Intrusive thoughts: confronting the taboo

I can trace my OCD symptoms back to when I was four. While most children don’t want to go to bed for fear of missing out, or wanting to stay up to watch one more episode on CBeebies, I didn’t want to go to bed because I knew I’d have to stay awake for at least another hour to complete my nighttime compulsion rituals. I found going to bed almost traumatic and I spent most of my childhood frightened of my room. Until secondary school I wasn’t able to spend any length of time in it, except when sleeping. I would always choose to play, or read, or write, or draw, in another room of the house.

I saw a child psychologist for CBT when I was ten/eleven. I have very little memory of what took place in the sessions, most likely because we discussed details of childhood trauma, which I often block out. But I know the sessions were helpful; in fact, it was these sessions that sparked my interest in mental health and inspired my proposed career path.

My physical compulsions (for me, this was repetitive touching, tapping, checking, orderliness and symmetry) got a lot better after this therapy. Initially, I had far less rituals around going to bed and I was able to resist most compulsions throughout the day. I was still very careful and deliberate with my movements, but there was less overt behaviour.

What I didn’t realise was that a whole other part of my life was being governed by OCD. Simultaneous to my obsessions focused on ‘completion’, balance, and symmetry, I was plagued by intrusive thoughts. I didn’t realise these thoughts were a part of OCD, but a part of me. I interpreted these thoughts as a reflection of my character and so they sparked an intense spiral of self-hatred. From the ages of about nine to sixteen I experienced these intrusive thoughts daily, and severely.

What are intrusive thoughts?

Intrusive thoughts are “obsessional thoughts that are repetitive, disturbing and often horrific and repugnant in nature” (OCDUK). They are involuntary; sufferers do not choose to have these thoughts, as they cause significant anxiety and distress. Everyone experiences such intrusive thoughts from time to time, and OCD sufferers do not choose to have these thoughts any more than a non-sufferer chooses to have them when they do.

The difference between those with OCD and those without, is that sufferers tend to question the meaning of these thoughts, and interpret them as fact or as a reflection of themselves. Because this causes them a great amount of anxiety, they complete compulsions to relieve the negative feelings that result from them. This becomes the cycle of OCD, where there is a trigger, obsession (intrusive thought), and compulsion. 

This is why those with OCD begin to experience the intrusive thoughts more often and with greater severity than those without OCD. It is not because they enjoy the thoughts, choose to have them, or that it reflects their moral values. The opposite is true: it causes them so much anxiety that they have to complete compulsions to supposedly ‘get rid of them’.

Intrusive thoughts are often egodystonic: they contradict a person’s moral values. Rather than question the intrusive thought, a person with OCD cannot feel certain that they don’t truly believe the egodystonic thought, so they question whether they hold that moral value instead. 

My therapist once told me that in his experience people with OCD tend to be particularly analytical people, who “have high expectations of themselves morally, and put great emphasis on values such as integrity”. It is this value and fear of uncertainty (as well as other environmental and biological factors) which causes the sufferer to get caught up in the OCD cycle. They fear immorality, they fear the uncertainty that they could be immoral, and in my case, I fear that I don’t fear immorality enough.

What are the common types of intrusive thought?

Sexual intrusive thoughts

  • Thoughts about being a paedophile (often referred to as POCD)
  • Thoughts about being sexually attracted to animals
  • Thoughts about being sexually attracted to members of one’s own family
  • Thoughts about being sexually attracted to someone of the opposite/same sex (often referred to as HOCD- unfortunately, a very outdated abbreviation)
  • Thoughts about God, saints, or religious figures

Common compulsions: 

  • Mental checking (e.g. Do I really think this? Am I really attracted to children? Does this thought cause me anxiety?)
  • Checking for symptoms of arousal
  • Avoidance (e.g. avoiding playgrounds, animals, certain family members that trigger the thoughts)
  • ‘Neutralising’ thoughts (thinking phrases to ‘neutralise’ an intrusive thought, acting in a way to ‘neutralise’ an intrusive thought)
  • Checking memory for past evidence of inappropriate sexual feelings/acts

Violent intrusive thoughts

  • Thoughts about harming children
  • Thoughts about harming loved ones
  • Thoughts about harming innocent people
  • Thoughts about harming yourself (often referred to as self-harm/suicide OCD)

