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EspañolWhat causes intrusive thoughts? Related conditions and treatments
Overview: What do intrusive thoughts feel like?
An intrusive thought is a bad thought, urge, or feeling that suddenly causes significant distress. As the name implies, such thoughts are intrusions. They are not the same as worrying or ruminating, where we repeatedly play the same bad thoughts, often for a good reason. Intrusive thoughts are unexpected and unexplainable. They can involve unusual thoughts about sexual acts, self-harm (jumping off a bridge), hurting other people, violent thoughts, or being in danger when there’s no danger. Remember that we all experience such disturbing thoughts, especially when stressed. Sometimes, in periods of stress, these intrusive thoughts keep coming back, like obsessions. That’s normal. However, some people can’t function well because of their intrusive thought patterns. They impinge on their lives, their jobs, and their relationships. In the worst cases, such as obsessive-compulsive disorder (OCD), intrusive thoughts can be disabling, preventing people from having a normal life.
Key takeaways:
Intrusive thoughts are a common symptom that may be caused by stress, worry, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD). Intrusive thoughts are also associated with depression, anxiety, ADHD, eating disorders, postpartum depression, and certain types of personality disorders.
Typically, intrusive thoughts do not require immediate medical attention, but thoughts, statements, or behaviors that threaten self-harm or harm to others do require immediate medical help.
Intrusive thoughts generally do not require treatment unless they impair a person’s ability to function. Intrusive thoughts may resolve or partly resolve with treatment, but the timeline will depend on the underlying cause and the treatment option used.
Treatment of intrusive thoughts may include psychotherapy, cognitive-behavior therapy, and prescription medications. Read more about treatments for anxiety, depression, PTSD, and OCD.
Intrusive thoughts can be managed with breathing, mindful relaxation, exercising, thought-stopping, and reframing.
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What causes intrusive thoughts?
Most people experience intrusive thoughts. The most common causes of intrusive thoughts in people who do not have a diagnosable mental illness include:
Medical conditions that are causes of intrusive thoughts include:
Although intrusive thoughts are not considered a symptom, some mental health conditions are associated with intrusive thoughts, including:
Depression
Attention deficit/hyperactivity disorder (ADHD)
Some personality disorders, such as borderline personality disorder
Should I be worried about intrusive thoughts?
Intrusive thoughts are a common experience. Many people without a diagnosable mental health condition experience clinically relevant intrusive and distressing thoughts. Intrusive thoughts can be normal in these situations, then. They are not a problem unless they are causing significant distress or negatively affecting daily life, jobs, careers, or relationships. At their worst, intrusive thoughts could cause people to harm themselves or others. In those cases, talk to a healthcare professional or mental health professional immediately. If you’re having repeated intrusive thoughts about harming yourself or others, call 911 or go to an emergency room.
Most people who seek help for intrusive thoughts and other symptoms will be evaluated by a mental health professional such as a therapist, psychologist, or psychiatrist. They will try to discover if such thoughts are due to an underlying mental illness. Even if intrusive thoughts are not associated with a mental health condition, it helps to see a mental health professional. Therapists can recognize them and assess their effects on a person’s life. They can then teach people skills to manage intrusive thoughts and other issues like worry or stress.
RELATED: How your thoughts can affect your health
How is the cause of intrusive thoughts diagnosed?
Healthcare providers and mental health professionals diagnose the cause of intrusive thoughts based on a medical history and symptoms. Mental health professionals have screening tests and other more detailed psychological tests that can help confirm a diagnosis, but these aren’t always necessary for a diagnosis.
The Diagnostic and Statistical Manual 5 (DSM 5) is the standard healthcare professionals use to diagnose mental health conditions. In the DSM 5, intrusive thoughts are only a relevant symptom for diagnosing OCD or PTSD. The types of intrusive thoughts may be different. People with OCD typically not only have unwanted intrusive thoughts but they engage in repetitive behaviors (compulsive behaviors) to manage those thoughts. People with PTSD usually have intrusive thoughts that replay the traumatic event that may have caused PTSD. Other symptoms have to be present to make an OCD or PTSD diagnosis.
Even though people with depression, anxiety, or other mental health conditions experience intrusive thoughts more than usual, such thoughts are not a hallmark symptom of those conditions. For instance, people with depression or anxiety may have intrusive thoughts, but more commonly, they experience rumination and negative or distressing thoughts that play repeatedly in their heads like a tape.
RELATED: What do the results of your anxiety screening mean?
How long do intrusive thoughts last?
Everyday intrusive thoughts or obsessions caused by worry, stress, or random events are usually temporary and last for a few seconds or minutes.
