Understanding Intrusive Thoughts and OCD

Have you ever found yourself in a dull meeting, contemplating the idea of just yelling out? Or perhaps while driving, you’ve thought about the possibility of crashing? These kinds of unsettling musings are known as “intrusive thoughts,” and most of us experience them occasionally, brushing them off without much concern.

However, for some individuals, these thoughts can spiral into overwhelming obsessions leading to compulsive behaviors.

Dr. Nina Higson-Sweeney recalls her childhood when she firmly believed that unless she only entertained “good” thoughts during her walk home from school, something terrible would happen to her family. “If I had an intrusive thought, I’d have to redo the entire walk from the bus stop,” she reflects. “I was genuinely scared that if something went wrong, it would be my fault.” Diagnosed with obsessive-compulsive disorder (OCD) at the age of 10, Nina is now a psychology researcher at the University of Oxford, specializing in the mental health of children and adolescents.

“Obsessions are intrusive, unwanted thoughts, feelings, and sensations, while compulsions are the repeated, ritualized actions individuals perform to relieve the anxiety these obsessions create,” Nina elaborates on the BBC’s Complex podcast. It’s estimated that about 1-4% of people struggle with OCD, but there’s been a concerning rise in reported symptoms among 16 to 24-year-olds in England—more than tripling in just a decade. A significant NHS survey indicates that OCD is now the second-most prevalent mental health disorder among young adults.

These intrusive thoughts can be deeply distressing, often clashing with a person’s values or identity. “You might find yourself having thoughts about harm befalling loved ones,” Nina explains. “Or questioning your sexual orientation—wondering if you might be gay or straight. Sometimes, it even escalates to worrying if you could be a pedophile.” One frequent concern involves contamination and the fear of getting sick or spreading illness, she adds. While OCD typically manifests in puberty or early adolescence, some individuals might not get diagnosed until later in life, often due to years of masking their distress.

Research indicates that genetics may contribute to the development of OCD, along with links to early-life stresses such as bullying or family breakdown, Nina notes.

Kimberley Wilson, a chartered psychologist, points out that nearly everyone encounters intrusive thoughts at some point. “Evidence suggests around 80% of us will experience them,” she states. For most, these thoughts are fleeting. “We can acknowledge them, think they’re unusual, and set them aside,” she says. However, if those thoughts can’t be dismissed, it might be time to seek help.

“Unlike typical intrusive thoughts, OCD-related thoughts linger—they become entrenched and are never pleasant. They’re often aggressive and challenging to manage, leading to compulsive behaviors,” Kimberley says. Signs of such compulsions might be mental, like counting, or physical, such as obsessively checking the locks on a door.

Managing OCD

If you find yourself in this situation, Nina suggests that a professional can help determine the best course of action for you. In addition to professional guidance, she mentions there are practical techniques you can employ daily to alleviate distress. One effective strategy is to label your thoughts. By recognizing “I’m having an intrusive thought,” you can create a sense of distance and remind yourself that it doesn’t define you.

Some also benefit from visualizing OCD as an external force. “Drawing what OCD looks like can be therapeutic—it sets apart you from the condition,” she says. Self-care is also crucial, as proper diet, rest, and physical activity can significantly improve your state of mind. Nina observes that her OCD symptoms worsen when she’s stressed or neglecting her self-care.

Despite living with OCD, Nina has learned to navigate her condition. “I haven’t overcome OCD, but I can function alongside it. I experience milder intrusive thoughts now and have a greater understanding of how to cope. But when stress strikes, dismissing those thoughts becomes more challenging, and they can still lead to compulsions,” she shares.

• If you have been affected by issues in this story, details of organizations offering advice and support for people in the UK are available from BBC Action Line.