Common compulsions: 

  • Mental checking (e.g. Do I really think this? Do I really want to cause this harm? Does this thought cause me anxiety?)
  • Checking for the urge to act on these thoughts, or for symptoms of anxiety
  • Avoidance (e.g. avoiding sharp objects, roads, bridges, violent films, writing violent words)
  • ‘Neutralising’ thoughts (thinking words to ‘neutralise’ an intrusive thought, acting in a way to ‘neutralise’ an intrusive thought)
  • Reassurance seeking (e.g. Am I a good person? Have I ever hurt you? Do you think I’m a violent person/would ever hurt anyone?)
  • Checking memory for past evidence of causing harm

Religious intrusive thoughts

  • Having repetitive blasphemous thoughts, often in religious buildings/around religious people
  • Thoughts about doing sinful things and these never being forgiven
  • Thoughts about going to Hell
  • Thoughts about losing touch with God
  • Thoughts about not believing in God/having true faith in their religion
  • Intrusive sexual thoughts about God, saints, or religious figures

Common compulsions: 

  • Mental checking (e.g. Do I really think this? Does this thought cause me anxiety? What does this thought mean?)
  • Avoiding places of worship and religious practice
  • Repetitive praying
  • Touching/kissing religious objects repetitively
  • ‘Neutralising’ thoughts (thinking words to ‘neutralise’ an intrusive thought, acting in a way to ‘neutralise’ an intrusive thought)

Relationship intrusive thoughts

  • Thoughts about not loving/being attracted to one’s partner
  • Thoughts about the relationship not ‘being right’
  • Thoughts about one’s partner not liking/loving you
  • Thoughts about one’s partner not being faithful
  • Thoughts about not being faithful to one’s partner
  • Thoughts about being attracted to other people (often questioning one’s own sexuality)

Common compulsions:

  • Mental checking (e.g. checking for feelings of love/arousal/hatred/indifference to one’s partner, repetitive questioning, rumination)
  • Avoiding one’s partner or potential triggers (e.g. sexual intercourse, saying ‘I love you’)
  • Testing feelings for one’s partner
  • Reassurance seeking (e.g. from others that you’re happy with your partner, or from your partner that they are faithful/happy with you)

Sensorimotor OCD

  • Hyperawareness of particular bodily sensations, such as:
    • Blinking
    • Breathing
    • Eye contact or eye floaters
    • Swallowing/salivation
    • Heart beat
    • Certain body parts

Common compulsions

  • Avoidance of triggers (e.g. eating particular foods that make swallowing louder, social settings where one will have to make eye contact)
  • Counting (e.g. to distract themselves from the obsession)

Magical thinking intrusive thoughts

  • Thoughts telling you that the only thing that can prevent an unwanted consequence (e.g. the death of a loved one) is completing a specific (set of) compulsions
  • Having an intrusive thought and then believing it will cause something bad to happen/make it more likely
  • Thoughts that certain days/colours/numbers have good or bad luck associated with them

Common compulsions

  • Avoidance (e.g. avoiding certain numbers, writing certain words, attempting to stop thinking certain thoughts)
  • ‘Neutralising’ supposedly ‘bad’ thoughts by thinking a ‘safe’ word, or performing a certain act (e.g. after an intrusive thought about someone dying, saying ‘life’ to counteract it)
  • Reassurance seeking (e.g checking that someone is okay/safe if they have had a thought about the person dying)
  • Tapping, counting, checking (i.e. overt behaviour) to stop a bad thought from becoming true

My own experience of intrusive thoughts

I have experienced sexual, violent, relationship, sensorimotor, and magical thinking intrusive thoughts. The severity changes, as does the type of intrusive thought I experience. When I was younger the violent intrusive thoughts were most frequent and severe. I would have thoughts telling me that I’m a bad person, that I’m a violent person, that I want to hurt people.

My OCD would convince me I had an urge to cause harm, particularly to my mum. The distress this caused is hard to put into words. I would try to get out of watching violent films or documentaries that focused on tragedies, because thoughts would tell me that I didn’t care or wanted bad things to happen to people. I would constantly ‘check in’ with my emotions and urges- ‘does that thought make me anxious enough?’, ‘what does the thought mean?’, ‘did I just enjoy that thought?’, ‘do I have an urge to act on that thought?’. I would avoid looking at sharp objects and would try to walk on the opposite side of the street to strangers; this was a way to avoid triggering the obsessive, intrusive thoughts.

