If you have obsessive-compulsive disorder (OCD), you may experience intrusive thoughts that feel frightening, disturbing, embarrassing, or completely inconsistent with who you are.
You might suddenly have an unwanted thought about hurting someone. You may experience a sexual thought or image that makes you deeply uncomfortable. You might have an intrusive thought involving your child, your relationship, your religious beliefs, or something else that is extremely important to you.
Then comes the question that can make an intrusive thought feel even more frightening:
“Why would I think that?”
For many people with OCD, the distress isn’t only about the intrusive thought itself. It is also about what they fear the thought might mean about them.
“What if having this thought means I secretly want it?”
“What if this says something terrible about who I am?”
“What if I lose control?”
“What kind of person thinks something like this?”
This is one reason OCD and shame can become so closely connected.
What Are Intrusive Thoughts in OCD?
Intrusive thoughts are unwanted thoughts, images, urges, impulses, or mental experiences that seem to appear without invitation. Intrusive thoughts are not unique to OCD. People without OCD can also experience strange, inappropriate, violent, sexual, offensive, or otherwise unwanted thoughts.
The difference is often in what happens next.
Someone without OCD may notice an unusual thought and think, “That was weird” and move on. For someone with OCD, the same thought may become incredibly difficult to dismiss.Instead of simply noticing the thought, the person may begin trying to understand why it occurred, whether it means something, whether it could come true, or whether having the thought reveals something important about their character.
What Do OCD Intrusive Thoughts Look Like?
OCD intrusive thoughts can involve almost any subject; however, they often involve topics that feel particularly frightening, unacceptable, or morally significant to the person experiencing them. Examples can include intrusive thoughts about:
- harming yourself or someone else
- accidentally causing something terrible to happen
- losing control and behaving violently
- inappropriate or unwanted sexual thoughts
- sexual orientation or identity
- harming or behaving inappropriately toward a child
- committing a crime
- violating religious beliefs
- being immoral or dishonest
- contamination or illness
- making a catastrophic mistake
- whether you truly love your partner
- whether you are actually attracted to your partner
- doing something embarrassing or socially unacceptable
- being responsible for another person’s safety
Although the themes may look very different, the underlying OCD process can be remarkably similar. An intrusive thought creates doubt or distress, and the person feels compelled to somehow make the uncertainty go away.
Why Do Intrusive Thoughts Feel So Real?
One of the challenges of OCD is that even when a person understands logically that a thought is simply a thought, it can still feel significant or threatening. OCD can lead people to place greater meaning on intrusive thoughts and incorrectly interpret them as evidence about themselves, their intentions, or what might happen.
A person might think:
“If I had a thought about hurting someone, maybe part of me wants to hurt them.”
“If that sexual image appeared in my mind, maybe it reveals something about me.”
“If I were really a good person, I wouldn’t have thoughts like this.”
But experiencing a thought is not the same as choosing it. A thought is not automatically an intention. An image is not automatically a desire. And something appearing in your mind does not necessarily tell you anything meaningful about your character.
For someone caught in an OCD cycle, however, accepting that uncertainty can be extraordinarily difficult.
Why Does OCD Cause So Much Shame?
OCD can be especially shame-provoking because intrusive thoughts often involve subjects people find difficult to discuss. When an intrusive thought conflicts strongly with how someone sees themselves, they may experience intense shame simply because the thought occurred. That share and fear can be incredibly isolating.
OCD Often Targets What Matters Most to You
One of the cruelest aspects of OCD is that it frequently becomes attached to things a person deeply values.
Someone who cares enormously about being kind may become consumed by intrusive thoughts about harming someone.
A loving parent may experience terrifying intrusive thoughts involving their child.
Someone with strong religious beliefs may experience unwanted blasphemous or sexual thoughts during prayer.
Someone who takes commitment seriously may become trapped in endless doubts about whether they truly love their partner.
This is part of what makes OCD intrusive thoughts so confusing.
Shame Can Prevent People With OCD From Seeking Help
Some people with OCD hide their intrusive thoughts for years. They may tell a therapist about anxiety, depression, panic attacks, insomnia, or stress while avoiding the symptoms they find most disturbing.
They may worry:
“What if my therapist thinks I’m dangerous?”
“What if they misunderstand me?”
“What if saying the thought out loud makes it more real?”
“What if someone thinks I actually want these thoughts?”
As a result, OCD can sometimes go unrecognized. This is why mental health professionals need to understand the difference between intrusive obsessional thoughts and actual intent, while also completing appropriate clinical assessment when necessary.
People need to be able to talk about distressing mental experiences without automatically feeling that the content of a thought defines who they are.
The OCD Cycle: Why Trying to Get Rid of Intrusive Thoughts Can Make Them Stronger
When an intrusive thought produces anxiety or shame, the natural response is often to try to make the discomfort disappear. For someone with OCD, this may involve compulsions that aren’t always obvious to other people. For example, someone may:
- repeatedly reassure themselves that they would never do something terrible
- ask family members or a partner for reassurance
- repeatedly search online for information about intrusive thoughts
- review past experiences looking for evidence about what kind of person they are
- check their emotional or physical reactions
- avoid people, places, objects, or situations that trigger intrusive thoughts
- confess unwanted thoughts to others
- mentally replace a “bad” thought with a “good” thought
- pray repeatedly until something feels right
- repeatedly analyze what a thought means
These behaviours can provide temporary relief, but with OCD the temporary relief can reinforce the cycle. The next time an intrusive thought appears, the brain learns, “This thought is dangerous, so we need to do something about it.” And the cycle begins again.
Treatment for OCD and Intrusive Thoughts
OCD is treatable.
One of the best-established psychological treatments for OCD is cognitive behavioural therapy (CBT) incorporating exposure and response prevention (ERP) techniques.
ERP helps people gradually learn to experience intrusive thoughts, triggers, uncomfortable feelings, and uncertainty without automatically engaging in the compulsions they have been using to reduce distress.
Depending on the person’s needs, OCD treatment may also involve education about OCD, identifying reassurance-seeking and mental compulsions, developing greater tolerance for uncertainty, and changing the significance assigned to intrusive thoughts.
Treatment should be individualized, and a qualified mental health professional can help determine whether someone’s symptoms are consistent with OCD or whether another explanation should be considered.
Getting Help for OCD and Intrusive Thoughts in Ontario
If intrusive thoughts are causing significant anxiety, shame, avoidance, reassurance-seeking, or other compulsive behaviours, it may be helpful to speak with a mental health professional who understands OCD.
At Psychology For Life, we provide psychological and psychotherapy services for children, adolescents, and adults in-person in Barrie and Bracebridge, as well as online across Ontario, including support for OCD, anxiety, intrusive thoughts, and related concerns.
If you have been afraid to talk about your intrusive thoughts because you worry about what they might say about you, you are not alone. Understanding the relationship between OCD, intrusive thoughts, and shame can be an important first step toward getting appropriate support.
For additional information about OCD, the Centre for Addiction and Mental Health (CAMH) provides a comprehensive OCD information guide.
