What if I kissed this stranger? What if I just stopped turning up for work?
While intrusive thoughts like these can pop into your mind, they are common and usually easy to brush off for what they are — unwanted, random and meaningless.
But how much a person can dismiss intrusive thoughts varies. And when those thoughts stick around, they can cause distress and anxiety, and be symptomatic of obsessive-compulsive disorder (OCD).
Brisbane-based writer and filmmaker Martin Ingle knows this well. He was diagnosed with OCD in his early 20s.
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His intrusive thoughts and compulsions didn’t fit the stereotype of the obsessively cleaning type of OCD often represented in pop culture.
Martin was instead plagued by concerns about his sexuality, or hurting people.
“I would not leave the house. I would avoid members of my family. I lost a lot of work because I didn’t want to do work around certain people. I retreated from almost all aspects of my life,” he told ABC Radio National’s All In The Mind.
When intrusive thoughts get stuck in your head
Why we have intrusive thoughts is a bit of a mystery, according to Vlasios Brakoulias, a psychiatrist and professor at Westmead Hospital and the University of Sydney.
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We don’t know their exact cause, but the mechanisms at play may be similar to what happens when we dream.
“Just like dreams, these are subconscious thoughts, and they tend to reflect some of the instinctual feelings that people have,” Professor Brakoulias tells All In The Mind.
“They might be embarrassing. They might be against what we really want to do.”
And if someone is experiencing poor mental health, it can be difficult to let intrusive thoughts go.
For example, if you’re stressed or anxious, you may find it harder to determine what thoughts are intrusive and what are conscious, Professor Brakoulias says.Â
Intrusive thoughts can be especially challenging for people with OCD. Thoughts become recurring and inescapable. Instead of being dismissed, they lead the person to wondering, “Why did I think of that? What if it’s true?”
This rumination can lead to developing compulsions, repetitive physical or mental actions to combat the persistent intrusive thoughts. This might look like excessive cleaning, double checking, or avoiding certain situations altogether.
Naming thoughts as intrusive and random may make them easier to dismiss. (Getty Images: Eoneren)
To be diagnosed with OCD, a person’s obsessive thinking and compulsions need to take up at least an hour every day, Professor Brakoulias says.
“So people with the disorder are unable to function because of the severity of their obsessions and compulsions.”
What are the subtypes of OCD?
There are several subtypes of OCD, some of which come with taboo or dangerous thoughts, which mean people may not feel comfortable seeking help.Â
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For example, some people with OCD experience intrusive thoughts related to paedophilia. This is sometimes referred to as paedophilia-themed obsessive compulsive disorder, and sees people struggle with thoughts related to harming children, despite having no intention of acting on them.
“So these are what we call ego-dystonic thoughts. They’re against their ego and they think, ‘Oh, that was a terrible thought…’ And it’s distressing for them. It confirms to them that they actually don’t want to do something terrible like that,” Professor Brakoulias says.
In his work as a psychiatrist, he often sees patients struggling with taboo intrusive thoughts, which impacts their mental health.
His research found people with these kinds of thoughts were more likely to use substances such as drugs or prescribed medications than people with other OCD symptoms.
“This likely reflects the distressing nature of these symptoms.”
Additionally, obsessive thoughts and compulsions can be internal, so close family and friends may not see the impact of OCD on someone, Professor Brakoulias says.
“These are hidden thoughts. They’re very embarrassed about them. So it’s not like they know that other people have the same thoughts as them.”
What treatment is available?
Around 4 per cent of the Australian population is diagnosed with OCD.
But there is also another 8–10 per cent who has what’s known as subclinical OCD. They don’t quite meet the criteria for diagnosis, but their intrusive thoughts may cause distress.
For people with subclinical OCD, being able to identify intrusive thoughts and having an understanding of what OCD is can improve symptoms even without treatment, Professor Brakoulias says.
But, he added, people who have clinical OCD may need support from a mental health care professional. With psychological or pharmacological treatment, people can get significantly better.
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A common psychological treatment for OCD is exposure and response prevention therapy. It’s a modified version of cognitive behavioural therapy, where patients are asked to confront their intrusive thoughts without engaging in any compulsions.
For Martin, treatment has been difficult but ultimately valuable.
“It is incredibly painful when you have someone who thinks that their, or someone else’s, life is on the line if they don’t do this certain thing, if they don’t tap this table a certain number of times.
“It’s kind of like walking through the fire to get out the other side. There’s no way out of it without going through the pain of that fire.”
Hear more about OCD on All In The Mind or subscribe to the podcast for more stories that explore the mind, mood and behaviour.