What are obsessive thoughts?

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a mental health disorder characterized by obsessions and compulsions that cause significant distress and interfere with daily functioning. OCD affects about 1-3% of the population at some point in their lives.

Obsessions are recurring, persistent thoughts, images or impulses that are intrusive and cause marked anxiety or distress. Common obsessions include:

• Fear of contamination or germs
• Fear of harming self or others
• Need for order, symmetry or perfection
• Religious or moral preoccupations

Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. Common compulsions include:

• Excessive cleaning and handwashing
• Repeatedly checking locks, switches, appliances
• Ordering and arranging items in a particular way
• Excessive praying
• Mental rituals like counting or repeating phrases

Performing compulsive behaviors provides temporary relief from obsessive thoughts but the cycle continues. OCD becomes clinically significant when symptoms consume over 1 hour per day and cause significant distress or impairment.

What are Obsessive Thoughts?

Obsessive thoughts refer specifically to the intrusive, unwanted thoughts or mental images that are characteristic of OCD. They are also called intrusive thoughts.

Obsessive thoughts are unwanted ideas or impulses that repeatedly well up in a person’s mind and cause extreme anxiety and distress. The individual often tries to suppress or ignore them but is unable to dismiss them.

Here are some examples of common obsessive thoughts:

• Fear of harming loved ones
• Fear of blurting out obscenities or insults
• Fear of acting out violent or horrific impulses
• Excessive concern with sacrilege or blasphemy
• Excessive focus on symmetrical or “just right” ordering
• Obsessions about contamination from germs or bodily fluids
• Disturbing sexual thoughts about strangers, family, children
• Aggressive images of killing others or oneself

Obsessive thoughts are a core symptom of OCD. However, having an occasional intrusive thought does not necessarily mean someone has OCD. Nearly everyone has experienced unwanted, disturbing thoughts at some point.

Obsessive thoughts become part of OCD when they are:

• Frequent – occurring regularly for an extended period
• Persistent – they won’t go away and keep coming back
• Uncontrollable – the person cannot stop the thoughts at will
• Distressing – they invoke feelings of anxiety, disgust, fear or panic
• Disruptive – they interrupt normal activities and functioning
• Ego-dystonic – they are inconsistent with the person’s values and sense of self

Why Do People Have Obsessive Thoughts?

Researchers are still investigating the underlying causes of obsessive thoughts and OCD. Contributing factors likely include:

Biology: OCD has a genetic component. Having a close relative with OCD increases risk. Differences in certain neurotransmitters and hormones may play a role.

Environmental factors: Childhood trauma and abuse are associated with increased risk for developing OCD. Some infections are linked to pediatric autoimmune neuropsychiatric disorders and OCD symptoms later in life.

Thought-action fusion: This cognitive bias means someone falsely believes a thought increases the likelihood they will actually carry out an action. For example, the thought “What if I hurt my child?” makes them believe they are actually more likely to do so.

Inflated responsibility: People with OCD often overestimate their ability to prevent harm or their responsibility to do so. This fuels anxieties that terrible consequences could result from their thoughts.

Intolerance of uncertainty: People with OCD have difficulty coping with the uncertainties and possibilities of everyday life. They crave certainty and try to prevent all perceived threats with compulsions.

Cognitive distortions: OCD is associated with cognitive distortions like overimportance of thoughts, need to control thoughts, and thought-action fusion. These distort reality and exacerbate symptoms.

Examples of Common Obsessive Thoughts

Obsessive thoughts vary widely but often fall into categories like:

1. Fear of contamination

Excessive worries about coming into contact with germs, bodily fluids, chemicals, environmental toxins, etc. Common obsessions include fear of:

• Dirt, dust or grime
• Bodily fluids like blood, semen, urine, feces
• Respiratory droplets from coughing or sneezing
• Saliva, sweat, tears
• Household cleaners or chemicals
• Soap or water that is “too dirty” to clean properly
• Food or utensils that were “contaminated”
• Touching garbage or anything in public places

2. Harm obsessions

Persistent fears about harm coming to oneself or harming others. Common examples include:

