What Are Intrusive Thoughts?

It’s common to have an upsetting thought enter your mind. You may worry about failing a test or losing your job. You may have more intense ruminations about a tumultuous relationship in your life. Some troubling thoughts might be fleeting; others, like intrusive thoughts, might be harder to make sense of, manage, and shake off.

Intrusive thoughts are unwanted, often troubling thoughts or images that pop into your head out of nowhere. Another key characteristic of an intrusive thought is that it does not align with who you are. It does not reflect your wants, desires, or mood — which is often what makes it so disturbing.

“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.

Is it common to have the same type of intrusive thought?

Obsessive-compulsive disorder plays on the things that are most difficult or horrifying for us. So usually, intrusive thoughts are of the things a person is most afraid of, or most vehemently disagrees with. They can often be about suicide or violence, or be sexually inappropriate.

If you know you’re having an intrusive thought, what is the best way to handle it?

Ironically, trying to get rid of the thought is what causes it to come into a person’s mind even more. What ends up happening is the more someone tries not to think about something, the more they think about it, and the more distressing it becomes. And the more distressing the thought becomes, the more the person thinks about it, and around and around we go.

So you want to do the opposite: You want to expose yourself to the fear, which in this case is having the thought on your mind. So let’s say you thought about stabbing your friend with a pencil; try facing the thought head-on. Recognize that a thought is just a thought, and that it’s not going to change your true desires.

And in treatment for OCD and these types of thoughts, we actually practice: When you’re having that thought, the practice might be holding that pencil rather than putting it down. It can be really powerful to understand that, if you don’t actually want to, say, stab your friend with a pencil, that just thinking the thought, or closing your eyes and imagining it, or even holding the pencil, is not going to actually change what you want to do.

If someone is having intrusive or troubling thoughts, when might it be time to reach out to a professional for guidance?

If you’re having trouble figuring out if what you’re experiencing are intrusive thoughts, you should reach out to a mental health professional first for an assessment, which will help determine the best treatment. Even if the thoughts are disturbing, it’s best to speak up and talk about them, because there are really effective treatments available.

When it’s disturbing your life — taking up a lot of time, causing significant distress, or getting in the way of your ability to function — it’s a good idea to reach out for help.

Everybody experiences strange thoughts sometimes. But just because a thought is bothersome, or you don’t want it, doesn’t necessarily make it an intrusive thought. However, if you’re having really bothersome thoughts — regardless of whether we would categorize them as fears, or worries, or ruminations, or intrusive thoughts — it’s really important to see a professional for help. All of these can be debilitating. And it’s a matter of figuring out what’s going on with the individual to make sure every person gets treated in a way that’s going to be most helpful.