intrusive thought intrusive thought an intrusive thought is an unwelcome, involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. when such thoughts are associated with obsessive-compulsive disorder (ocd), tourettes syndrome (ts), depression, body dysmorphic disorder (bdd), and sometimes attention-deficit hyperactivity disorder (adhd), the thoughts may become paralyzing, anxiety-provoking, or persistent. intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from ocd, post-traumatic stress disorder, other anxiety disorders, eating disorders, or psychosis. intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes. intrusive thoughtspecialtypsychiatry, clinical psychology description general many people experience the type of negative and uncomfortable thoughts that people with more intrusive thoughts experience, however most people can dismiss these thoughts. for most people, intrusive thoughts are a "fleeting annoyance". psychologist stanley rachman presented a questionnaire to healthy college students and found that virtually all said they had these thoughts from time to time, including thoughts of sexual violence, sexual punishment, "unnatural" sex acts, painful sexual practices, blasphemous or obscene images, thoughts of harming elderly people or someone close to them, violence against animals or towards children, and impulsive or abusive outbursts or utterances. such thoughts are universal among humans, and have "almost certainly always been a part of the human condition". when intrusive thoughts occur with obsessive-compulsive disorder (ocd), patients are less able to ignore the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing. attempting to suppress intrusive thoughts often cause these same thoughts to become more intense and persistent. the thoughts may become obsessions that are paralyzing, severe, and constantly present, these might involve topics such as violence, sex, or religious blasphemy, among others. distinguishing them from normal intrusive thoughts experienced by many people, the intrusive thoughts associated with ocd may be anxiety provoking, irrepressible, and persistent. how people react to intrusive thoughts may determine whether these thoughts will become severe, turn into obsessions, or require treatment. intrusive thoughts can occur with or without compulsions. carrying out the compulsion reduces the anxiety, but makes the urge to perform the compulsion stronger each time it recurs, reinforcing the intrusive thoughts. according to lee baer, suppressing the thoughts only makes them stronger, and recognizing that bad thoughts do not signify that one is truly evil is one of the steps to overcoming them. there is evidence of the benefit of acceptance as an alternative to the suppression of intrusive thoughts. in one particular study, those instructed to suppress intrusive thoughts experienced more distress after suppression, while patients instructed to accept the bad thoughts experienced decreased discomfort. these results may be related to underlying cognitive processes involved in ocd. however, accepting the thoughts can be more difficult for persons with ocd. the possibility that most patients with intrusive thoughts will ever act on those thoughts is low. patients who are experiencing intense guilt, anxiety, shame, and are upset over these thoughts are very different from those who actually act on them. patients who are not troubled or shamed by their thoughts, do not find them distasteful, or who have actually taken action, might need to have more serious conditions such as psychosis or potentially criminal behaviors ruled out. according to lee baer, a patient should be concerned that intrusive thoughts are dangerous if the person does not feel upset by the thoughts, or rather finds them pleasurable; has ever acted on violent or sexual thoughts or urges; hears voices or sees things that others do not see; or feels uncontrollable irresistible anger. aggressive thoughts intrusive thoughts may involve violent obsessions about hurting others or themselves. they can be related to primarily obsessional obsessive compulsive disorder. these thoughts can include harming a child; jumping from a bridge, mountain, or the top of a tall building; urges to jump in front of a train or automobile; and urges to push another in front of a train or automobile. rachman's survey of healthy college students found that virtually all of them had intrusive thoughts from time to time, including: causing harm to elderly people imagining or wishing harm upon someone close to oneself impulses to violently attack, hit, harm or kill a person, small child, or animal impulses to shout at or abuse someone, or attack and violently punish someone, or say something rude, inappropriate, nasty, or violent to someone. these thoughts are part of being human, and need not ruin the quality of life. treatment is available when the thoughts are associated with ocd and become persistent, severe, or distressing. one example of an aggressive intrusive thought is the high place phenomenon, the sudden urge to jump from a high place. a 2011 study assessed the prevalence of this phenomenon among us college students; it found that even among those participants with no history of suicidal ideation, over 50% had experienced an urge to jump or imagined themselves jumping from a high place at least once. a 2020 study carried out in germany reported similar results. the phenomenon is more commonly experienced by individuals with a high level of anxiety sensitivity, and may be caused by the conscious mind's misinterpretation of an instinctive safety signal. sexual thoughts sexual obsession involves intrusive thoughts or images of "kissing, touching, fondling, oral sex, anal sex, intercourse, and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures", involving "heterosexual or homosexual content" with persons of any age. common sexual themes for intrusive thoughts for men involve "(a) having sex in a public place, (b) people i come in contact with being naked, and (c) engaging in a sexual act with someone who is unacceptable to me because they have authority over me." while common sexual intrusive thoughts for women are (a) having sex in a public place, (b) engaging in a sexual act with someone who is unacceptable to me because they have authority over me, and (c) being sexually victimized. like other unwanted intrusive thoughts or images, most people have some inappropriate sexual thoughts at times, but people with ocd may attach significance to the unwanted sexual thoughts, generating anxiety and distress. the doubt that accompanies ocd leads to uncertainty regarding whether one might act on the intrusive thoughts, resulting in self-criticism or loathing. one of the more common sexual intrusive thoughts occurs when an obsessive person doubts their sexual identity. as in the case of most sexual obsessions, individuals may feel shame and live in isolation, finding it hard to discuss their fears, doubts, and concerns about their sexual identity. a person experiencing sexual intrusive thoughts may feel shame, "embarrassment, guilt, distress, torment, fear of acting on the thought or perceived impulse, and doubt about whether they have already acted in such a way." depression may be a result of the self-loathing that can occur, depending on how much the ocd interferes with daily functioning or causes distress. their concern over these thoughts may cause them to scrutinize their bodies to determine if the thoughts result in feelings of arousal. however, focusing their attention on any part of the body can result in feelings in that body part, hence doing so may decrease confidence and increase fear about acting on the urges. part of the treatment of sexual intrusive thoughts involves therapy to help them accept intrusive thoughts and stop trying to reassure themselves by checking their bodies. this arousal within the body parts is due to conditioned physiological responses in the brain, which do not respond to the subject of the sexual intrusive thought but rather to the fact that a sexual thought is occurring at all and thus engage an automatic response (research indicates that the correlation between what the genitalia regard as "sexually relevant" and what the brain regards as "sexually appealing" only correlates 50% of the time in men and 10% of the time in women). this means that an arousal response does not necessarily indicate that the person desires what they are thinking about. however, rational thinking processes attempt to explain this reaction and ocd causes people to attribute false meaning and importance to these physiological reactions in an attempt to make sense of them. people can also experience heightened anxiety caused by forbidden images or simply by discussing the matter which can then also cause physiological arousal, such as sweating, increased heart rate and some degree of tumescence or lubrication. this is often misinterpreted by the individual as an indication of desire or intent, when it is in fact not. religious thoughts