Intrusive Thoughts: What Do They Actually Mean?

Just imagine: You're careening down the freeway and suddenly, out of nowhere, the thought just comes to you — what would happen if you swerved your car directly into the median? Or rammed the vehicle in front of you?

Or maybe you’re on your afternoon stroll when an adorable ball of fluff on a leash saunters toward you and you suddenly imagine kicking the pup or tossing it across the soccer field.

“Wow, what is WRONG with me?” you might think. But really ... probably nothing is. No, you’re not an exceptionally twisted and bad individual. The dark side hasn’t won — you’ve just experienced an intrusive thought.

What are intrusive thoughts?

Intrusive thoughts are unwanted and disturbing mental images or ideas that pop into your head without warning.

“They often have themes that are violent or sexual in nature or are really embarrassing,” says Sarah Campbell, assistant teaching professor in the Department of Psychiatry and Behavioral Sciences at the UW School of Medicine.

Other common intrusive thoughts include:

• Pushing someone off the subway platform onto the tracks.
• Doing something erratic while driving — like swerving towards a group of kids playing ball by the side of the road.
• Participating in a sexual act in public or private that you would never really want to do.
• Acting in a violent way toward a loved one for no reason while doing something as mundane as making dinner together.

“These thoughts are oftentimes distressing and are usually in opposition to a person’s values and their goals,” says Georganna Sedlar, assistant teaching professor in the Department of Psychiatry and Behavioral Sciences. “People will have a lot of feelings of shame and guilt about them.”

In other words, while intrusive thoughts are varied in nature, they all have one thing in common: They don’t align with the morals and usual actions of the person. Just because you have the thoughts doesn’t make you some kind of creepy monster — really.

“Most people have some kind of intrusive thought at some point,” says Campbell. “And they think, ‘Where did that come from?’ I want to normalize that it only becomes problematic if it's really distressing to the person and they feel like they can't control it in any way.”

What causes intrusive thoughts

No one knows exactly why people experience intrusive thoughts, but psychologists do know they can be prompted by certain external stimuli, like a specific event or situation, or by internal stimuli, like intense feelings.

Also, intrusive thoughts don’t always exist in isolation — they can be closely connected to specific mental health disorders, especially obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).

For people dealing with OCD, intrusive thoughts can be accompanied by “compulsions” or a desire to do a specific behavior to prevent the thoughts from actually coming true.

"Those obsessions truly impede a person’s life because they are preoccupied with either trying to battle them or trying to accommodate them by doing the compulsions,” says Kari Stephens, a clinical psychologist with UW Medicine and professor in the Department of Family Medicine at the UW School of Medicine.

When it comes to people with PTSD, intrusive thoughts often are related to memories or images about traumatic experiences or events that impair their day-to-day functioning. One example? Imagine a kid trying to sit in class and focus on a lecture or group assignment and, suddenly, they're having intrusive thoughts about a past traumatic experience. That can take them out of the present and cause immense distress.

People who run a little anxious in general are more likely to experience intrusive thoughts. It’s also common for new parents because of the huge life changes, lack of sleep and shift in hormones that occur after birth, with some parents even experiencing thoughts of injuring their baby — something they’d never want to do in reality.

Impulsive versus intrusive thoughts

So, what’s all of this on social media about "letting the intrusive thoughts win” by throwing raw eggs on the floor, getting a goofy tattoo (that really is exceptionally bad) or meowing in the middle of your lecture hall?

Well, those are impulsive thoughts (or even just plain ‘ole thoughts) that people are simply miscategorizing.

“Because of social media, people are learning lingo that you normally wouldn't be exposed to unless you went to a doctor,” says Stephens. “For someone to say, ‘Well, I've got these intrusive thoughts’ — that’s a very jargony term that we use in diagnosis territory in a doctor’s office, but now people have it to use as a casual term.”

The thing that truly distinguishes impulsive thoughts (or the like) from intrusive thoughts is the degree of impairment and how distressing the thoughts are for the individual.

"When you look at social media and someone says, ‘Oh, I wonder what would happen if I threw a rock at that window?’ And then they do it — that's what I would call an impulsive act,” says Sedlar. “An intrusive thought about that would be someone who's debilitated by thinking that they're going to hurt somebody badly — maybe by throwing a rock at them — every time they go for a walk.”

Impulsive ideas are often acted on to get a reaction from others, and, unlike intrusive thoughts, are not necessarily distressing, persistent or uncontrollable.

Treatments for intrusive thoughts

If you are experiencing intrusive thoughts often, and they’re affecting your day-to-day activities and quality of life, you should connect with a licensed mental health professional for treatment. There are many well-researched and effective treatment options available for those struggling with this issue.

“If people are truly experiencing a pattern of thoughts that they're having difficulty controlling that are leading to harmful outcomes, then that's bad,” says Stephens. “We don't want people to feel out of control with thoughts that are scary or promote damaging things.”

Mental health professionals often use exposure and response prevention, a type of cognitive behavioral therapy, with people who have OCD and are experiencing intrusive thoughts. For example, if you have unwanted thoughts about germs and dying from some sort of infection, you might be asked to touch something dirty, forcing you to confront your fear. And the “response” would be you not acting on the compulsion — like washing your hands a bunch of times.

"For that person who has been doing the compulsion, there's a lot of initial distress around this, and then they see that they can tolerate it, and that what they thought was going to happen didn’t come true,” says Sedlar.

OCD also responds well to medication, so talking with a licensed psychiatrist or a primary care provider who can prescribe effective medications can be an important step to calming your intrusive thoughts.

There are also well-researched treatments for PTSD based on exposure therapy.

“Oftentimes, with people who've experienced trauma, there's a lot of avoidance, which can actually make symptoms worse,” explains Sedlar.

Various kinds of exposure treatments, which are also cognitive behavioral therapies, allow you heal from your traumatic experiences and change your thoughts about the trauma — helping you process both emotionally and cognitively. Once you see that you don't have to avoid the memories or other reminders anymore, you can heal from your trauma. Exposure is a powerful treatment used to treat all anxiety-related disorders.

And usually, intrusive thoughts will diminish with therapy, as you can learn how your trauma has affected you and acquire skills taught in therapy.

Acceptance and commitment therapy is another type of therapy that may be helpful for anyone experiencing intrusive thoughts. With this treatment, you’re encouraged to not take intrusive thoughts so seriously and focus on acting in ways aligned with your values. You resist accepting them as evidence that you're going to do that thing that you're worried about, and instead acknowledge the thought and move along. This treatment can help you lower anxiety symptoms and reduce the power of the thought.

You can work with a therapist to get a personalized plan that will help you with your specific thoughts and the behaviors that may go along with them.

The wrap-up

Hopefully, now you can rest easy knowing that that strange urge you occasionally have to stick your finger in the garbage disposal does not make you a threat to society or yourself — it just makes you a person experiencing an intrusive thought.

Also, please don’t do that.