)

If you believe it is wrong to hurt or kill an innocent human being or animal, you could get terrifying thoughts of hurting or killing people or animals. These will get particularly bad when you are in a position to do just that – for example, when you are alone with a child or vulnerable adult.

If you think it is wrong to sexually abuse a child (or an adult), you could get vile thoughts of doing so. Again, these will get worse when you are in a position to do so – for example, when you are left alone with a child.

If you think you should not have sexual thoughts outside of a relationship, you could get sexual thoughts / images towards family members, friends, strangers or animals.

If you think it is wrong to cheat on your partner, you could worry that you are attracted to every other person you meet.

If you think it’s wrong to be gay / straight / trans (or whatever), you could get thoughts that you are the opposite to your real “sexual orientation”.

If you think it is wrong to infect someone with Aids, you could think that you are doing so. (Even if blood test after blood test comes back negative.)

If you cannot cope with thoughts of your own death, you could get horrible thoughts of injuring or killing yourself.

If you think it’s wrong to cause an accident, you could get terrible fears of knocking down a pedestrian when driving or of crashing your car into another car.

Other intrusive thoughts could center around the fear of messing your pants in public or beng a terrorist or saying offensive things in public or … or … or …

Many people have a mix of different intrusive thoughts.

So How Do Such Horrible Unwanted Thoughts Happen?

The truth is, they happen to most people. Research has shown that the vast majority of “normal” people get odd, random thoughts that – if you held that thought up to the light and said  “this is what that person is like” – would make that “normal” person seem pretty shocking.

The difference between a “normal” person and one with Intrusive Thought OCD is that “normal” people think “what a strange thought” and then forget all about it.

Someone with Intrusive Thought OCD, however, is SHOCKED by the thought, HORRIFIED by it. They start worrying about it and beating themselves up about it and hoping that they don’t think like this again. This excessive worrying and beating-yourself-up is called “OCD rumination” and these ruminations are what cause Intrusive Thoughts to get a hold in the brain.

These ruminations create a neural pathway in the brain between a “trigger” and an unwanted thought. The more you ruminate, the deeper this neural pathway becomes. The deeper it becomes, the more likely the thought is to pop into your mind whenever you see/hear/think about the “trigger”. The more that happens, the more you fear the thoughts happening, the more you ruminate and the deeper the neural pathway becomes. A vicious circle is established.

Example of How Intrusive Thoughts Happen

Note: I am indebted to this example to two OCD psychotherapists who have both come forward and admitted that they personally have had this type of thought. I am “stealing” this example as, in my local support group, we tend to use this example to avoid the stress of revealing our own personal “shameful” thoughts; also, I hope it will help other people to understand the process.

Two people are standing at the train station when a train is coming in. Both have an odd, fleeting thought – wouldn’t it be terrible if I pushed the person in front of me into the path of the train.

The normal person thinks – what a strange thought and then goes back to planning the day and forgets all about the “strange thought”. He/she does not push anyone in front of the train.

The Intrusive Thought OCD sufferer does not push anyone in front of the train, either. BUT they are shocked by the thought and analyse it and think more about it – “how terrible this is. Why am I thinking this? That person could be a father, a son, a husband. If I pushed him in front of the train, I would be a murderer. I could be making someone lose their father. What a terrible person I am”.

These ruminations cause a faint neural pathway to form in the brain between the trigger (the train coming into the station) and the unwanted thought (pushing someone in front of the train).

The person then goes home and, at some stage,  worries a bit more about the thought. Maybe hopes it won’t happen again tomorrow at the train station.

The next morning, because of the ruminations, the person goes to the train station hoping that they do NOT think about pushing someone in front of the train again.

By hoping NOT to think of pushing someone in front of the train again, they effectively bring this thought into the forefront of their mind.

Note: let me say to you “do not think of a pineapple. Do not think how juicy and sweet it is. Do not think of tinned pineapple, Do not think of pineapple juice.” I can guarantee that most of you will have thought of a pineapple!

And so the train comes in. In front, is a young mother with a child. Because of the previous ruminations (basically beating themself up and worrying), the thought pops into their mind “if you pushed this person into the train, you would be a murderer. You would be a child murderer. The police would arrest you. You would go to jail. Your family would be horrified. This would be unforgivable.”

The person becomes even more shocked, more horrified. They worry more, beat themselves up more. These ruminations go on for a bit longer than the first day. By ruminating, the neural pathway in the brain gets deeper.

As time goes by, the thoughts get more and more frequent.

Ruminations become more and more often. Ruminations take longer and longer. The neural pathways in the brain between the trigger and thought get deeper and deeper.

The person’s anxiety levels increase. And increase.

The person’s self-image starts to become affected. “I am thinking such evil thoughts; surely I must be an evil person”. Gradually, self-talk can shift from “wouldn’t it be terrible if I pushed that person” to “I’m going to push that person”.

Eventually, the anxiety gets so much that the person feels the need to alleviate it by means of rituals. These rituals are the compulsions and the thoughts are the obsessions in the titlte Obsessive Compulsive Disorder.  These rituals / compulsions can be physical (take three steps back and put hands behind the back) or mental (say a special silent prayer a certain way a certain number of times) or avoidance (avoid train stations and take the bus instead.) These rituals provide momentary relief from the chronic anxiety but then feed back into the brain – hey, this thought is s-o-o-o-o important, s-o-o-o-o-o significant, that I need to do rituals to counteract it. The rituals thus become another way of reinforcing your unwanted thoughts.

And then OCD mushrooms, as OCD has a habit of doing …

The sufferer leaves the train station and catches the bus. Everything is hunky-dory UNTIL the odd little thought pops into the brain – wouldn’t it be terrible if I pushed someone in front of the bus.

