Intrusive thoughts are unwelcome involuntary thoughts, images, or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to manage or eliminate. When they are associated with obsessive-compulsive disorder (OCD), depression, body dysmorphic disorder (BDD), and sometimes attention-deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD, post-traumatic stress disorder, other anxiety disorders, eating disorders, or psychosis.
Many people experience the type of bad or unwanted thoughts that people with more troubling intrusive thoughts have, but most people can dismiss these thoughts. For most people, intrusive thoughts are a “fleeting annoyance.” Psychologist Stanley Rachman presented a questionnaire to healthy college students and found that virtually all said they had these thoughts from time to time, including thoughts of sexual violence, sexual punishment, “unnatural” sex acts, painful sexual practices, blasphemous or obscene images, thoughts of harming elderly people or someone close to them, violence against animals or towards children, and impulsive or abusive outbursts or utterances. Such bad thoughts are universal among humans, and have “almost certainly always been a part of the human condition”.
How people react to intrusive thoughts may determine whether these thoughts will become severe, turn into obsessions, or require treatment. Intrusive thoughts can occur with or without compulsions. Carrying out the compulsion reduces the anxiety, but makes the urge to perform the compulsion stronger each time it recurs, reinforcing the intrusive thoughts. The possibility that most patients suffering from intrusive thoughts will ever act on those thoughts is low. Patients who are experiencing intense guilt, anxiety, shame, and upset over these thoughts are different from those who actually act on them. The history of violent crime is dominated by those who feel no guilt or remorse; the very fact that someone is tormented by intrusive thoughts and has never acted on them before is an excellent predictor that they will not act upon the thoughts. Patients who are not troubled or shamed by their thoughts, do not find them distasteful, or who have actually taken action, might need to have more serious conditions such as psychosis or potentially criminal behaviors ruled out.
Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and they can be divided into three categories: inappropriate aggressive thoughts, inappropriate sexual thoughts, or blasphemous religious thoughts.
Inappropriate aggressive thoughts
Intrusive thoughts may involve violent obsessions about hurting others or themselves. Rachman’s survey of healthy college students found that virtually all of them had intrusive thoughts from time to time, including:
- causing harm to elderly people
- imagining or wishing harm upon someone close to oneself
- impulses to violently attack, hit, harm or kill a person, small child, or animal
- impulses to shout at or abuse someone, or attack and violently punish someone, or say something rude, inappropriate, nasty, or violent to someone
These thoughts are part of being human. Treatment is available when the thoughts are associated with OCD and become persistent, severe, or distressing.
Inappropiate sexual thoughts
Like other unwanted intrusive thoughts or images, everyone has some inappropriate sexual thoughts at times, but people with OCD may attach significance to the unwanted sexual thoughts, generating anxiety and distress. The doubt that accompanies OCD leads to uncertainty regarding whether one might act on the intrusive thoughts, resulting in self-criticism or loathing.
One of the more common sexual intrusive thoughts occurs when an obsessive person doubts his or her sexual identity. As in the case of most sexual obsessions, sufferers may feel shame and live in isolation, finding it hard to discuss their fears, doubts, and concerns about their sexual identity. Part of treatment of sexual intrusive thoughts involves therapy to help sufferers accept intrusive thoughts and stop trying to reassure themselves by checking their bodies.
Blasphemous religious thoughts
Blasphemous thoughts are a common component of OCD, documented throughout history; notable religious figures such as Martin Luther and St. Ignatius were known to be tormented by intrusive, blasphemous or religious thoughts and urges. One study suggests that content of intrusive thoughts may vary depending on culture, and that blasphemous thoughts may be more common in men than in women.
According to Fred Penzel, a New York psychologist, some common religious obsessions and intrusive thoughts are:
- sexual thoughts about God, saints, and religious figures
- bad thoughts or images during prayer or meditation
- thoughts of being possessed
- fears of sinning or breaking a religious law or performing a ritual incorrectly
- fears of omitting prayers or reciting them incorrectly
- repetitive and intrusive blasphemous thoughts
- urges or impulses to say blasphemous words or commit blasphemous acts during religious services
Suffering can be greater and treatment complicated when intrusive thoughts involve religious implications; patients may believe the thoughts are inspired by Satan, and may fear punishment from God or have magnified shame because they perceive themselves as sinful. Symptoms can be more distressing for sufferers with strong religious convictions or beliefs.