Your anxious thoughts could be a symptom of OCD
Have you ever had an unwelcome thought that ruined your day? Or lost sleep over a worry that looped endlessly in your mind?
These anxious thought patterns could be a symptom of obsessive-compulsive disorder (OCD). Though OCD is the fourth most common mental health condition, it is often misunderstood – it takes 14 to 17 years for adults to receive a diagnosis on average, and one study found that family physicians misdiagnosed over half of OCD cases.
OCD isn’t always visible – if you’re plagued by relentless, uncontrollable thoughts, you may be dealing with the disorder. When intrusive thoughts take over, they can disrupt every aspect of day-to-day life.
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The truth about OCD
Clinical psychologist Jon Abramowitzis, an expert on obsessive-compulsive disorders, says a common misconception around OCD is that it’s purely about neatness.
‘In reality, it involves intrusive thoughts that are distressing and often completely unrelated to cleanliness or order. People with OCD engage in compulsions (behaviours or mental rituals) to try to neutralize these thoughts or prevent feared outcomes. That's the real essence of OCD.’
You know that menacing impulse to jump onto the tracks as a train approaches? Or the sudden fear you might swerve into oncoming traffic? These kinds of intrusive thoughts are a core symptom of OCD.
Don’t be alarmed if you relate – an international study from Concordia psychology professor Adam Radomsky found that these urges were widespread, with 94% of people experiencing some form of intrusive thought or impulse.
The issue doesn’t lie in the thought itself, but how we respond to it. When we can’t let a thought go, it gets stuck on repeat and can cause mental health to spiral. Dr. Jon Kole, Medical Director of Headspace, breaks down how OCD presents itself in both physical and mental compulsions:
‘Compulsions are repetitive physical or mental acts performed to neutralize the anxiety caused by the intrusive thoughts. The individual feels they must perform these rituals to prevent a feared outcome or to get temporary relief from the underlying anxiety.’
‘Physical Compulsions: Repeatedly checking locks, washing hands excessively, or arranging objects symmetrically.
‘Mental Compulsions: Mentally reviewing past events, praying, counting, or seeking constant reassurance from others.’
How to spot an intrusive thought
Intrusive thoughts symptomatic of OCD are often confused for generalized anxiety disorder (GAD), which is characterised by an excessive fear or worry around the everyday.
‘Overthinking involves replaying scenarios, worrying about the future, or second-guessing decisions. It’s often logical, though unproductive,’ explains Psychotherapist and Founder of North London Therapy, Naomi Magnus.
‘Intrusive thoughts, on the other hand, are unwanted, disturbing, and often irrational. They pop into the mind uninvited. People with OCD may attach great meaning to these thoughts, leading to compulsions.’
Though both mental impulses can be debilitating, overthinking is rooted in real-life concerns, whereas intrusive thoughts can cut you off from your reality.
‘(They) are often taboo, and feel alien or inconsistent with the person’s values,’ says Jon Abramowitzis. ‘A key sign of OCD is that the person feels compelled to perform rituals – like checking, counting, or seeking reassurance – to cope with the thoughts.’
When negative thoughts take over
Unsettling thoughts aren’t a concern when they drift in and out of the mind without struggle. ‘Most people experience fleeting, odd thoughts. They can be triggered by stress, anxiety, or even boredom,’ explains Magnus.
‘For people without OCD, these thoughts are easily dismissed. But for those with OCD, the brain’s threat detection system misfires, interpreting the thought as dangerous or significant, leading to anxiety and compulsive behaviours to try to “undo” it.’
An obsessive-compulsive tendency will snowball an intrusive thought into an existential crisis, a violent thought would be followed up with questions like “what does this thought say about me?”, “is this a sign I’m a dangerous person?”, and an obsession with trying to supress, fight or solve it.
A common intrusive thought associated with OCD is a fear of contamination – when someone is hyper focused on exposure to germs and contracting disease. This tends to result in someone taking extreme measures to combat germs, like frequently washing hands or refusing to encounter public spaces.
However, there are many other forms of intrusive thoughts which are less recognisable as OCD, like a fear of losing control and impulsively acting out, obsession around perfectionism and unwanted sexual thoughts.
‘There is a shared aspect of threat, whether in harm physically to self or others, social or faith consequence from deviant behaviour, or loss of status or relationship,’ says Kole.
‘These thoughts are often ego-dystonic, meaning they are jarring, shocking, and go against the person's sense of self. The content is typically highly improbable, unrealistic, or even bizarre. The individual is usually aware that these thoughts are irrational, but they feel unable to stop them.’
The 7 most common types of intrusive thought
1. Harm
Ever been at a great height and thought, “what if I jumped?”. This doesn’t mean you’re suicidal – the impulse arises because it frightens you. An obsession around purposely or accidentally harming yourself or others can plague someone with OCD. Sufferers agonise over the idea that they could lose control and be involved in a violent outburst or a hit and run.
2. Sexual obsessions
Around 13-21% of people with OCD experience sexual intrusive thoughts. This can vary from constantly picturing people naked to disturbing and taboo sexual imagery that goes against a person’s values. You could also obsessively worry about your sexual orientation despite understanding your sexuality.
