Intrusive thoughts and OCD

The NHS says almost everyone has unpleasant or unwanted thoughts at some point. These can include sudden violent or offensive images that seem to come from nowhere.

OCD-UK says many people without OCD have the same kinds of thoughts as people with OCD. The difference is that in OCD the thoughts are more intense, come more often and are harder to control.

OCD-UK also explains that the thought itself is not the problem. The problem is how you make sense of it and what you do about it.

When an unwanted thought keeps coming back and causes anxiety, it may be an obsession. You may then feel you have to do something to ease the feeling. This is a compulsion. The relief does not last, so the cycle starts again.

Harm thoughts might be about hurting someone on purpose, or about causing harm by mistake. OCD can latch on to almost anything, and it often fixes on things that are important to you.

OCD-UK says people with these fears often label themselves a bad person just for having the thoughts. They wrongly believe that having the thoughts means they could act on them.

You might start avoiding things that trigger the thoughts. For example, the Royal College of Psychiatrists says a parent with OCD during pregnancy or after birth (perinatal OCD) may hide all their knives. Avoidance can feel safer, but it is a type of compulsion.

NHS inform says compulsions make OCD harder to manage. They stop you learning two things:

If your thoughts are about harming your baby, our guide to perinatal OCD may help.

Some people with OCD have unwanted sexual thoughts. OCD-UK says the main themes are a fear of causing sexual harm without meaning to, for example to a child, and repeated, distressing doubts about your own sexuality.

These can be some of the hardest thoughts to talk about. NICE says people with OCD often feel ashamed and embarrassed, and may find it very difficult to discuss their symptoms, even with professionals.

Focusing on the thoughts can lead to unwanted feelings in your body. OCD-UK explains that these sensations are normal. They do not show your sexual orientation or what you want.

The fear can change how you live. OCD-UK says a parent with these thoughts may avoid bathing or hugging their own child, which can be upsetting for both of them.

We know it can feel hard to share thoughts like these. Our aim is to offer a confidential, compassionate and safe space to talk.

OCD often fixes on things of great importance to you, and religion is a common focus. OCD-UK says this is sometimes called scrupulosity. NICE also recognises that OCD can involve a person’s religion or cultural practices.

Sometimes it is hard to tell where religious practice ends and OCD begins. Current NICE guidance says that, with your consent, professionals may consider asking an appropriate religious or community leader for advice and support.

OCD-UK describes magical thinking as the fear that even thinking about something bad will make it more likely to happen. It is sometimes called thought-action fusion.

This can lead to rituals that try to ‘neutralise’ the thought. You might repeat an action many times, or replace a bad thought or image with a good one. NHS inform says repeating an action to ‘neutralise’ a frightening thought is particularly common in children with OCD.

The NHS says most people with OCD know their compulsions make no logical sense. But they still feel they need to do them ‘just in case’.

In OCD, rumination means long spells of thinking about a question or theme. OCD-UK describes this thinking as undirected and unproductive. It goes round in circles and does not lead to an answer.

You might go over and over whether a thought means something about you. Or you might replay memories to check what happened. OCD-UK says the harder people try to recall, the more the doubt tends to grow.

Trying to block the thoughts out does not help either. NHS inform says the harder you try not to think about something, the more likely you are to think it.

The Royal College of Psychiatrists advises resisting the compulsion, but not fighting the thought itself.

You may have seen the term ‘Pure O’ online. It suggests OCD that is made up only of obsessions, with no compulsions.

OCD-UK explains that ‘Pure O’ is an online term. It is not a medical term or a separate type of OCD.

People described as having ‘Pure O’ still have compulsions. Some are hidden mental rituals, such as repeating words in your head or ‘neutralising’ a thought. But OCD-UK says there are nearly always outward compulsions too, such as checking, seeking reassurance or avoiding things.

This means you do not need a special ‘Pure O’ therapist. OCD-UK says it is treated with the same standard methods used for every other type of OCD.

Current NICE guidance (CG31) covers this too. For adults with obsessive thoughts but no obvious outward compulsions, it says professionals should consider CBT. This includes facing the thoughts without doing mental rituals or trying to ‘neutralise’ them.