Intrusive thoughts are an unsettling part of human experience—unwanted and distressing ideas that pop into our minds seemingly out of nowhere. Everyone experiences them to some degree, whether it’s an absurd mental image, an alarming question about harming oneself or others, or an embarrassing sexual fantasy. Unpleasent, unwanted, distressing thoughts likely fall into six main categories:
1. Intrusive Thoughts of Self-Harm: For exmaple intrusive thought about cutting off ones finger whilst in the kitchen.
2. Intrusive Thoughts of Harming Others: For example driving car into pedestrians.
3. Intrusive Sexual Thoughts: For example thoughts of acts against sexual preferences.
4. Blasphemous or Immoral Thoughts: For example “What if I committed a sin?” or “What if I offended God?”
5. Self-Doubt and Mistakes: For example accidently leaving the oven on.
6. Contamination or Health Fears: For example what if I got a fatal disease from that stranger?
One of the core issues in OCD is Thought-Action Fusion (TAF)—the cognitive distortion that equates thoughts with actions. There are two types of TAF:
- Likelihood TAF: The belief that merely thinking about an event increases the likelihood of it happening. For example, thinking about a loved one being in a car accident makes the person feel responsible, as if the thought itself could cause the event.
- Moral TAF: The belief that having an immoral thought is as bad as committing the immoral act itself. For instance, a person who has a fleeting thought about harming someone may feel as guilty as if they had actually done so.
TAF fuels OCD by turning ordinary, passing thoughts into crises. A thought like, "What if I hurt my partner?" isn't dismissed as absurd. Instead, it leads to the belief, "If I have this thought, it must mean I want to harm my partner," resulting in compulsive behaviour to neutralise the thought - that is, an action of sorts, even if unrelated, to reduce the anxiety.
Here’s where things get tricky for someone with OCD. They don’t necessarily experience more intrusive thoughts than others, but they interpret those thoughts in a significantly different way. Their belief system supports what we’ll call Theory A:
- Theory A: "I am anxious because I am a bad person, and therefore, I need to perform compulsions to prevent the feared outcome."
When a person with OCD experiences an intrusive thought, such as "What if I stab my loved one?" their anxiety spikes. They interpret this thought as a reflection of their character, believing it means they are inherently violent or dangerous. As a result, they engage in compulsions—checking knives, seeking reassurance, avoiding their loved one—to reduce the anxiety. This approach, however, only keeps the cycle of obsession alive, feeding the belief that they are at risk of harming someone.
Now, consider Theory B, which represents the alternative response to these intrusive thoughts:
- Theory B: "I am anxious because I am *worried* that I am a bad person. I need to stop doing the compulsions that are maintaining this preoccupation and worry."
In this theory, the person recognises that the thought itself is not the problem. The real issue is the fear of the thought and the compulsions that follow. By reframing the problem, they can stop giving the thought undue importance and allow it to pass. This approach, often taught in Cognitive Behavioral Therapy (CBT), helps break the OCD cycle by weakening the connection between the thought and the anxiety.
When someone with OCD chooses Theory B, they acknowledge that thoughts are just thoughts. Intrusive thoughts, no matter how bizarre or distressing, are not inherently harmful. What maintains OCD is not the thoughts but the response to them—the compulsions.
For example, let’s take a common intrusive thought: "What if I didn't lock the door?" A person without OCD might think, "That’s weird," and move on with their day. But someone with OCD might panic, thinking, "Why would I have that thought? Maybe I am really careless!" They might then rush home to check or obsessively seek reassurance from others. The compulsions reinforce the belief that the thought is dangerous.
In therapy, patients are encouraged to resist the compulsion—to not seek reassurance, not avoid things, check things, neutralise things, and allow the thought to exist without acting on it. Over time, this exposure helps the brain realize that the thought is not dangerous, and the anxiety decreases.
The key takeaway from Theory B is acceptance. By accepting that intrusive thoughts are a normal part of the human mind, and by refusing to engage in compulsions, people with OCD can slowly reduce the power these thoughts have over them. Intrusive thoughts may not stop, but their impact is reduced, and if we are less preoccupied with something we may think about it less. Reframing the problem from one of moral failure (Theory A) to one of misinterpreted anxiety (Theory B) is a fundamental shift in understanding. It breaks the feedback loop of obsession and compulsion and allows individuals to reclaim their mental space from the clutches of OCD.
By practicing non-engagement with intrusive thoughts and rejecting Thought-Action Fusion, people with OCD can regain control over their lives, learning to live with the uncertainty and discomfort that comes with human thought. The thoughts themselves are not dangerous—it’s how we interpret and react to them that makes all the difference.
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