The same things happen all over again.

Ruminations create a neural pathway between the trigger (this time a bus) and an unwanted set of thoughts. Now there are two triggers that can spark intrusive thoughts.

Anxiety builds up.

The self-image gets even worse. I am having these thoughts in TWO different situations. I really must be a “bad” person.

Ruminations get more frequent and longer.

Anxiety builds up again.

Rituals begin again.

And so the sufferer leaves the train station, leaves the bus, and walks. Only OCD mushrooms again …

A thought occurs – wouldn’t it be terrible if I pushed someone in front of a car.

And the old ruminationanxietyrituals – damage-to-self-esteem syndrome starts all over again. Only now there are three triggers and three set of unwanted thoughts and the sufferer is even more convinced they are evil, viloent, dangerous.

Left untreated, OCD can mushroom to such an extent that the sufferer ends up thinking that they are a danger to society in more and more ways – if they are evil enough to push someone in front of a train, then is a family member safe around them as they use a knife to cut vegetables? And if they are evil enough to kill someone, then are they also evil enough to abuse someone?

And So to a Question

Is this imaginary OCD sufferer, who is so terrified of pushing someone into a train / bus / car that they traumatise themself to this degree, really a “bad” or “dangerous” person?

Or are they just a normal person, with a strong moral compass and a great deal of anxiety?

If I have explained myself properly, it should be obvious to most people that this person is no worse than the “normal” person who had the same odd, fleeting thought at the start of this example.

This is why anyone who understands Intrusive Thought OCD will tell you that sufferers are NOT bad people, they are NOT evil people and they are NOT dangerous people. They are just people with a misunderstood anxiety disorder.

Regardless of whether the intrusive thoughts are violent or sexual or blasphemous, they represent the person’s taboos. They are the exact opposite of everything that person stands for morally.

Evidence That Intrusive Thought OCD is Not Dangerous

Disclaimer: I am not a psychiatrist and I cannot possibly give anyone a diagnosis or prognosis. People may have OCD and other issues (eg anger management); whilst OCD is highly unlikely to pose a risk to others, the anger management may or may not.

I have, however, gathered together a few of the many statements by mental health specialists in the hope of reducing the stigma attached to this anxiety disorder.  

Mind 

“People with OCD are very unlikely to act on their thoughts because they find them so distressing and repugnant. There are no recorded cases of a person with OCD carrying out their obsession.”

David Veale (UK OCD Expert)

“At its simplest, this need never be a concern: there are no recorded cases of a person with OCD carrying out their obsession. By definition, such intrusions are unacceptable and ego-dystonic, and the person is no more likely to act on their intrusions than a person with height phobia is to jump off a tall building.”

Royal College of Psychiatrists (on Post-Natal OCD)

“You may worry that you will accidentally or deliberately harm your baby, including sexual and violent thoughts. We know that people with OCD don’t become violent or act on these thoughts. …. Although mothers with OCD may fear harming their baby, they are not a risk to their babies. There are no recorded cases of people with OCD acting on their obsessional thoughts.”

BBC Programme on OCD

“There have been cases of people going to doctors and telling them that they’re having terrible thoughts about harming children and that they need to be locked away. Sometimes, doctors don’t know it’s OCD, and think the person in front of them might be dangerous.
This would be extremely distressing for a sufferer and totally the wrong response – the point is, people with OCD become obsessed with these thoughts because they are so unacceptable to them and at odds with their personal values that they simply can’t dismiss them.
Psychiatrists have often described people with OCD as the last people on Earth who would do something bad.”

 

Treatment for Intrusive Thought OCD

Treatement tends to be via CBT, Exposure Response Therapy (ERP) and / or drug-based treatments. Support groups are very beneficial to many.

Mindfulness helps some (some recommend the Headspace app) but I have heard a report that a Mindfulness course triggered an OCD relapse in one person.

I also found that just understanding how intrusive thoughts work helped me a lot.

In one of my OCD groups, we are taught to label these thoughts as an “OCD Intrusive Thought” and then to refocus, using whatever distraction techniques we can (listening to music, counting the flowers in a picture, watching a movie, planning something in detail etc). Anything to stop the ruminations from kicking in and deepenng the neural pathway between the trigger and the thought. We are taught to never “go into the thought”, never to argue with it or analyse it or to give it any sort of importance. Just label it as an OCD thought and move on. That way the neural pathways in your brain between the trigger and the thought can gradually fade.

 

Variations On Intrusive Thought OCD

False memory OCD can overlay false memories of supposed “crimes” on top of intrusive thoughts. Those sufferers can become so convinced that they have hurt someone, murdered someone, abused someone, that they hand themselves into the police as criminals.

Moral scrupulosity OCD is dominated by excessive concerns about right or wrong.

 

Please Share So Others Do Not Suffer Alone

On average, it still takes 12+ years for someone to get the right help for Intrusive Thought OCD due to lack of knowledge, fear and stigma. This is unacceptable and needs changing.  As with any illness, if you treat OCD in the early stages, it is so much easier to treat and less damage gets done to a person’s life.

I would love for posters about this horrible form of OCD to be shared across Twitter and the internet, to be in doctors’ surgeries, schools, universities, magazines.

I would also love for prospective parents to be made aware of the possibilities of postnatal OCD in the same way that they are now made aware of PND.

I would also love for GPs, nurses, midwives, health visitors, police, social services etc all to be aware that people with Intrusive Thought OCD are NOT a danger to others and need to be treated as anxiety sufferers rather than as potential criminals.

 

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