• Stabbing or poisoning loved ones
• Strangling or drowning one’s child
• Crashing the car on purpose
• Jumping in front of a train
• Causing harm by spreading illness or contamination
• Accidentally poisoning dinner guests
• Causing fires or other accidents

3. Sexual obsessions

Intrusive sexual thoughts or images that are disturbing but not in keeping with the person’s character. Common sexual obsessions include:

• Thoughts of molesting children
• Fears of being attracted to same-sex individuals
• Aggressive or disturbing images during sex
• Impulses to touch strangers inappropriately
• Taboo thoughts or images during prayer or worship
• Intrusive thoughts of forbidden acts like incest

4. Religious obsessions

Excessive concerns about morality, blasphemy, sacrilege, or offending God. Common religious obsessions include:

• Fears of sinning without knowing it
• Excessive confessing or asking for forgiveness
• Aggressive or sexual thoughts during prayer
• Fears of saying blasphemous things during worship
• Excessive concern about right vs. wrong acts

5. Need for symmetry or exactness

Obsessions about balance, order, and precision. Common symptoms include:

• Arranging items so they are perfectly aligned or symmetrical
• Mental rituals to count footsteps or repeat actions a certain number of times
• Fixations on “lucky” vs. “unlucky” numbers
• Fears about getting words or statements exactly right
• Excessive list-making, note-taking or checking to prevent mistakes

6. Intrusive sounds, words, or music

Repetitive auditory intrusions like:

• Hearing violent or disturbing lyrics over and over
• Mental repetition of sounds or words
• Fear of shouting obscenities or insults at others
• Hearing same songs or phrases in one’s head
• Need to keep repeating words or prayers in one’s head

When Are Obsessive Thoughts Problematic?

Most people experience strange thoughts and mental images from time to time. However, for people with OCD, obsessive thoughts are excessive, disruptive, extremely distressing and seem impossible to ignore or control.

Obsessive thoughts may be a problem if they:

• Cause significant anxiety, fear or discomfort
• Interrupt concentration at work or school
• Disrupt sleep
• Interfere with relationships or social life
• Lead to avoidance of certain places, people or activities
• Cause compulsions that take over an hour per day
• Are very repugnant, unacceptable or distressing

Obsessive thoughts on their own are not dangerous, but the resulting anxiety often drives compulsions and avoidance behaviors. Treatment by an OCD specialist can help manage symptoms.

What Should You Do About Obsessive Thoughts?

Living with obsessive thoughts and OCD is challenging but several strategies can help:

Get an accurate diagnosis. See a doctor or mental health professional to discuss your symptoms. OCD is often misdiagnosed at first. The right diagnosis leads to effective treatment.

Learn to identify OCD thought patterns. OCD has certain thought distortions like inflated responsibility, thought-action fusion, overimportance of thoughts, need for certainty, and perfectionism. Recognizing these patterns helps target treatment.

Begin cognitive-behavioral therapy (CBT). CBT is the gold standard treatment for OCD. With exposure and response prevention (ERP), patients confront feared thoughts and situations until anxiety diminishes.

Ask about medications. SSRIs like Prozac, Luvox, Paxil and Zoloft can help relieve OCD symptoms for some people. Anafranil and antipsychotics are also sometimes prescribed.

Join a support group. Connecting with others facing similar challenges provides perspective. Groups like the IOCDF, ADAA, and NAMI provide resources and help.

Make lifestyle changes. Reducing stress through diet, exercise, sleep, social connection, nature time and mindfulness practices helps improve OCD management.

Avoid reassurance seeking and compulsions. Reassurance from others and performing rituals in response to obsessions only provide temporary relief. Fighting compulsions is essential.

Keep tabs on symptom severity. Monitoring OCD symptoms and triggers helps identify treatment progress. Smartphone apps can help track obsessive thoughts and compulsions.

When to Seek Emergency Care

Most obsessive thoughts are not dangerous. However, a mental health crisis warrants immediate care if someone:

• Is at imminent risk of suicide or self-harm
• Has harmed others or is at risk of doing so due to violent obsessions
• Shows signs of psychosis like hallucinations or detachment from reality
• Is unable to care for themselves adequately due to severe OCD symptoms

Emergency warning signs require intervention to ensure safety and prevent lasting harm.