As I got older the sexual intrusive thoughts started. My thoughts would tell me I was sexually attracted to (younger) children, animals, members of my own family. I felt constantly sick. Whenever there was a moment of happiness the thoughts would pop in my head telling me I was a paedophile; a threat to society. I would avoid playgrounds, turn my head whenever a child passed, lay awake at night questioning what these thoughts meant, whether I should go to the GP or report myself to the police. I was twelve.

Even seeing my half-brothers was difficult; I would try to resist holding their hands, or picking them up when they wanted me to. I was disgusted with myself. Even now, writing this, I have the urge to question and repeatedly analyse; I’m trying to resist.

No part of OCD is fun or a “quirk”, but what makes intrusive thoughts so debilitating is that, because their themes are often considered taboo, people don’t like talking about them. And why? Because it’s just not as comfortable as talking about cleaning, tidying and orderliness. Sorry, but this is the reality of OCD (I bet you wish your messy son didn’t have it now, huh?!). Because there is a lack of discussion, people can suffer with these intrusive thoughts for years and never realise that they’re a symptom of OCD.

When I was fifteen I joined an OCD forum (with OCD Action). At this point I had been suffering with intrusive thoughts for six years and still wasn’t aware that they were a symptom of OCD, despite being diagnosed when I was ten. I initially joined the website out of mere curiosity; I was interested in mental health, had supposedly recovered from OCD, and wished to offer current sufferers advice and support; the kind I wished I had received. But after reading a few posts I soon realised I was not recovered; not even close. Below shows an extract of the post I wrote:

Aug 2017

I remember writing this post in tears. It is difficult to describe the all-consuming emotional pain I was feeling; the intensity of self-disgust and shame. I was convinced I was going to be bombarded with responses telling me what an awful person I was, or that I was going to be reported. For the next week I was incredibly anxious, constantly expecting the police to knock on my front door. I didn’t know everyone experienced these intrusive thoughts from time to time, and that they’re extremely common in those with OCD.

What really happened? I got one response telling me they understood how difficult it was to deal with OCD. My post was a cry for help, but nothing happened. I didn’t ‘deal/treat with it on my own’, but continued to suffer.

Where am I now?

I still have OCD and I still suffer with intrusive thoughts. However, the content of these intrusive thoughts and their frequency has changed a lot. Since realising these are a symptom of my OCD, and after doing a lot of research, I am better at coping with most of them (definitely not all! I’m still working on it). I am currently in the process of writing a post on the evolution of mental illnesses, specific to my OCD. So stay tuned for that 🙂

Why do we need to talk about intrusive thoughts more?

Unless you specifically research OCD, intrusive thoughts as a symptom is not often discussed in the non-OCD community. So unless you already know you have OCD, you may not understand the symptoms, and never consider you could have it. In my case, my age combined with the fact I thought I was recovered, meant that I never researched this.

The lack of understanding surrounding intrusive thoughts is strange considering how common they are; speak to any OCD specialist and they won’t bat an eyelid at the content of any intrusive thought you may be experiencing, no matter how horrific. This is because they’re used to hearing about these taboo, egodystonic intrusive thoughts within OCD; they’re that common.

But within the non-OCD community it is not widely talked about. I believe this is because there is a huge misunderstanding around intrusive thoughts. People may question why someone would be consumed by thoughts focusing on whether they were a paedophile, if they weren’t a paedophile. Why wouldn’t someone be able to stop thinking of committing violent acts, if they weren’t a violent person? 

There needs to be much more discussion and education on the topic of intrusive thoughts. A lack of understanding and silence on the issue, because of the taboo themes, causes the sufferer to internalise society’s judgement and disgust. They take this silence and unwillingness to discuss the topic as evidence for their worst fears. From my own experience, this fear leads to a severe feeling of isolation. It was within this that other mental health issues began to worsen. In the context of mental health, ignorance is particularly dangerous.

Whether you suffer with frequent intrusive thoughts (as an OCD sufferer) or not, I hope this post has been insightful. I tried to write the post I wish I’d have read as my fifteen year old self. It may have helped me to feel less alone.

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