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Understanding Intrusive Thoughts

Why do we have thoughts we don't want?

By Christopher Craig from Fredericton, NB, Canada. Wikimedia Commons.
Source: By Christopher Craig from Fredericton, NB, Canada. Wikimedia Commons.

“There is no institution more powerful than the institution of your mind.” —Naide P. Obiang

Intrusive thoughts are unwanted thoughts, images, or urges that seem to pop into your mind out of nowhere. Such thoughts can take the form of any number of offensive ideas. The content is commonly violent, sexually explicit, or otherwise socially inappropriate. These thoughts may be directed towards loved ones, people who are close by, or oneself.

Some examples of common intrusive thoughts include:

  1. The sudden image of harming your child or other loved one, despite having no intention or desire to do so.
  2. The thought of performing a sexual act with someone, despite it being inappropriate and/or lacking attraction towards that person.
  3. The sudden urge to yell obscenities or expose oneself in public.
  4. A fleeting, unexpected urge to jump when standing on a bridge.

The unwanted and unexpected nature of intrusive thoughts separates them from other types of thoughts, like worries, ruminations, or desires. In fact, intrusive thoughts are often so contrary to one’s character and wishes that the person is distressed or disgusted by the thoughts.

What do these thoughts mean?

Intermittent intrusive thoughts are common and normal. In investigating this phenomenon, one study by Hames and colleagues (2012) suggested that over 50 percent of people with no history of suicidal thoughts have had the sudden urge to jump when standing on a tall building or bridge. Psychologists call this the “high place phenomenon."

Intrusive thoughts have also been well-studied in new mothers. A 2008 study by Fairbrother and colleagues showed that half of the healthy mothers had intrusive thoughts of harming their infants by four weeks after birth. A recent meta-analysis of 50 studies showed that nearly all women have had intrusive thoughts of harming their baby at some point after birth (Brok, 2017).

People who are more sensitive to anxiety are more likely to experience intrusive thoughts (Hames, 2012). And while these thoughts can be normal, they are more common in certain psychiatric disorders, including anxiety disorders, mood disorders like major depression and bipolar disorder, and psychotic disorders like schizophrenia.

What causes intrusive thoughts?

So why does a normal brain produce seemingly abnormal and unwanted thoughts? Some researchers hypothesize that these thoughts are a sort of misinterpreted warning signal (Hames, 2012).

For example, when a mother experiences a sudden, undesired urge to drop her newborn baby, perhaps it is her brain’s way of warning her to hold on tighter to avoid dropping the child. Or in the context of the high place phenomenon, the strange and unexpected urge causes you to step back from the edge of the bridge or building. So in some ways, these intrusive thoughts may protect you from the thing you fear.

Importantly, these thoughts do not seem to predict an increased risk of carrying out the feared thought or urge. In the meta-analysis cited above, none of the 50 studies included found an increased risk of violence in mothers with isolated intrusive thoughts of harming their children (Brok, 2017).

What can you do when intrusive thoughts become a problem?

When intrusive thoughts become severe, recurrent, and anxiety-provoking, we call them obsessions. Obsessions are perhaps best known in the context of obsessive-compulsive disorder (OCD). People with OCD often suffer from compulsions as well—behaviors or mental rituals that aim to decrease the anxiety associated with the obsessions.

In people with normal, transient, non-distressing intrusive thoughts, no treatment is needed. It is important to realize that these thoughts are normal, and over-pathologizing them can create unnecessary anxiety. Think of these thoughts as brain hiccups. As frightening as they may initially seem, intrusive thoughts will dissipate if you accept them and allow them to pass without giving them too much attention or trying to push them away.

If intrusive thoughts reach the level of obsessions, we can use medications and therapy to help. Selective serotonin reuptake inhibitors (SSRIs) and other antidepressant medications have been shown to be effective in treating obsessions. Cognitive-behavioral therapy (CBT) can also be very helpful, especially when it includes exposure and response prevention (ERP) and anxiety management strategies.

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Hames, J. L., Riberiro, J.D., Smith, A.R., & Joiner, T. E. (2012). An urge to jump affirms the urge to live: An empirical examination of the high place phenomenon. Journal of Affective Disorders, 136, 1114-1120.

Fairbrother, N., & Woody, S. R. (2008). New mothers’ thoughts of harm related to the newborn. Arch Women Mental Health, 11, 221-229.

Brok, E. C., Lok, P., Oosterbaan, D. B., Schene, A. H., Tendolkar, I., & van Eijndhoven, P. F. (2017). Infant-related intrusive thoughts of harm in the postpartum period: A critical review. J Clin Psychiatry, 78, e913-e923.

Stern, T. A., Herman, J. B., & Gorrindo, T. (2012). Massachusetts General Hospital psychiatry: Update & board preparation. MGH Psychiatry Academy Publishing.

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