Conclusion: Keys to Managing Obsessive Thoughts

Obsessive, intrusive thoughts are core to OCD. Though often disturbing, the thoughts themselves are not dangerous. The anxiety from obsessions drives the compulsive behaviors that disrupt functioning. Effective treatment involves:

• Accurate diagnosis and cognitive-behavioral therapy
• Learning to identify OCD thought patterns
• Developing skills to resist compulsions through exposure therapy
• Using medications as an adjunct treatment if prescribed
• Making healthy lifestyle adjustments to reduce stress
• Joining support groups to combat isolation and hopelessness

With professional help and diligent practice of healthy coping strategies, the cycle of obsessive thoughts and anxiety can be overcome. Relief from distressing thoughts is possible.

FAQs about Obsessive Thoughts

What are some examples of common obsessive thoughts?

Some of the most common obsessive thoughts that people with OCD experience include:

• Contamination obsessions - excessive fears about germs, chemicals, or bodily fluids
• Harm obsessions - persistent thoughts about harm coming to oneself or family
• Sexual obsessions - intrusive, disturbing sexual thoughts or images
• Religious obsessions - excessive concern with sacrilege, blasphemy or sin
• Need for symmetry/ordering - obsessions about balance, precision, exactness
• Obsessions with intrusive sounds, words, or music

Do obsessive thoughts mean I have OCD?

Not necessarily. Many people have occasional intrusive thoughts that are disturbing but don't necessarily mean they have OCD. If the thoughts are happening frequently over an extended period, feel uncontrollable, and are causing significant distress and life interference, it may be a sign of OCD. Consulting with a mental health professional can help determine if OCD is present.

How do I get obsessive thoughts to stop?

Trying to force obsessive thoughts to stop is usually ineffective. The more someone tries to suppress the thoughts, the more powerful they become. Cognitive behavioral therapy with exposure and response prevention helps reduce distress. Rather than make the thoughts disappear completely, treatment focuses on accepting the existence of thoughts while learning not to respond with compulsions.

Can OCD obsessive thoughts lead to suicide or violence?

Obsessive thoughts themselves do not usually lead to suicide or violence in people with OCD. OCD is characterized by ego-dystonic thoughts, meaning they are repugnant to the person. However, the chronic anxiety and distress of obsessive thoughts may increase suicide risk in some individuals if it becomes overwhelming. Violent obsessions rarely manifest into actual violence. But very rarely, in severe cases with psychotic features, harm to self or others could occur, requiring emergency evaluation.

Do obsessive thoughts mean I secretly desire to act them out?

No. Obsessive thoughts are highly intrusive and feel completely foreign to the person's true character. Just because someone has a violent or disturbing thought does not mean they secretly wish to carry it out. In fact, they are so distressing because they contradict the person's values. It is a common misconception that intrusive thoughts represent true desires. They do not.

I can't stop mental rituals in response to obsessions. What should I do?

The urge to perform mental and physical rituals is powerful. But compulsions only provide temporary relief while perpetuating obsessions. With support from a cognitive behavioral therapist, you can learn to sit with anxiety triggered by thoughts without reacting. It is called exposure and response prevention. Starting small and facing fears gradually makes it more tolerable. Over time, resisting rituals becomes easier.

How do I explain intrusive thoughts to loved ones?

Many people have misconceptions about obsessive thoughts, so education can help. Explain that intrusive thoughts do not represent your true desires, interests or intent. Share resources about OCD so they understand it is a common symptom. Let them know you do not want reassurance or for them to participate in rituals. Their support of your treatment progress is most helpful.

Should I confess or apologize for violent obsessive thoughts?

No. Confessing observives thoughts or apologizing for their content tends to make OCD worse by seeking reassurance. Accept that the thoughts do not represent who you are. False urges to confess should be resisted. However, if thoughts turn into psychotic delusions, then evaluation is needed.

Is it normal for OCD to ebb and flow over time?

OCD is characterized by waxing and waning symptoms. During periods of lower stress, symptoms may feel more manageable. But it is common for them to flare up during times of higher stress. Don't get discouraged by spikes in obsessions and compulsions. Stay the course with treatment and have faith your hard work will pay off in the long run.