Examples:
- I just won the lottery. The worst part is that I can’t tell my family and friends because if I did, they’d all want some of the money.
- A new higher paying job would be a good thing except for the change in the commute, possible reduction in health insurance and having to get to know a whole new group of people.
Many people experience the type of bad or unwanted thoughts that people with more troubling intrusive thoughts have, but most people are able to dismiss these thoughts. For most people, bad thoughts are a “fleeting annoyance”. London psychologist Stanley Rachman presented a questionnaire to healthy college students and found that virtually all said they had bad 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 bad thoughts are universal among humans, and have “almost certainly always been a part of the human condition”.
When intrusive thoughts co-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. The thoughts may become obsessions which are paralyzing, severe, and constantly present, and can range from thoughts of violence or sex to blasphemy. 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 bad 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 person’s anxiety, but makes the urge to perform the compulsion stronger each time it reoccurs, reinforcing the intrusive thoughts. According to Lee Baer (an OCD specialist at the Massachusetts General Hospital’s OCD clinic), suppressing the thoughts only makes them stronger, and recognizing that bad thoughts don’t 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 suppression of intrusive thoughts. A study showed that 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. But, accepting the thoughts can be more difficult for persons with OCD. In the 19th century, OCD was known as “the doubting sickness”; the “pathological doubt” that accompanies OCD can make it harder for a person with OCD to distinguish “normal” intrusive thoughts as experienced by most people, causing them to “suffer in silence, feeling too embarrassed or worried that they will be thought crazy”.
The possibility that most patients suffering from intrusive thoughts will ever act on those thoughts is low; patients who are experiencing intense guilt, anxiety, shame, and upset over bad thoughts are different from those who actually act on bad thoughts. The history of violent crime is dominated by those who feel no guilt or remorse; the very fact that someone is tormented by intrusive thoughts, and has never acted on them before, is an excellent predictor that they won’t act upon the thoughts. Patients who aren’t troubled or shamed by their thoughts, don’t find them distasteful, or who have actually taken action, might need to have more serious conditions, psychosis or potentially criminal behaviors ruled out. According to Baer, a patient should be concerned that intrusive thoughts are dangerous if the person doesn’t feel upset by the thoughts, rather finds them pleasurable; has ever acted on violent or sexual thoughts or urges; hears voices or sees things that others don’t see; or feels uncontrollable irresistible anger.