Intrusive thoughts associated with anxiety or depression will usually improve with treatment. Most treatment options for depression or anxiety relieve the core symptoms in a few weeks, but treatment may continue for six months or longer. However, intrusive thoughts may continue unless managing thoughts, stress, and distress are directly addressed in psychotherapy.
However, people with some conditions, such as OCD or PTSD, may experience intrusive thoughts all their lives. Treatment can reduce the incidence and the degree to which intrusive thoughts or obsessions impair people.
How to stop intrusive thoughts
Treatment options will depend on the underlying mental health condition:
People who do not have a diagnosable psychiatric condition can manage and reduce intrusive thoughts through cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) that will teach skills such as managing thoughts, reframing thoughts, solving problems, managing stress, and tolerating distress.
Clinical depression is usually treated by antidepressants, cognitive behavioral therapy, and other forms of psychotherapy—intrusive thoughts are primarily addressed in psychotherapy.
Generalized anxiety disorder and other anxiety disorders are also treated by anti-anxiety drugs (anxiolytics), cognitive behavioral therapy, and different types of psychotherapy. Most first-line anxiolytics are antidepressants such as SSRIs and SNRIs.
OCD is primarily treated by SSRIs and cognitive behavioral therapy that includes exposure and response prevention (ERP). Antipsychotic medications and benzodiazepines may be used in more severe cases. CBT helps people with OCD change their beliefs about their obsessions. ERP exposes people to triggers to teach them more appropriate responses and behaviors.
RELATED: Medications that treat anxiety and depression
Living with intrusive thoughts
Intrusive thoughts are a normal part of life, but sometimes they can seem out of control. Stress, worry, or mood problems can worsen the situation.
Both cognitive and behavioral therapy teach people methods to control their thoughts and emotions, including intrusive thoughts. These include:
Thought reframing
For people who are distressed by intrusive thoughts, the standard CBT treatment is to face those thoughts and come to terms with them, something similar to exposure and response therapy. Research has shown that trying to suppress unwanted thoughts may worsen the situation. The idea is this: thoughts are thoughts. They’re not real so they can be managed and changed. Accept that you’re having these thoughts, you’re not a bad person for having them, the thoughts aren’t catastrophic, and the negative thoughts can be changed to productive thoughts by reframing or reinterpreting them. People learn that these intrusive thoughts are not dangerous or a threat by facing unwanted thoughts.
Learn to tolerate distress
The thoughts themselves are just one component of intrusive thoughts. The hard part is the emotional distress that people experience. Again, people can learn skills to tolerate and manage distress, including distress caused by intrusive or disturbing thoughts. Distress tolerance skills involve accepting the situation, focusing on the present, finding something else to direct one’s attention to (like a project or exercise), practicing self-soothing, or fixing the problem (or making a plan to fix the problem). Again, intrusive thoughts are just thoughts. Learning to tolerate and manage the distress takes away their power over our lives.
Manage stress and worry
Another way to reduce intrusive and negative thoughts is to manage stress actively. This involves deliberately practicing relaxation, meditating, exercising, and getting enough sleep. Breathing exercises are beneficial in moments of stress or distress. Breathing techniques such as 4-7-8 breathing, box breathing, and lion’s breath breathing are effective at reducing stress and helping to regain control over mood and thoughts.
Most importantly, get medical help
If intrusive thoughts or negative thoughts are causing distress or interfering with your life or the life of a family member or loved one, talk to a mental health professional. People fundamentally misunderstand much of the work mental health professionals do. In some cases, they treat mental health disorders. In many other cases, they help with mental issues that are interfering with day-to-day life. For intrusive or obsessive thoughts, there may be nothing that needs to be cured. Instead, the current model in psychotherapy is to teach people the skills they need to manage their emotions, thoughts, behaviors, and reactions to the world around them. This way, therapy increases people’s ability to function and be happy. This model of psychotherapy is phenomenally successful and usually only takes a few weeks to a couple of months, so don’t hesitate to seek help if intrusive thoughts are causing problems.
What’s next? Additional resources for people with intrusive thoughts
Test and diagnostics
OCD symptoms: What are the early signs of OCD?, SingleCare
PTSD symptoms: What are the early signs of PTSD?, SingleCare
Treatments
Anxiety treatments and medications, SingleCare
Depression treatments and medications, SingleCare
Managing intrusive thoughts, Harvard Health
OCD treatments and medications, SingleCare
PTSD treatments and medications, SingleCare
Scientific studies and clinical trials
Psychopathology and thought suppression: A quantitative review, Clinical Psychology Review