3. Catching disease
Affecting up to 46% of OCD patients, contamination OCD is an obsessive concern with germs that can turn into an unhealthy cycle of cleaning rituals. Touching handles, using public restrooms or preparing food can trigger fears around contracting disease.
4. Forgetting or losing something
An irrational fear of misplacing items or forgetting important daily tasks. Whether it’s constantly double-checking that doors are locked, items are safely in your bag, or switches are turned off – the fear of forgetting is often stronger than the memory of having done it.
5. Moral or religious fears
A fixation on thoughts that conflict with religious or moral beliefs. This could be an intense worry about committing a sin, acting inappropriately in a place of worship or thoughts that are morally corrupt.
6. Embarrassment
Imagining mortifying scenarios, like saying something improper or doing something embarrassing, can lead to self-doubt and isolation. These thoughts evoke feelings of shame and can result in someone ostracizing themselves from social situations.
7. Relationship
Doubts about the validity of a relationship is another form of intrusive thought. Convinced that a partner is cheating without any evidence? Second-guessing if a relationship feels right despite being happy? These thought patterns can exhaust and sabotage healthy relationships.
Why OCD often slips through the cracks
Around 3% of the global population has OCD, yet there is still limited understanding of how the condition manifests. Intrusive thoughts can latch onto anything, whether unspeakable impulses or irrational worries, meaning the signs of the disorder can often be missed.
‘OCD is frequently misdiagnosed as generalised anxiety or even depression, especially when the compulsions are internal rather than visible,’ says Magnus. ‘Both conditions involve worry and distress, but OCD is characterised by a cycle of obsessions and compulsions.’
The taboo nature of intrusive thoughts can lead many to hide them, completely unaware they’re a symptom of OCD. ‘They can be deeply upsetting and interfere with relationships, work, and daily functioning,’ says Abramowitzis.
‘People often avoid situations that trigger these thoughts or spend hours performing rituals to try to make the anxiety go away. This also takes up time and energy and can create a cycle of fear and avoidance that significantly limits quality of life.’
Breaking the stigma
Sudden, intrusive thoughts don’t reflect a person’s true intentions and moral compass. In fact, they mirror our worst fears rather than our deepest desires.
According to the Anxiety and Depression Association of America (ADAA), one of the most dangerous myths surrounding intrusive thoughts is that they might lead to action. Someone experiencing them could feel compelled to prove they won’t act – try to ‘think’ their way to certainty or search for hidden meaning behind the random thought.
This cycle of rumination and compulsive reassurance-seeking can become all-consuming. Unfortunately, people with OCD sometimes avoid professional help for fear that their obsessive thought patterns will be misunderstood as darker ideation.
OCD tends to attack what a person values most, so it’s important to remember that intrusive thoughts don’t offer insight into your character, and that dwelling on them will only exasperate the issue.
Letting go of intrusive thoughts
Fighting intrusive thoughts can create a catch-22 effect, where the harder you try to supress thoughts, the stronger they persist. Abramowitzis’ one piece of advice for someone suffering with intrusive thoughts is to take away the power they hold over you: ‘Know that you are not your thoughts. Intrusive thoughts don’t define who you are and having them does not mean you’ll act on them.’
Magnus echoes this sentiment: ‘They’re not actions, just mental events. One of the most effective treatments is Exposure and Response Prevention (ERP) therapy, which helps you face the thoughts without performing compulsions.
‘Cognitive Behavioural Therapy (CBT) can also be helpful. Mindfully observing thoughts without judgment can reduce their power. Resisting the urge to “fix” or neutralise thoughts is key to breaking the OCD cycle.’
A guide to coping with intrusive thoughts
- Find a healthy distraction
Break free from intrusive thoughts with a distraction. Redirecting your focus with a change of scenery can do wonders, so try going for a walk or engaging in an outdoor activity. You can also shift your attention without leaving the house – give your mind a rest by listening to music or immersing yourself in your favourite movie.
- Label your negative thoughts
Defining a disturbing thought as “just a thought” takes away its power, stopping rumination in its tracks and allowing you take back control. Writing them down or simply making a mental note helps create distance and reduce their emotional impact. A mantra like “I am not my thoughts” can also help quieten them down.
- Be kind to yourself
Don’t beat yourself up and instead practice self-care. Unwelcome thoughts are exhausting, so take time to be kind to yourself and soothe a distressed mind. Stress and anxiety only worsen the symptoms, so run yourself a bath, pop on a face mask and let the thoughts float away rather than allowing yourself to get swept up with them.
- Use relaxation techniques
Mindfulness and meditation ground your mind in the present, focusing on the physical sensations rather than thoughts. Deep breath work can also regulate stress levels and help you get out of a mental loop. Progressive muscle relaxation (PMR) where you intentionally tense and then relax allows the body to signal safety to the brain, interrupting negative cycles around a threatening thought.
- Seek support
Confide in a trusted friend or family member, find a support group, or consider seeking professional help if intrusive thoughts are persistent and interfere with your day-to-day.
‘You are not alone. What is mentionable is manageable,’ says Dr Jon Kole. ‘We are not in control of our thoughts but keeping these unmentioned for fear of being stigmatized or judged, may (cause) intense shame, guilt, or fear.’
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