KEY POINTS
- Unwanted intrusive thoughts often center around sexual, violent, or otherwise disturbing content, and can cause serious emotional distress.
- Contrary to widespread myths, however, having such thoughts does not mean that the thoughts reflect true desires.
- Individuals bothered by intrusive thoughts can benefit by reminding themselves that the thoughts are irrelevant and unimportant.
Everyone has passing intrusive thoughts that seem to come from outside their control: The content may feel alien, absurd, or threatening, and may pass after a few weird moments. Intrusive thoughts can be frightening worries about what might happen to you or someone you care about, or what mistake you might make, or what terrible impulsive act you might possibly commit.
For some people, intrusive thoughts are part and parcel of panic or intense anxiety. These types of intrusive thoughts feel like they are a result of, or about the anxiety itself, and they function to add more fear to the anxiety you are already experiencing. The intrusive thoughts keep the anxiety going and maintain the fear-producing spiral. So, for example, you might think, “What if I have a heart attack?” in the midst of a panic attack. Or you might envision yourself knocking people over as you rush to exit the room.
However, there is another class of intrusive thoughts: Unwanted intrusive thoughts. These are stuck thoughts that cause great distress. They seem to come from out of nowhere, arrive with a distressing whoosh, and trigger anxiety, guilt, disgust, panic, or misery. The content of unwanted intrusive thoughts often focuses on sexual or violent or socially unacceptable images. Typical examples include killing someone, torturing a pet, stabbing or molesting a child, throwing someone (or yourself) out of a window or in front of a train, raping someone, taking off your clothes in public, grabbing a stranger’s hand. Some refer to sudden doubts, like “Did I hurt someone or make a bad mistake and not realize it?” “What if I am not who I seem?” This is not a complete list, but it gives you a good sense of the content of these thoughts.
People who experience unwanted intrusive thoughts become afraid that they might commit the acts they picture in their mind. They also fear that the thoughts mean something terrible about them. Many become ashamed and worried about these thoughts, and therefore keep them secret.
Many unwanted intrusive thoughts have more benign content—repetitive doubts about relationships, decisions small and large, sexual orientation or identity, concerns about safety, religion, or death, or worries about questions that cannot be answered with certainty.
There are many myths about unwanted intrusive thoughts. One of the most distressing is that having such thoughts means that you unconsciously want to do the things that come into your mind. This is simply not true; in fact, the opposite is the truth. It is the effort people use to fight the thought that makes it stick and fuels its return. People fight these thoughts because the content seems alien, unacceptable, and at odds with who they are. People with violent, unwanted intrusive thoughts are gentle people. People who have unwanted intrusive thoughts about suicide love life. And those who have thoughts of yelling blasphemies in church value their religious life.
A second myth is that every thought we have is worth examining. In truth, these thoughts are not messages, red flags, or warnings—despite how they feel.
The problem for people who have these thoughts—one estimate is that more than 6 million people in the United States are troubled by them—is that unwanted intrusive thoughts feel so threatening. That’s because anxious thinking takes over, and the thought—abhorrent as it might be—seems to have power that it does not. People tend to try desperately and urgently to get rid of the thoughts, which, paradoxically, fuels their intensity. The harder they try to suppress, distract, or substitute thoughts, the stickier the thought becomes.
People bothered by intrusive thoughts need to learn a new relationship to them—that their content is irrelevant and unimportant. Virtually everyone has occasional weird, bizarre, socially improper, annoying, or violent thoughts. Our brains sometimes create junk thoughts, and these are just part of the flotsam and jetsam of our stream of consciousness. Junk thoughts are meaningless. If you don’t take them seriously or get involved with them, they dissipate and get washed away in the flow of consciousness.
In reality, a thought—even a very scary one—is not an impulse. People with unwanted intrusive thoughts don’t have a problem with impulse control. On the contrary, their problem is one of overcontrol. They are trying to control their thoughts. And we all know what happens when you try not to think of pink elephants. However, sufferers get bluffed by their anxiety and become desperate for reassurance, which only works temporarily: People can become reassurance junkies. The only way to effectively deal with unwanted intrusive thoughts is to reduce one’s sensitivity to them. Not by being reassured that it won’t happen or is not true, but by rising above it.
Unwanted intrusive thoughts are reinforced by getting entangled with them, worrying about them, struggling against them, and trying to reason them away. They are also made stronger by trying to avoid them. Leave the thoughts alone, treat them as if they are not even interesting, and they will eventually fade into the background.
Identifying intrusive thoughts
So, how can you tell if you are experiencing intrusive thoughts? There are some signs to look for.
The thought is unusual for you. An intrusive thought is usually very different from your typical thoughts. “For example, it might be uncharacteristically violent,” says Dr. Williams.
The thought is bothersome. If a thought is disturbing and it’s something you want to push out of your mind, it might be an intrusive thought.
The thought feels hard to control. Intrusive thoughts are often repetitive and won’t go away.
The more you think about it, the more anxious you get and the worse the thoughts get Instead of fighting intrusive thoughts, it’s better to learn to live with them. When these thoughts emerge, try taking the following steps:
1. Identify the thought as intrusive. “Think to yourself, ‘that’s just an intrusive thought; it’s not how I think, it’s not what I believe, and it’s not what I want to do,’” says Dr. Williams.
2. Don’t fight with it. When you have an intrusive thought, just accept it. “Don’t try to make it go away.”
3. Don’t judge yourself. Know that having a strange or disturbing thought doesn’t indicate that something is wrong with you.