Existential Psychiatry Blog

Understanding the Uninvited: A Closer Look at OCD and Intrusive Thoughts

December 6, 2023
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Obsessive-compulsive disorder (OCD) is a mental health condition affecting millions of people worldwide. One of its hallmark features is the presence of intrusive thoughts. These are unwanted, distressing ideas or images that repeatedly enter your mind. You can’t control when they pop up or how long they stay, causing anxiety and discomfort.

It’s crucial to note that intrusive thoughts aren’t only present in individuals with OCD and show up in a number of other mental health conditions. Examining the ways in which they present in OCD helps promote accurate diagnosis, as well as effective treatment and symptom management.


Obsessive-compulsive disorder is characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed in response to these thoughts. OCD can significantly interfere with daily life, relationships, and overall well-being.

Intrusive Thoughts

Intrusive thoughts are unwelcome, involuntary mental images or thoughts that can be disturbing and distressing. These thoughts often go against an individual's values and may involve themes of violence, harm, or socially unacceptable behaviors. While everyone experiences intrusive thoughts from time to time, those with OCD find these thoughts particularly distressing and challenging to manage.

The Intersection of OCD and Intrusive Thoughts

OCD and intrusive thoughts are closely linked. People with OCD often ruminate on these unwanted thoughts triggering the cycle of obsession.

For example, an individual might have an intrusive thought about harming a loved one, leading to intense anxiety. To alleviate this feeling, they may engage in compulsive rituals such as counting or checking to prevent harm.

Differential Diagnosis: Intrusive Thoughts in Other Disorders

Intrusive thoughts are common in other mental health conditions, such as anxiety, PTSD, body dysmorphia, and schizophrenia. Understanding the different ways these thoughts present helps clinicians accurately diagnose and treat their patients.

Anxiety Disorders

Intrusive thoughts are common in anxiety disorders, including generalized anxiety disorder (GAD) and panic disorder, but differ from those experienced in OCD. In anxiety disorders, these thoughts often revolve around worries related to potential future events, personal safety, or catastrophic outcomes. The intrusive thoughts increase the individual’s anxiety. However, unlike OCD, the person doesn't use repetitive actions to reduce their worries.

Post-Traumatic Stress Disorder (PTSD)

In post-traumatic stress disorder (PTSD), intrusive thoughts present as distressing and vivid recollections of past traumatic events. They are often accompanied by intense emotions, flashbacks, and a sense of reliving the trauma.

Unlike OCD, where intrusive thoughts may encompass a broad range of themes, PTSD-related intrusive thoughts are anchored to the specific traumatic experience. Individuals with PTSD may struggle with memories that intrude upon their daily lives, disrupting their thoughts and emotions.


Intrusive thoughts in depression are often persistent, negative, and self-critical. These thoughts contribute to a pervasive sense of hopelessness and worthlessness that is prevalent with depression.

In OCD, compulsive actions are aimed at reducing anxiety. In depression, individuals experiencing intrusive thoughts may struggle with continual low mood, lack of motivation, and impaired cognitive functioning.

Body Dysmorphic Disorder (BDD)

People with body dysmorphic disorder (BDD) experience intrusive thoughts centered around perceived flaws or defects in their physical appearance. These thoughts can be relentless and upsetting, leading individuals to engage in compulsive behaviors such as excessive grooming, mirror-checking, or seeking reassurance.

Unlike the broad spectrum of thoughts seen in OCD, BDD's intrusive thoughts are consistently fixated on the individual's perceived flaws.


Those with schizophrenia experience intricate intrusive thoughts as part of a range of psychotic symptoms, like hallucinations and delusions. These thoughts, unlike the specific and distressing themes in OCD, are linked to disrupted thinking and perception. They often lead to the development of elaborate belief systems not based in reality.

Man sitting against a brick wall thinking about treatment in Seattle for OCD and intrusive thoughts.

Types of Intrusive Thoughts

The different kinds and severity of intrusive thoughts a person experiences varies, and uniquely impacts each person.

Violent or Aggressive Thoughts

Intrusive thoughts may involve you being violent towards yourself or others or doing something illegal. You don’t have any intent to act on these thoughts. They likely go against your values and lead you to worry about what having these thoughts says about you.

Sexual Intrusive Thoughts

These are characterized by unwanted and distressing sexual ideas or images. They may be explicit, inappropriate, or contrary to your values, causing significant anxiety or guilt. Having these thoughts doesn’t reflect your actual desires or intentions.

Doubt-Inducing Thoughts

Doubts, whether about relationships, sexual orientation, or tasks like locking doors, are prevalent intrusive thoughts. They often involve questioning decisions, actions, or beliefs, leading you to second-guess yourself.

Fear of Germs or Illness

Concerns about contamination and illness, even in low-risk situations, are common intrusive thoughts. You might experience unwanted and distressing thoughts related to cleanliness, hygiene, or the fear of getting sick. Such worries can lead to obsessive health concerns or behaviors such as excessive hand washing or avoiding contact with others.

Religious Thoughts

Intrusive religious thoughts refer to involuntary and unwanted ideas or images related to one's faith or religious beliefs that repeatedly enter your mind. These thoughts may be distressing and conflict with your personal beliefs, causing anxiety or guilt. They can vary widely, from blasphemous or sacrilegious ideas to doubts about religious practices.

How to Deal With Intrusive Thoughts

If intrusive thoughts or other symptoms of OCD are negatively impacting your daily life, reach out for help. Effective treatment is available and often includes a combination of therapy, medication, and mindfulness practices, depending on your needs.

Cognitive-Behavioral Therapy (CBT)

CBT is a widely recognized therapeutic approach for OCD, specifically exposure and response prevention (ERP). This form of CBT involves gradually exposing you to the feared thoughts or situations and preventing the compulsive rituals. Over time, this can lead to a reduction in the anxiety associated with intrusive thoughts.


Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed medications for OCD. These medications can help regulate neurotransmitters in the brain, reducing the severity of obsessive thoughts and compulsive behaviors.

Mindfulness and Acceptance

Mindfulness techniques, such as meditation and deep breathing exercises, can help you observe and accept intrusive thoughts without judgment. Trying to control or shame yourself out of unwanted thoughts runs the risk of worsening symptoms or harming your mental health.

Supportive interventions can significantly improve your quality of life. Talk to your health care provider about the best treatment options for you.

Searching for Help With OCD and Intrusive Thoughts in Seattle?

Dr. David Zacharias specializes in helping individuals find relief from the distress of OCD and intrusive thoughts. With over 20 years of experience and a client-centered approach, Dr. Zacharias provides his patients with holistic and empowering OCD treatment.

Diagnostic assessment, therapy, and medication management are available in person in the greater Seattle area and virtually across Washington state. Reach out today for a free consultation.

Written by Existential Psychiatry Staff


OCD (Obsessive-Compulsive Disorder): Symptoms & Treatment.” Cleveland Clinic, December 14, 2022. Accessed November 28, 2023.