“I think people tend to label a lot of things as intrusive thoughts,” says Dr. Avital Falk, director of the Pediatric Obsessive-Compulsive Disorder, Anxiety, and Tic Disorders program at NewYork-Presbyterian and Weill Cornell Medicine. “Clarifying what intrusive thoughts are — versus worries or ruminations or fears — can be really helpful in finding the right treatment.”
Here, Dr. Falk, who is also program director of the Intensive Treatment Program for OCD and Anxiety in collaboration with the Center for Youth Mental Health at NewYork-Presbyterian, shares insights to help understand intrusive thoughts, along with tips on managing them in the moment, and when it’s time to seek help.
Health Matters: What are intrusive thoughts?
Dr. Falk: An intrusive thought is an unwanted thought that comes into our head and intrudes upon us. It’s very much the opposite of what we want or what we agree with. Intrusive thoughts are not aligned with our desires or our mood.
For example, you might have a thought pop into your head like, What if I just stabbed my friend with this pencil right now? If that thought keeps popping into your head — even though you’re not feeling angry at your friend, and you have zero desire to do that — then that could be considered an intrusive thought.
But let’s say you’re thinking, What if something bad happens to my parents? That sounds more like a worry or a fear — it’s something that you’re scared of happening. You don’t want anything bad to happen to your parents, and you’re experiencing worries and fears that are consistent with who you are and the concerns you have. This may be a worry that might come with separation anxiety.
Are intrusive thoughts normal? Is it common to have one from time to time?
Most people have weird thoughts sometimes. For example, almost every New Yorker has found themselves on a subway platform and thought, I could just fall onto the tracks right now. And what if I jumped? Or what if someone pushed me? Many people can have those fleeting thoughts and then might think, Wow, that was odd, that’s not really what I want, I guess I’m just thinking about how the subways can be dangerous, and then move on with their day. But for individuals with obsessive-compulsive disorder, intrusive thoughts tend to be “stickier.”
Can you explain the connection between intrusive thoughts and obsessive-compulsive disorder?
Intrusive thoughts are most often talked about within the context of obsessive-compulsive disorder (OCD). Individuals with obsessive-compulsive disorder tend to give these thoughts more credit. Meaning that, instead of being able to say, Oh, that was a weird thought and moving on, somebody with OCD might start to wonder, Why did I have that thought? What does it mean? What does it say about me as a person?
Do intrusive thoughts tend to linger awhile?
It depends. If it was just a weird thought that popped in and didn’t bother you too much, it would probably pop out pretty quickly. You might not even remember it the next day. But somebody with OCD who struggles with intrusive thoughts would remember it, because they would have obsessions concerning whether or not that thought means something about them. They would then try to get rid of the thought, because they’d be concerned that having the thought meant something about who they are. Some people have many of these thoughts throughout the day; they may even feel inundated by them.