Have you ever wondered what people mean when they talk about intrusive thoughts? If you’re like most people, you’ve had a strange thought pop in your head from time to time that TOTALLY freaked you out and was NOT something you actually felt or wanted to do. And, like most people, it may have left you feeling panicked and thinking, “where did that come from? Is something wrong with me?”

Let’s start by debunking the idea that unwanted (egodystonic) intrusive thoughts are inherently bad; say something about you as a person; or mean something is wrong with you. This couldn’t be less accurate. EVERYONE has intrusive thoughts! (Well, the actual stats say roughly 90% of people have intrusive thoughts – but I’m not buying that. I think the question either was not properly explained to the other 10%, or they might have been too nervous to answer yes).

Brains are weird and sometimes think unusual things – they “misfire” with odd thoughts all the time, just as any computer system might have an “error message” or glitch on occasion.

Intrusive thoughts can evolve into obsessions when our reaction to these thoughts is to get on the anxiety train, instead of watching it pass by.

For example, one person might have the unwanted image of driving their car into a median. They have no actual desire to do this, are quite happy with their life, and are not suicidal. This person might be able to shrug and say “huh…that was weird. Anyways, back to that podcast I was listening to.”

They don’t get on the anxiety train, and the train leaves the station. People without clinical anxiety or OCD can experience intrusive thoughts once in a while without experiencing too much distress and can go about their day with minimal interference. These thoughts do not evolve into something greater.

Someone who has anxiety (may even meet criteria for OCD) gets on the train. They are panicking on the train; desperately want to get off of it; and to stop thinking the thought. But ironically, the more they try to stop thinking about it – the more intense the thought gets! The thought ends up getting stuck on a loop in the brain. It’s distressing, anxiety provoking, and distracting from important things in your life that need attention.

When intrusive thoughts evolve into obsessions, compulsions can follow next.

Compulsions occur we feel the need to DO something about those thoughts to get rid of them. Compulsions can be broken down into two categories: internal or external (or mental or physical).

Mental compulsions are the mental gymnastics that occur when we are trying to figure something out and answer the question “what if?” (i.e., what if I drove my car into the median? What if I harm my baby? What if I lose control and stab someone while I’m unloading the dishwasher? What if I get food poisoning if I go out to eat? What if I have a terminal illness that I don’t know about? What if I get into a car accident? What if something happens to my loved ones?)

Common mental compulsions include ruminating; excessively reviewing past situations seeking clarity or certainty; obsessing about future events that have not yet occurred; or “feeling checking” to see if you really want to do something or if you truly feel a certain way (often shows up with relationship obsessions or harm obsessions).

Mental compulsions differ from helpful problem-solving in several ways.

Problem-solving occurs in response to facts you have in front of you in the here and now and involves an appropriate action plan. For example, let’s say you’ve had some health symptoms lately that are stressing you out. Maybe you’ve been experiencing GI issues, so you make a plan to visit the doctor and have some tests done.

With helpful problem-solving, the mental energy of “figuring it out” any further is over. If more worries do pop-up while you’re waiting for the appointment, which would be natural, you remind yourself of the plan you have in place and then go back to your life and the things right in front of you.

Compulsive behavior with this example might include repeatedly Googling symptoms; excessively asking for reassurance from loved ones; or spending a lot of time lost in thought imagining that you have a serious illness. These compulsions are intended to find certainty, because the doubt about what could happen feels intolerable; however, this complete certainty is NOT achievable, and compulsions only further fuel obsessions.

Many people wonder, “how do I know if I have obsessive-compulsive disorder, or if I’m just stressed out relative to circumstances?”

Let’s review: we all have intrusive thoughts sometimes. We all obsess about something from time to time. And we all have some compulsions.

Obsessive-Compulsive Disorder or Generalized Anxiety Disorder (if you’re new here I’ve learned to see these as on a spectrum rather than two district disorders) occur when intrusive thoughts that ALL of us have get stuck and turn into obsessions, and then we do compulsions in an attempt to reduce the anxiety.

When this cycle repeats continually; takes up a lot of time (1+ hour per day); causes distress; and impairs our ability to function (sleep disturbance, trouble focusing at work, or avoidance of necessary things in our lives)- that’s when symptoms might meet criteria for a diagnosable condition.

OCD can develop any time in life. While there are lots of theories about how it develops, it is likely a multitude of factors that work together to create the conditions for OCD to occur.

Sometimes there is a genetic predisposition for OCD and a very stressful life event can trigger its manifestation. Viruses (PANDAS in children) have also been known to cause OCD symptoms. Having a baby can cause OCD to emerge for the first time.

No matter what caused OCD, it can all be treated very effectively with Exposure and Response Prevention Therapy.

Even if the causes were physical (virus or postpartum period) and those physical causes have been treated, it’s often the case that the compulsions have created new neural pathways in the brain where we need ERP to rework the brain’s understanding of what behaviors are “necessary” to keep us safe. The original trigger for OCD may be gone, but the brain changes likely sustain (as they would with any behavior that we’ve gotten used to doing, like walking straight to the coffee pot every morning on autopilot).

If you are questioning if you have OCD, it is important to receive an assessment from a specialist trained in Exposure & Response Prevention Therapy (gold standard) or Inference-Based CBT (I’m newer to this model but it’s gained a lot of traction in the literature recently).

If you do not have OCD, but find yourself experiencing occasional bouts of intrusive thoughts, obsessions and compulsions relative to stressful events occurring in your life – you can STILL benefit from ERP and the foundational principles.

In fact, I’m not sure that there is truly a more effective way to cope with anxiety than the work of improving our ability to handle uncertainty and approach things that we fear, because these are inevitabilities of life that cannot be avoided.

We do not get better at tolerating doubt by avoiding things or busying ourselves with a flurry of relaxation strategies (although these can be awesome for stress management; nervous system repair; and trauma work!)

For the purpose of anxiety or OCD treatment related to fear of uncertainty or doubt, we have to get more comfortable and confident with handling and facing hard emotions without trying to escape them by doing more to take the edge off in that moment. The key here is to actually stop doing, because compulsions are all about doing more.

We ultimately get better at tolerating uncertainty by cultivating courage, bravery, and resilience by approaching hard things.

By refusing to waste our time getting on the anxiety train and spending our lost in thought or typing things in to Dr. Google.

By deciding that we are not going to avoid things that are often necessary to function in society – like go to the doctor, drive in our cars, park in parking garages, use a public restroom, or go on an airplane.

By choosing to live a life according to our VALUES – not our fears.

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